Enterovirus: ‘A real summer bummer’

Kirk Coverston, MD Kirk D. Coverston, MD, FAAP
My child has Hand, Foot and Mouth Disease – that can’t be!  It’s almost summertime!  Why is my child sick with a sore throat, stomachache
and fever now?

That is a question being asked by a lot of parents right now and the
answer is … Enterovirus infection.

Enterovirus is a group of viruses that includes poliovirus, Coxsackie and echoviruses, which are estimated to cause 10 to 15 million or more symptomatic infections each year. That is right behind the common cold!  All types of polio viruses have virtually been eliminated due to vaccines; however, nonpolio enteroviruses can cause the symptoms we are seeing now.  Most of these infections are not serious and will resolve on their own with some rest and time; however, it can be more serious in younger children and babies.  The most common virus we have seen in Tulare County this year is the Hand, Foot and Mouth disease which is caused by the Coxsackie virus.


What are the symptoms?

1. Upper respiratory infections

2. Runny nose

3. Sore throat

4. Cough

5. Flu-like illnesses with body aches and fever (usually higher at night)

6. Development of vomiting and diarrhea

7. Abdominal pain

8. Headache

9. Decreased appetite or poor eating

10.Increased drooling in infants or younger children (oral lesions)

11. Rash – small, flat, red dots on the skin of the chest, abdomen, back , palms of hands and feet, which develop about 3 -4 days into the illness.

 

If your child presents with a severe headache, fever, and pain in the chest (pleurodynia), this would require a full evaluation by your pediatrician as concerns for aseptic or viral meningitis caused by enterovirus could be a possibility.

Enteroviruses are found in the saliva, mucous and stool of the infected person.  People can become infected with direct contact or contamination of objects like toys, cups and desks.  There are approximately 60 different strains of enterovirus that can cause symptomatic infection.  On average, children will be exposed to 3 to 4 infections per year, which builds up their immunities.  Adults rarely get as sick with enterovirus, as over the years they have built up their antibodies for most strains.   There is no vaccine currently available.

Treatment:
• Proper dosages of Acetaminophen and Ibuprofen, alternating every 6 hours until fever improves
• Push small sips of fluid and popsicles to prevent dehydration
• Gargle or apply back of the throat with a mixture of viscous Lidocaine, Diphenhydramine and an antacid for pain control (see your primary pediatrician)
• Patients with severe symptoms or concerns for dehydration should be seen by their primary pediatrician for evaluation.

Prevention:
• Good handwashing!!!
• In daycare centers with a breakout, make sure all toys and countertops are washed down with an appropriate cleanser.
• Children can return to daycare or school when they have no fever for 24 hours without the use of any medications, no open lesions and no excessive drooling.

(Dr. Coverston is a Board-certified pediatrician who practices at Visalia Medical Clinic. He is a Fellow of the American Academy of Pediatrics and has been in practice in Tulare County since 2012.)