A respiratory virus making hundreds of children ill across the country also might be sickening children in the Richmond area, officials said.
Doctors at Bon Secours St. Mary’s Hospital and Children’s Hospital of Richmond at VCU are reporting an increase in children being admitted with severe respiratory illness, though it is not clear if those children have the same virus responsible for widespread outbreaks in other parts of the country.
St. Mary’s has admitted 10 children with serious, sudden-onset respiratory illness in the past 48 hours, Dr. William Lennarz, Bon Secours Virginia chief medical officer of pediatrics, said Monday. “The patients I am talking about are sick enough that four were critically ill when they arrived here,” he said. Lennarz said those four children were admitted to the pediatric intensive care unit.
Nationally, hundreds of children have been sickened in clusters of cases in at least a dozen states. The first cases were reported in mid-August in Kansas City, Mo., and Chicago.
The suspected germ, enterovirus D68, is an uncommon strain of a common family of viruses that typically hit from summertime through autumn.
The virus can cause mild coldlike symptoms, including runny nose, coughing and wheezing. Mark Pallansch, director of the viral diseases division at the federal Centers for Disease Control and Prevention, said this summer’s cases are unusually severe and include serious breathing problems.
“It’s not highly unusual but we’re trying to understand what happened this year in terms of these noticeable and much larger clusters of severe respiratory disease,” Pallansch said Monday.
The virus typically causes illness for about a week and most children recover with no lasting problems.
“Children’s Hospital of Richmond at VCU has seen a recent increase in admissions of children with upper respiratory and asthma problems,” said Dr. Gonzalo Bearman, chairman of infectious disease at VCU Medical Center, in a statement provided by university public affairs.
“VCU infection prevention services, along with a multidisciplinary group, have met and have a contingency plan for dealing with both upper respiratory infections and patients with confirmed or suspected enterovirus D68.”
“We are confident that we have the appropriate isolation equipment and personnel to care for potential patients with enterovirus. If parents are concerned about severe respiratory or asthmatic symptoms in their children, they should seek immediate care from a pediatrician, urgent care center or emergency room,” Bearman said.
A CDC special report released Monday described the Kansas City and Chicago clusters. The Kansas City cases were reported Aug. 19, and 19 of 22 patients tested positive for enterovirus D68. Chicago hospital officials reported a cluster of cases Aug. 23, and the virus was indentified in specimens from 11 of 14 patients. Since then, both locations have reported additional cases.
The CDC said it is testing to see if the virus caused respiratory illnesses reported in children in Alabama, Colorado, Georgia, Iowa, Kansas, Kentucky, Michigan, Ohio, Oklahoma and Utah.
“I can’t tell you whether this is the same illness as the Midwest epidemic, only that when we see a cluster of either severe or large numbers of illness, or a combination thereof, we are always required to report it to the state Department of Health,” Lennarz said, explaining that specimens have been sent for testing and the results are not available.
“We always see an increased number of viral illnesses of any kind when schools are in session. What distinguishes these cases is the rapidity of the onset,” Lennarz said.
“These children all went from being totally well, to being moderately to severely ill in less than 24 hours. And the severity itself, that is what distinguishes it from the background viral infections that we would always see at this time of year,” he said.
Lennarz said the children at St. Mary’s suspected of having the virus range from 2 to 10 years old.
“They are being treated much the same way that children with moderate or severe respiratory distress are from any cause,” Lennarz said. “Bronchodilators and steroids that we use for the asthma-type component … and antibiotics if they have fever or pneumonia on X-ray.”
Lennarz said the health department’s outbreak investigation would examine whether the children had any common exposures or contacts.
An official at HCA Virginia’s Chippenham Hospital said there had not been any suspect cases there as of Monday afternoon.
“The thing that is concerning about the enterovirus D68 is that it’s affecting children — teens down to infants, and it starts out as a cold. They typically don’t even have a fever with it,” said Dr. Kevin Connelly, assistant medical director of the Chippenham Hospital Pediatric Emergency Department.
“Oftentimes, they don’t even have wheezing but have difficulty breathing and just aren’t able to get enough oxygen into their lungs,” Connelly said, adding that he sent out a notice to doctors Monday urging them to be alert for the illness.
There are multiple other germs that could be making kids sick.
“The situation is evolving quickly,” Dr. Anne Schuchat of the CDC said Monday in a briefing.
Enterovirus D68 was first identified in California in 1962 and has been rarely reported in the United States, she said. It is thought to be spread through respiratory secretions such as saliva and mucous.
“The full spectrum of all of the illnesses that it can cause are not well defined,” Schuchat said.
The Associated Press contributed to this report.
Wash your hands often.
Avoid touching eyes, nose and mouth with unwashed hands.
Avoid kissing, hugging and sharing cups or eating utensils with people who are sick.
Disinfect frequently touched surfaces, such as toys and doorknobs, especially if someone is sick.
Centers for Disease Control and Prevention, www.cdc.gov/non-polio-enterovirus/
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