Enterovirus D68

NOTE:  This post has been updated twice to follow new developments (see below).

The virus every parent is talking about.  Here are the facts:

According to the CDC, it has now been confirmed in 32 states, including Washington.  From mid-August to now, there have been 220 cases of confirmed Enterovirus D68.

Fear
I think whenever we as parents hear about a new threat to our children, we become at least a little more alert, if not downright afraid.  This virus is especially scary because it's spreading quickly, and it's landing kids in the hospital.  Find comfort in the fact that as of September 22, no deaths have been associated with Enterovirus D68 (Medscape).  Also, remember that every year the flu sends kids to the hospital too.  Finally, remember that not every child who goes to the hospital for respiratory distress tests positive for Enterovirus D68.  I say these things not to minimize the concern and the need for caution surrounding this virus, but to put those concerns in perspective for those of you who may be overcome with fear.

What You Can Do
A lot of what I'll suggest here echoes what I suggest every year as we go into cold and flu season.  Kids are starting school, the weather is changing, and with that come the inevitable runny noses, coughs, GI bugs and asthma attacks.  Basic precautions and a little kitchen table medicine go a long way toward keeping them well.

• Wash hands.  I know you hear this one over and over and over, but it's for good reason. Researchers recently found that a virus placed on a single doorknob spread to over 50% of hands in that building within 4 hours.  Remember that kids are constantly touching their mouths, noses, and eyes, thereby giving germs direct access.

Photo by SuSanA Secretariat; Flickr; no amendments

• Manage asthma.  Most (but not all) of the kids ending up in the hospital have asthma.  Be sure you have recently visited your doctor, and that you have an up to date asthma action plan.  Also, be sure you are using all your preventive medicines:  discuss a steroid inhaler with your doctor, as well as herbs and supplements that can decrease attacks and their severity.  Finally, be sure your child always has access to her rescue medication.
• Know the signs.  Respiratory distress can actually be missed quite easily.  The untrained eye might not notice anything wrong.  Review the signs with your doctor; any child can go into respiratory distress, not just those with asthma.  For more information on respiratory distress, see the "Unrecognized Respiratory Distress" section of my previous blog post.  If you do notice any difficulty breathing, call 911, go to the ER, or call your child's provider.
• Support the immune system.  Your Naturopathic Doctor can recommend his or her favorites to you, but here are some of my most basic and easy tricks for getting through the winter:  (NOTE:  you should ALWAYS discuss any supplements, herbs, or medications with your doctor before taking them.)

Photo by thedabblist; Flickr; no amendments

• Vitamin D: Your doctor can personalize your dose, but the American Academy of Pediatrics and the Institute of Medicine both recommend 600 iu daily for children over 1 year of age. 
• Fish oil:  Unless you and your kids eat fish high in omega 3s several times a week, taking a supplement is indicated (although there are some people who need to be cautious with omega 3 supplements, or must avoid them completely).  There is no set dosage; discuss with your child's provider.  Be sure to get a good quality product that tests for impurities.
• Probiotics:  Not just for the gut, these little guys are great at supporting the immune system.  As with fish oil, discuss dosing with your doctor as there is no set dosage, and be sure you get a good quality product so you know it will work.
• Bone broth:  extremely rich in nutrients, including those that kick start the immune system.  If you are new to bone broth, Nourished Kitchen has a great introduction and good recipes.
• Elderberry syrup:  Anti-viral, immune supportive, and great tasting, this is one I give myself and my kid every morning during the cold months.  Again, dosing varies widely, so discuss with your child's provider.
• Get enough rest: The immune system works best when we are well rested.  Be sure your child is getting plenty of sleep.
• Decrease sugar: this includes juice.  Studies have shown that sugar, including juice, dampens the immune response for hours after exposure.

Photo by Lindsey Turner; Flickr; no amendments

• Stay home.  As always, taking your sick child out not only spreads the illness to other people, but it makes recovery for him more difficult.  When we are sick, we should be home resting, not running errands, going to school or play dates.

A note on immune compromised children:  be especially sure that you have had a recent visit with your child's provider.  There may be extra steps you can take to protect your child, including certain vaccines not recommended for the general public.

While these tips may not keep your child from ever getting sick, they should lessen the frequency and the severity of illness.  As Benjamin Franklin said, "an ounce of prevention is worth a pound of cure."

Resources:
CDC 
WebMD
Your local Health Department 

I have no affiliations to disclose.  Please note that this blog does not constitute medical advice; even specific supplement recommendations should be cleared by your child's provider.  Always be sure that you address any questions or concerns directly to your child's provider.

UPDATE OCTOBER 3:
Unfortunately, Enterovirus D68 has taken a turn for the uglier.  It has been associated with paralysis in rare cases.  We do not yet know whether this paralysis is temporary or permanent.   We also are not certain that it is Enterovirus D68 causing the paralysis; it is possible that the people with Enterovirus D68 and paralysis have a co-infection with some other paralysis causing virus.

Furthermore, the CDC is currently investigating four deaths potentially associated with Enterovirus D68.  One of the deaths was not caused by Enterovirus D68, but rather by sepsis caused by the bacteria Staphylococcus aureus.  The girl did test positive for Enterovirus D68, but it is not entirely clear what role the virus played in her death.  The other three deaths occurred in patients who tested positive for the virus, but it is not clear yet what role the virus played in their deaths.

More resources:
Medscape "Paralysis in Children with Enterovirus D68"
Medscape "CDC Investigating Four Deaths Linked to Enterovirus D68"
CNN

UPDATE OCTOBER 6:
Sadly, there has now been one confirmed death attributed to Enterovirus D68.  A four year old in New Jersey stayed home from school with pink eye, went to bed with no other symptoms, and did not wake up the next day.  Officials have confirmed the cause of death to be Enterovirus D68.  As you all know, I am the parent of a toddler; obviously I find this news terrifying.  However, what we have to do at this point is two things:  remember our immune support protocol, and remember that viruses like the flu actually claim many more lives every year.  I don't mean to make us all terrified of the flu, but just to put Enterovirus D68 into perspective.  So let's take our supplements, wash hands, and go out and enjoy each day as it comes.

More resources: 
CNN 
CBS