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Good Hygiene is Best Defense Against Frightening Enterovirus, Experts Say

With parental concerns rising after death of Mercer County child, infectious-disease specialists urge caution but also note that most will experience only mild symptoms

Amisha Malhotra
Dr, Amisha Malhotra, associate professor of pediatrics at Rutgers Robert Wood Johnson Medical School and a pediatric infectious disease consultant with the Bristol-Myers Squibb Children’s Hospital at Robert Wood Johnson University Hospital in New Brunswick.

Few things are terrifying as a child dying unexpectedly in his or her sleep, so the death of a 4-year-old Mercer County boy from enterovirus D68 has raised alarms across the state.

However, experts say children and adults can take steps that will greatly reduce their risk of contracting the virus, and stress that most who do contract it will experience no more than mild symptoms.

To date, 14 cases have been confirmed in the state, in eight counties. Health officials have found no ties between any of the confirmed cases, showing the wide variation in the enterovirus affects people. Some -- primarily children -- experience severe flu-like symptoms, while others have no symptoms at all.

However, Eli Waller, 4, of Hamilton Township in Mercer County, showed only mild symptoms the night of Sept. 24 before dying the next morning.

Dr. Amisha Malhotra noted that many subtypes of enterovirus circulate around the United States every year. People build up immunity to these strains as viruses infect them. But the strains that are more rare present a challenge because young children haven’t been exposed to them.

Enterovirus D68 “is not your regular enteroviral strain that we see every year -- young kids probably have not developed immunity from old infections,” said Malhotra, an associate professor of pediatrics at Rutgers Robert Wood Johnson Medical School and a pediatric infectious disease consultant with the Bristol-Myers Squibb Children’s Hospital at Robert Wood Johnson University Hospital in New Brunswick.

She has treated patients who have some of the symptoms of the virus, but the test returns are still out on whether they contracted it, she said.

While there are still some open questions about the virus, it’s certain that good hygiene can be an effective defense against it.

Parents and schools should be alert for children with common-cold-like symptoms, particularly those who have had contact with a child who has the virus, Malhotra said.

“But that doesn’t mean a whole school would be at risk,” if children didn’t have contact with a child with the virus, she added.

Parents should pay particular attention with to children who have a history of asthma or respiratory problems, and consult a primary-care provider if they have symptoms like a runny nose or fever, she said. But most children who have these cold-like symptoms will soon recover.

Most importantly, parents should practice and teach their children good hygiene, including:

  • Wash hands for 20 seconds with soap and water frequently;

  • Stay home when sick;

  • Cover coughs and sneezes using the inside of the elbow;

  • Regularly clean and disinfect commonly used surfaces; and

  • Avoid touching the face and eyes with unwashed hands.

The increased awareness of respiratory symptoms, as well as the fall allergy season, have resulted in New Jersey hospitals seeing a slight uptick in visits for respiratory ailments in recent days, according to Aline Holmes, who is the senior vice president of clinical affairs for the New Jersey Hospital Association as well as a registered nurse and doctor of nursing practice.

Holmes said the best defense against the virus is to take the same hygienic precautions that people should always take.

“Don’t send your child to school or any kind of play date if they’re sick,” she said.

“I just think you need to be a little hypervigilant,” particularly if your child has asthma, Holmes added.

Providing students, parents and school staff members with accurate, factual information about the virus is the best response to concerns about the virus, according to Michael Yaple, a spokesman for the state Department of Education.

“You’re seeing posters placed on the walls of schools showing the basics of good hygiene; you’re seeing information being posted online; and children are going home with (frequently asked questions) sheets in the backpacks,” Yaple said, describing the fast, statewide response as “a major effort.”

Responding to concerns raised by parents on social media sites about limits to the time students are given to wash their hands in schoool, Yaple said parents should handle them like any concerns: Start by talking with the teacher and, if the issue isn’t resolved, bring it to the attention of the principal and, ultimately, the superintendent and school board.

“It’s just one of those issues that’s handled on a case-by-case basis,” he said.

The North Brunswick public schools provide a typical example of how districts are responding to the virus. . The district has been sending out email, text and phone blasts with up-to-date information about the virus and proper hygiene, according to Superintendent Brian Zychowski. The district is also working with the Middlesex County Health Department to monitor any cases. Zychowski added that he hasn’t heard a large amount of concern from parents, although he said this may change as awareness of the link between Eli Waller’s death and enterovirus -- which was confirmed over the weekend -- grows.

Dr. David Cennimo of Rutgers New Jersey Medical School and University Hospital in Newark said infectious-disease experts still have some unanswered questions about enterovirus D68. They remain uncertain over exactly how widespread it’s been, and therefore, what portion of cases led to serious symptoms.

However, good hygiene and getting flu shots may ultimately be the most important steps to protect public health. As Cennimo has pointed out to hospital staff, influenza “will kill more people than enterovirus and Ebola put together” in New Jersey.

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