Nevada last state in lower 48 without confirmed case of enterovirus D68

The confirmation Thursday that an Arizona patient had been infected with enterovirus D68 leaves Nevada as the only state in the lower 48 without a confirmed case of the pathogen, which has caused a national wave of severe respiratory illnesses.

This week, three specimens from Southern Nevada were sent to the U.S. Centers for Disease Control and Prevention, and results are expected in about a week, Brian Labus, senior epidemiologist for the Southern Nevada Health District said Thursday. Five tests were submitted earlier this month, and all five were negative, Labus said.

“We’re looking for it,” Labus said. “We’re going to keep submitting specimens because we’re the last state in the continental United States without a confirmed case. It’s not for lack of trying.”

Health care professionals will not be surprised if a case of enterovirus D68 eventually occurs in Southern Nevada because the area is such a popular travel destination.

“I’m stunned that we haven’t had a case of D68 because of the transient nature of our population,” said Dr. Lisa Miller, a pediatrician with Good Night Pediatrics, an all-night urgent care facility in Henderson for children and teenagers.

Symptoms caused by enterovirus D68 can be similar to the flu, but the infection itself can be deadly to certain children. As of Thursday, CDC had documented 973 cases of enterovirus D68 in 47 states and the District of Columbia. D68 has been found in test specimens from eight people who have died during the current outbreak.

The respiratory illness affects mainly infants, children and teenagers with symptoms ranging from fever, runny nose, sneezing and coughing to body and muscle aches. Severe symptoms can include wheezing and difficulty breathing. Children with asthma are at a higher risk for severe respiratory complications caused by the enterovirus D68 infection.

Two of the five negative tests from Southern Nevada originated at Sunrise Children’s Hospital, and at least one of the other cases came from University Medical Center. Health officials in Maricopa County, Ariz., said Thursday that a child with a history of asthma was the first case in that state. The child has since recovered.

Labus said D68 might have infected someone in Southern Nevada because the person could have experienced milder symptoms of the illness and recovered without seeking medical attention. D68 typically presents more serious complications only in patients with underlying medical conditions, Labus said.

“Most of the people who get this are not going to have the types of problems that will require hospitalization,” Labus said.

D68 is one of about 100 enteroviruses that spread nationwide typically from July to October. Those viruses tend to decline after September, and some experts think D68 is behaving similarly. Most enteroviruses prefer to inhabit the intestinal tract and cause few or minor symptoms, but D68 usually affects the upper respiratory tract.

The complications the virus causes in patients already diagnosed with breathing issues makes D68 especially worrisome for certain children, said Dr. Craig Nakamura, a pediatric pulmonary specialist with Children’s Lung Specialists in Las Vegas. Nakamura has been advising parents of his patients to be especially cautious if their kids get sick and have prolonged symptoms, increased work of breathing or unexplained muscle weakness.

No cure has been found for patients infected with D68, so treatment consists of supportive care, which includes rest, fluid replacement and medications to relieve any pain or fever. Children with lung diseases might need more frequent breathing treatments, oxygen therapy or hospitalization.

Miller has been reminding parents of children with underlying medical conditions to have their kids take medications as ordered and use a spacer with their inhalers. A spacer 4 to 8 inches long helps children breathe at their own pace, allows more medicine to reach their lungs and prevents medicine from escaping into the air.

The most effective precaution against D68, as with any microbe, is hand washing and using hand sanitizers. People become infected by contacting the virus, and that usually starts with the hand.

Miller has been advising families coming to her clinic on a number of steps to prevent D68 or any other virus. Now that flu season has begun, she said, everyone should be following tried-and-true illness prevention measures.

In addition to frequent hand washing, Miller recommends parents have their children bathe after coming home from preschool or school. The younger the children the less likely they will be to wash their hands correctly, and the more likely they will be to put their hands in their mouth, scratch their noses or rub their eyes.

Preschools especially become prime spots for the spread of microorganisms. Having children bathe after school reduces the risks that viruses and germs will result in sickness, Miller said. She also recommends using a saline solution in the nose to cleanse the nasal cavity.

Another precaution might conflict with some rules of being a good friend but is important, especially during flu season: Don’t share sodas or other drinks, food or gum.

With temperatures cooling, proper hydration also is a concern. Children drinking plenty of fluids have better defenses against pathogens. Children who become sick need clear liquids or an oral electrolyte solution designed to replace lost fluids and minerals.

And Miller said the damage caused by enterovirus D68 should be a cautionary tale for everyone this flu season. No immunization exists to prevent D68, but flu shots have been found to be effective at protecting people against numerous bugs. She highlighted another infectious disease grabbing headlines to illustrate the importance of getting a flu shot and the resistance of some people to being immunized.

“If someone came up with an inoculation against Ebola, don’t you think three-fourths of the U.S. population would get one?” she said.

Contact Steven Moore at 702-380-4563 or smoore@reviewjournal.com.