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 
 

Don't Drink the Water?

Water.  Such a basic need that a lot of us take for granted.  In this country, we are so lucky to have (mostly) clean, safe water at our fingertips.   In Seattle, we are even luckier in that we have some of the best water in the country.

Water contamination does occur, but according to the EPA:  "actual events of drinking water contamination are rare, and typically do not occur at levels likely to pose health concerns."  But, what are the potential issues with water quality in this country?

Microbial Contaminants

• Bacteria, viruses, and parasites can all find their way into our water.
• In general, these contaminants cause diarrhea and vomiting.
• Shallow wells are most vulnerable to this type of contamination, particularly after flooding.

Chemical Contaminants

• Lead:  can get into your water from chipped lead paint or other contamination of source water (rare) or, more likely, comes from your own pipes.  Old homes are more likely to have leaded pipes, but new homes may have them too.  According to the EPA, certified "lead free" pipes may still contain lead that leaches into your water.  Find more information here.
• Arsenic:  occurs naturally in the earth, or can come from industrial / agricultural waste.  Find more information here.
• Other heavy metals:  cadmium, selenium, and chromium can all leach into water from the earth.
• Fluoride:  occurs naturally in the earth, and can leach into the water at amounts that are high enough to discolor teeth.  (Yes, I have an upcoming post exploring fluoride in more detail.)
• Nitrate: gets into the water via fertilizer.  High levels of nitrates can cause "Blue Baby Syndrome," which can be fatal.  It usually occurs in already ill babies who are drinking formula made with the water.

Photo by Adapting to Scarcity; Flickr; no amendments

Is It Safe Or Not?  
Annual quality reports should be readily available for your municipal water supply.  If your jurisdiction reports to the EPA, you can access a report here.  Otherwise, try doing an internet search, or call your local jurisdiction.

Well Water Quality
Wells have a special set of potential problems, and are not regulated by the EPA regulations that protect drinking water.   Here are some highlights of potential well water contamination sources (this list is by no means exhaustive):

• Radon
• Bacteria (from septic tanks)
• Barnyard runoff
• Pesticide and fertilizer residues on re-purposed former farmland

Bottled Water Quality
Why not just go with bottled water to be on the safe side? 

• You may be wasting your money:  bottled water may just be tap water!  This is according to an NRDC study; the same study found that bottled water was no safer or cleaner than tap water.  They found that some brands even contained contaminants above the legal limit allowed in tap water.
• You are exposing yourself to extra chemicals:  plastic bottles contain phthalates and BPA, which may disrupt your body's hormone production, and may cause asthma.  For more information on phthalates and BPA, see WebMD, Medscape, and CNN.
• You are increasing your carbon footprint:  all those bottles have to be made, and then recycled (if not put in a landfill); those processes have a great impact on the environment.  For more information on the environmental impact of bottled water, see this article.

Photo by epSos .de; Flickr; no amendments

What types of water are available in bottles?

• Distilled:  boiled and re-condensed, which removes microbes and minerals and electrolytes.  I don't recommend distilled water, since we need minerals and electrolytes.
• Spring:  collected straight from a natural spring.
• Artesian:  collected from a well that taps an aquifer directly.
• Purified:  could be collected from any source.
• Mineral:  groundwater that naturally contains a specific quantity of minerals.
• PWS:  public water supply

Water Filters
Water filters can be a great option if your tap water is less than ideal.  Consumer Reports has a useful article summarizing water filter options.  Remember to find out exactly what your filter can and cannot filter out!  Also, consider what's touching your water: if your water sits in a plastic reservoir or passes through plastic tubing, then you're getting filtered water at the high cost of BPA and phthalate exposure.

 

Photo by Sidney Brent Goodwin; Flickr; no amendments

Special Populations
Newborns drinking formula, young babies drinking water for the first time, elderly people, and people with immune compromise are all more susceptible to water-born contaminants.  Before giving your baby water, whether it's straight or mixed with formula, consult your child's health care provider for his or her opinion on the best water to use.


Drink Your Water!
I'm always telling patients to drink more water.  Without it we die; without adequate amounts of it, we fall ill or show symptoms such as headache and fatigue.  So, take a quick moment to assess the quality of your water, and then, go forth and drink! 

Resources:
EPA on drinking water
USGS on well water
EPA on well water
EPA on well water testing
NRDC on bottled water

Find more information on the problem of exposure to BPA and phthalates at:
WebMD
Medscape
CNN
WebMD Fetal Exposure to Plastics and Asthma Risk 

This blog does not constitute medical advice.  I have no affiliations to disclose.