孩子、感冒和肠道病毒D68

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子、感冒和肠道病毒D68
正值开学之季,我们这些做家长的第一反应就是返校常常意味着寒冷、流感和其它一些传染病，如急性结膜炎、手足口病或水痘。而今年对于一些家长不幸的是，返校可能会感染肠道病毒 -D68（EV-D68）。
肠道病毒是一组病毒，包括3种脊髓灰质炎病毒和61种非脊髓灰质炎病毒，后者包括柯萨奇病毒，埃可病毒和其它4个肠道病毒（如鼻病毒）。在随即而来的普通感冒中，肠道病毒是导致人类常见感冒的第二元凶，每年在美国造成1,000~1,500万例感染。1962年在加利福尼亚第一次分离出EV-D68，然而在过去的40多年中美国对其相关报道寥寥无几。
这是因为EV-D68很难分离，对其研究甚少，传播方式也不明确。与其它肠道病毒相似，EV-D68也会导致呼吸系统疾病，存在于唾液、鼻粘液和痰液的呼吸道分泌物中。病毒很可能是通过直接接触呼吸道分泌物，以及间接接触被污染的环境表面和污染物后形成传播。
然而，这种病毒已不再罕见了。在8月15日至8月23日期间，密苏里州堪萨斯城慈善儿童医院和伊利诺斯州芝加哥大学医学卡默儿童医院向美国疾控中心（CDC）报告急性呼吸系统疾病的患者检查及入院率增加。堪萨斯城22例标本中19例EV-D68呈阳性，芝加哥14例标本中11例EV-D68呈阳性。在另外10个州中，亚拉巴马、科罗拉多州、密歇根州、佐治亚州、俄亥俄州、爱荷华州、堪萨斯州、俄克拉荷马州、肯塔基州和犹他州也有群体病例报道。在这10个州中，只有科罗拉多州和爱荷华州已确认EV-D68为致病病原体。总的来说，当肠道病毒感染多发时，需要重症监护的重病患儿数量也显著增加,多数患者有哮喘或气喘病史。
目前尚没有针对预防EV-D68的疫苗或治疗EV-D68的抗病毒药。预防感染的方法包括用肥皂和水清洁手，在换尿布后要特别注意手卫生，勿用未洗的手接触眼睛、鼻和嘴。
消毒高频接触的物体表面，如门把手和玩具类的公共物品。然而在选择消毒剂时，因为EV-D68为罕见病毒，目前市面上销售的绝大多数消毒剂不可能声称杀死EV-D68病毒。可寻找声称能杀死同类病毒的产品，如脊髓灰质炎病毒、柯萨奇病毒或鼻病毒。
在此希望今年的返校不是意味着一个忙碌的秋季爆发性传染病季节的开始。流感和诺瓦克传染病即将来临！
Posted: 12 Sep 2014 12:52 PM PDT
Kids, Colds and Enterovirus D68
Since the inception of the Talk Clean To Me blog, we have included a blog on back to school infection prevention.  Those of us who are parents know firsthand that back to school often translates into colds, flus and other diseases such as Pink Eye, Hand Foot Mouth or Chickenpox.  Unfortunately for some parents, back to school this year has lead to the introduction of Enterovirus D68 (EV-D68).
Enteroviruses are a family of viruses that include 3 Polioviruses and 61 non-Polioviruses including Coxsackieviruses, Echovirusesand 4 other Enteroviruses (e.g. Rhinovirus).  Next to the common cold, Enteroviruses are the second most common viral infectious agents in humans causing upwards of 10 - 15 million infections each year in the United States. EV-D68 was first identified in 1962 in California, however, for the last 40-odd years it has been very rarely reported in the United States.
Due to the fact that EV-D68 is rarely identified, it has been less studied and the ways in which it spreads are not as well defined. Like other Enteroviruses, EV-D68 causes respiratory illness and can be found in respiratory secretions such as saliva, nasal mucous or sputum.  It is very likely that the virus is transmitted via direct contact with respiratory sections and indirect contact with contaminated environmental surfaces and fomites.
The rarity of this virus, however, changed on August 15th and August 23rd when Children's Mercy Hospital in Kansas City, Missouri and the University of Chicago Medicine Comer Children's Hospital of Illinois notified the CDC of an increase in patients examined and hospitalized with severe respiratory illness. EV-D68 was identified in 19 of 22 specimens from Kansas City and 11 of 14 specimens from Chicago.  Ten (10) additional states; Alabama, Colorado, Michigan, Georgia, Ohio, Iowa, Kansas, Oklahoma, Kentucky and Utah have also reported clusters of Enterovirus illness.  Of the additional 10 states, only Colorado and Iowa have confirmed EV-D68 as the causative agent.  While Enterovirus infections as a whole are common, the number of critically ill children who have required intensive care has been unprecedented. Many of these children have a history of asthma or wheezing.
At present there are no vaccines or antiviral medications that can be used to prevent or treat EV-D68.  Infection prevention measures include hand hygiene using soap and water, paying particular attention to hand washing after changing diapers, as well as avoiding touching your eyes, nose and mouth with unwashed hands and disinfectingfrequently touched surfaces such as door knobs and shared items such as toys.  When choosing a disinfectant however, it is important to understand that due to the rarity of EV-D68, most commercially available disinfectants will not have specific claims against EV-D68.  As such look for products that have claims against viruses within the same family such as Poliovirus, Coxsackieviruses or Rhinovirus.
Here's hoping that this back to school this year does not signal the start of a busy fall outbreak season!  Influenzaand Norovirusseason are just around the corner!

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