Received this from our EMS contact at primary childrens hospital this morning in my email and felt I should share. Weve had a lot of questions at Primary Childrens recently about the respiratory virus EV-D68. See this recent news report... ksl/?sid=31482832&nid=148&s_cid=rec2 Heres the lastest from PCHs infection control team... Enterovirus D68 Respiratory Infections Many of you may have heard news reports of severe respiratory illness among children in several states associated with “a new virus.” Clusters of respiratory illness have been reported from at least 12 states, including large clusters in Kansas City, Denver and Chicago. They have seen increased volume of ED visits, admissions, and PICU admissions. Children are presenting with wheezing, difficulty breathing and hypoxemia. Many of the children admitted to the hospital have a previous history of asthma or wheezing but some have never wheezed before. Fever has been uncommon. Deaths have not been reported so far. It’s not a new virus Enterovirus D68 (EV-D68 or EV-68) was detected in 19/22 specimens from children with moderate to severe respiratory disease at Children’s Mercy Hospital in Kansas City (who tested positive for rhinovirus by multiplex PCR) and 11/14 specimens from University of Chicago Medicine Comer Children’s Hospital. What is EV-D68? There are more than 100 enterovirus types. They are closely related to rhinoviruses and most PCR tests cannot discriminate between them. Most enteroviruses cause non-specific respiratory symptoms, rash illness, conjunctivitis, mouth ulcers (herpangina) or hand foot and mouth disease. Myocarditis, pericarditis, and viral meningitis can be caused by enteroviruses. EV-D68 is not new and was recognized in 1962. It is unusual in that it has been primarily associated with more severe respiratory disease. It has been recognized in a series of small outbreaks, but this appears to be the largest to date. Situation at Primary Children’s Hospital (PCH) We are seeing a significant increase in admissions to PCH of children with asthma, pneumonia and respiratory failure many of whom test positive for rhinovirus/enterovirus by our FilmArray respiratory panel (reported as “rhinovirus detected”). It is likely that many of these are EV-D68. We are awaiting confirmation by CDC. Clinical Care We recommend testing children with severe asthma exacerbations, pneumonia and respiratory failure by FilmArray viral respiratory panel, regardless of fever. As is always our policy, any child admitted with respiratory symptoms should have a respiratory viral panel performed. Positive tests will be reported out as “rhinovirus detected” because the FilmArray does not discriminate between rhinovirus and enterovirus. There is no specific therapy for enterovirus infections; care focuses on managing reactive airway and other respiratory symptoms. Infection Control and Personal Protective Equipment Enteroviruses are transmitted in respiratory secretions and stool. Children suspected or proven to have rhinovirus or enterovirus, and any child with an asthma exacerbation during this outbreak should be placed in respiratory droplet precautions (mask, gown and gloves) in a single room. You should use PPE when initially evaluating a child with respiratory illness. If you are performing high-risk respiratory procedures such as suctioning, providing respiratory treatments or collection respiratory specimens, you should wear eye protection (mask with face shield or mask with googles). The child will need to remain in droplet isolation until they go home or are completely free of respiratory symptoms. Hospital-wide Visitor Restrictions Primary Children’s Hospital is instituting visitor restrictions as follows: · No visitors under 14 years of age · Limit 2 visitors per patient room (includes parents) Advice to Parents Parents should know that the best way to avoid EV-D68 infection is frequent hand washing, especially after contact with nasal secretions or diapers, avoiding sharing utensils with people who are sick and disinfection of frequently touched surfaces. Children with a history of asthma should have an asthma plan and follow it. Most children with cold symptoms are not going to get severely ill. Parents should be alert to wheezing or difficulty breathing and seek medical attention if their children have these symptoms. Patients with- or parents of children with underlying lung problems like asthma or history of wheezing, should be especially vigilant. Please spread the word and be sure to protect yourselves during transport through the use of your personal protective equipment and good handwashing. Thanks all Tia Dalrymple, RN, BSN EMSC Pediatric Clinical Consultant RN State of Utah Department of Health Bureau of Emergency Medical Services and Preparedness (801) 707-3763 [email protected] [email protected]
Posted on: Thu, 11 Sep 2014 15:24:01 +0000
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