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New visitor protocol protects against Enterovirus

September 18, 2014

Baystate Children’s Hospital has started to see an increase in young patients visiting the emergency room with a respiratory illness, which may be related to the enterovirus. This is in line with national trends.

The Massachusetts Department of Public Health recently confirmed cases of enterovirus D68 in the state.

While most of these children are treated and soon discharged from the Emergency Department, a small number of children are being admitted to the hospital. Most of those children have been going home within a day or two. The cases seen so far at Baystate are generally less severe than those observed in the Midwest.

"While increased concern exists for some children with predisposing conditions such as asthma, the majority of these infections will not be serious, and will require only treatment of the symptoms," said Dr. Michael Klatte of the Division of Pediatric Infectious Diseases at Baystate Children’s Hospital.

The enterovirus outbreak

The strain thought to be causing the current outbreak, Enterovirus D68 (EV-D68), was first identified in California in 1962. In the United States, it has been relatively rare since the initial outbreak (with only 79 confirmed cases reported by the CDC since 2009). This is the first widespread EV-D68 strain outbreak we have seen in our country.

Enterovirus D68 has now spread to 18 states in the Midwest and East Coast. There are 153 confirmed cases as of Sept. 18. No cases have been reported in Massachusetts, but the state Department of Public Health said, "It is likely that cases will be seen here."

Laboratory tests obtained from young hospitalized patients from our community who are suspected of having the EV-D68 infection have been sent to the Massachusetts Department of Public Health. The Department of Public Health will send them to the Centers for Disease Control for confirmation. The current turnaround time until notification is between seven and ten days.

Identifying symptoms

Enteroviruses mainly affect the respiratory system and gastrointestinal tract, causing symptoms such as fever, upper respiratory symptoms, including cough, runny nose, and nasal congestion, as well as diarrhea and stomach pain. Depending on the specific type of enterovirus that a child is infected with, rashes (including hand, foot, and mouth disease), conjunctivitis (redness of the whites of the eyes), and neurologic illnesses such as aseptic meningitis and encephalitis may be seen.

EV-D68 appears to cause symptoms primarily affecting the airways, including wheezing, increased difficulty breathing, and the need for more oxygen.

"Given these symptoms, EV-D68 is more of a concern for children who have underlying respiratory issues, or for premature babies with respiratory airway difficulties, which would make them more predisposed to severe infection with this virus,” said Dr. Klatte.

Prevention methods

There are currently no antiviral medications for treating the EV-D68 infection, which in most cases runs its course. There are no vaccines to protect you from it.

Enteroviruses are spread by contact with infected bodily fluids, such as mucous and stool.

Prevention involves:

  • Good hand hygiene – washing them often with soap and water for 20 seconds, especially for those who might be changing a baby’s diaper.
  • Avoiding touching your eyes, nose or mouth with unwashed hands.
  • Covering your nose when sneezing.
  • Avoiding kissing, hugging, and sharing cups or eating utensils with those who are sick.
  • Disinfecting frequently touched surfaces, such as toys and doorknobs, especially if someone is sick.

To protect our community and our most vulnerable patients against the spread of contagious illness, Baystate Health has adopted temporary changes to its Visitor Policy. The changes will provide the safest environment possible for patients, visitors and team members.

Effective immediately: Anyone visiting a child or new mother in the hospital must be 14 years or older. The temporary visitor policy applies to the following Baystate Health hospitals: Baystate Medical Center and Baystate Children’s Hospital in Springfield, Baystate Franklin Medical Center in Greenfield, Baystate Mary Lane Hospital in Ware, and Baystate Wing Hospital in Palmer.