RV, EV and EV-D68 and kids: What parents should know

Signs, symptoms and treatment of RV, EV and EV-D68 in kids and kids with asthma

There have been recent reports of pediatric infections due to rhinoviruses (RV) and enteroviruses (EV) across the country. Because of Enterovirus D68 (EV-D68) — a virus within that group — some of these infections have led to pediatric hospitalizations for breathing difficulties or limb weakness.

Because of this, the Centers for Disease Control and Prevention (CDC) has issued an alert to doctors and public health experts to consider this virus when treating kids who are sick.

Upon seeing these viruses mentioned in the news, parents may understandably have questions about what they are and how to keep their children safe.

In this Q&A, Dr. Jasjit Singh, a pediatric infectious disease specialist and medical director of infection prevention at CHOC, answers parents’ commonly asked questions about rhinoviruses and enteroviruses. 

What are the rhinoviruses and enteroviruses in kids?

Rhinoviruses (RV) and enteroviruses (EV) are a group of viruses that commonly cause respiratory illnesses such as the common cold. Cases of EV viruses are most commonly seen in the summer and fall seasons.

Most people who contract an RV or EV virus have mild symptoms. However, in some infants and children with asthma or weak immune systems, these viruses may cause acute respiratory infections.

What is EV-D68 and what are its symptoms?

Enterovirus D68 (EV-D68) is a virus within the group of enteroviruses.

Signs of EV-D68 range from a routine cold to more serious asthma-like symptoms with cough, wheezing and difficulty breathing; it has also been reported that about half of cases of EV-D68 include fever.

Infants, children with asthma and those with weak immune systems have a greater chance of breathing problems and complications; some kids may require treatment in the intensive care unit.

In some cases, EV-D68 has been associated with acute flaccid myelitis (AFM), a rare but serious neurological complication involving limb weakness.

Are rhinoviruses the same as enteroviruses?

Although RVs and EVs are separate groups of viruses, they belong to the same parent group of viruses called the Picornaviridae family and are closely related at a genetic level.

RV and EV viruses are hard to differentiate. Because of this, RVs and EVs are usually reported together in test results.

How serious are the rhinoviruses, enteroviruses and EV-D68 in kids?

Most children who contract an RV or EV virus will have mild symptoms like the common cold. Infants and children with asthma or weak immune systems may develop severe respiratory illnesses or AFM from some of these viruses.

The CDC is advising parents to contact their child’s health care provider right away if their child has trouble breathing or sudden symptoms of limb weakness.

How do rhinoviruses, enteroviruses and EV-D68 spread?

These viruses are spread when you make contact with the secretions, or germs, of an infected person. You can also become infected by touching objects or surfaces that have the virus on them and then touching your mouth, nose or eyes.

Keep infants younger than 3 months away from children or adults who have colds.

Make sure your child washes his or her hands often. This will decrease the chances he or she will get most viruses.

How are rhinoviruses, enteroviruses and EV-D68 treated?

There is no vaccine available to prevent these illnesses, and no specific treatments for RVs, EVs and EV-D68. However, most children will recover on their own. You can relieve your child’s symptoms by:

Children with a high fever and those with cold symptoms lasting longer than 7 to 10 days should talk with their pediatrician.

Seek immediate medical attention if you or your child develops any of these symptoms, especially following a respiratory illness:

  • Arm or leg weakness.
  • Pain in the neck, back, arms, or legs.
  • Difficulty swallowing or slurred speech.
  • Difficulty moving the eyes or drooping eyelids.
  • Facial droop or weakness.

Do rhinoviruses, enteroviruses and EV-D68 negatively affect kids with asthma?

Anyone with asthma is at increased risk of serious illness — the CDC is urging that ensure their child’s asthma action plan is up to date.

EV-D68 is particularly hard on children’s lungs. Therefore, it is especially important for parents of children previously diagnosed with asthma to:

  • Help your child follow their asthma action plan.
  • Communicate with your child’s pediatrician or specialist to plan ahead for times when symptoms may need urgent medical care.
  • Take prescribed asthma medications as directed.
  • Keep the reliever (rescue) medication (inhaler or nebulizer) on hand.
  • Get the seasonal influenza vaccine, because an influenza infection in the lungs can trigger asthma attacks and a worsening of asthma symptoms. Household members should get the flu vaccine, too.
  • Make sure the child’s caregiver and/or teacher is aware of their condition, and that they know how to avoid asthma triggers and what to do if the child experiences any symptoms related to asthma.
  • Although no children should be exposed to secondhand smoke, it is especially important to prohibit smoking in homes and cars where children with asthma live.

Are rhinoviruses and respiratory syncytial virus (RSV) the same thing?

Rhinoviruses and respiratory syncytial virus (RSV) — both similar to the common cold — are the most common viruses associated with respiratory tract infections, or infections of parts of the body involved in breathing such as the sinuses, throat, airways or lungs.

RVs and RSV may have similar mild, cold-like symptoms in most children. For both RV and RSV, if your child has a high fever and cold symptoms lasting longer than seven to ten days — speak to your pediatrician. 

If your child is having severe difficulty breathing, visit your nearest emergency department.

Use CHOC’s comprehensive guide, where to go for care, to determine if your pediatrician’s office, urgent care or the emergency department is the best place for your child.

Are rhinoviruses, enteroviruses and EV-D68 like the flu?

No. RVs, EVs and EV-D68 are different from the flu. CHOC recommends all children ages six months and older get their flu vaccine at the earliest possible time.

There are antiviral treatments available for flu which your pediatrician will prescribe if needed.

How can rhinoviruses, enteroviruses and EV-D68 be prevented in children?

  • Help protect yourself from getting and spreading respiratory viruses, like rhinoviruses or EV-D68, by following these steps:
  • Wash your hands often with soap and water for 20 seconds.
  • Avoid touching your eyes, nose, and mouth with unwashed hands.
  • Avoid close contact such as kissing, hugging, and sharing cups or eating utensils with people who are sick, and when you are sick.
  • Cover your coughs and sneezes with a tissue or your upper shirt sleeve, not your hands.
  • Clean and disinfect frequently touched surfaces, such as toys and doorknobs, especially if someone is sick.
  • Stay home when you are sick.
  • Consider wearing a mask around other people if you have respiratory symptoms.
  • Stay up-to-date with all recommended vaccines.

From babies to teens, pediatricians from CHOC’s Primary Care Network partner with parents to offer immunizations, sick visits, sports physicals and more.