Sep 24, 2014


Announcer: Medical news and research from University of Utah physicians and specialists you can use for a happier, healthier life. You're listening to The Scope.

Scott: Enterovirus has been identified here in the state of Utah. It has taken a while to get here, but it's finally here. We're with Dr. Ed Clark, who's the Chair of Pediatrics at University of Utah Health Care and the Chief Medical Officer at Primary Children's Medical Center. Now what? It's here. Now what?

Dr. Clark: Well we knew it was coming, and this was not a secret. Our colleagues early in August were seeing it in Kansas, they were seeing it in Chicago, and they were seeing it in other children's hospitals. We knew it was only a matter of time and we also knew we needed a plan.

Scott: So you detected the first case. How exactly does that happen? If somebody comes in with something that you think is this enterovirus d68. What do you do at that point?

Dr. Clark: Well we were watching our pattern of patients who were coming into the emergency department. We were checking that against the viral surveillance that we do here in Utah, and let me just give you a plug for GermWatch for anybody who's interested in what viruses are here in the community. Go to and you can find the GermWatch site. We started seeing changes of activity. That change in activity was the early sign. Then as we saw these kids, we used the existing molecular test that was developed here by Biofire, identified the virus we were seeing as an enterovirus or a rhinovirus. Then we figured that this most likely was d68, treated the kids but also at the same time sent these samples to the CDC in Atlanta. They did the final molecular fingerprinting and just last week returned the results, which confirmed our original supposition.

Scott: So you know it's here. What's the plan at this point? Did you have any idea how many kids you'll likely see with this?

Dr. Clark: You know, it was very interesting, Scott, because what we did is we actually used a model that we had developed for other viruses. Remember a few years ago we had swine flu in the community? We used the model that we developed at that time to predict what it might look like, the worst case scenario and a sort of better case scenario, to give us a sense of what could possibly happen. Then, we also implemented our surge plan for viral diseases, which we expect every winter.

Scott: What is the plan when it comes to enterovirus? How do you hope to control it or contain it? What is the goal here?

Dr. Clark: With this particular virus, it's actually relatively mild and self-limited, relatively mild meaning yes children had more chance of having an asthmatic attack and requiring hospitalization and treatment and not as severe as the swine flu, which actually led tragically to deaths of some children.

Scott: Okay. And, if I understand correctly, healthy children generally are not going to be that big of a worry. It's just children that tend to be asthmatic that you're going to want to be concerned about.

Dr. Clark: Yes and that was the message also that we worked with our communications teams and the city and state health department, which was to say to families, "If you have a child who has had asthma or has asthma now and they start wheezing, this is the time to get some medical help."

Scott: So now that it's here it could spread. How does it spread and what can families do to prevent that?

Dr. Clark: Well the spread we think is probably occurring in schools and other places that kids congregate. It's a little hard to control that. What we expect with this virus, and what we're seeing so far, is that we'll see about a five to six week course within the community, a rather steep rise, and then a plateau, and then it will fall off with time. We're now into week four of what we anticipate to be about six weeks.

Scott: So we're almost through this thing.

Dr. Clark: We are. The worst case scenario didn't play out. We anticipated 800 plus cases requiring hospitalization. We're probably in the 250 range right now, and we're just watching carefully.

Scott: I understand this is a hand washing virus; you wash your hands and that helps prevent the spread. It's difficult to do in schools, so the important thing is to just look for if your child has it if they're asthmatic. Do something about it at that point.

Dr. Clark: Right. It's also a cough and sneeze virus. It's a hand washing virus. It is a virus, very interestingly, that is not seeming to affect adults. It's very possible that we as adults have seen this in decades past and then it's just swept back into the community.

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope, the University of Utah Health Sciences Radio.

For Patients