All families in our region, and likely more widespread across the nation, should know that a major epidemic of a virus causing very high fevers is here and is happening now.

The most important thing is that this is a virus like all the viruses common to childhood, typically very harmless.

And, the very high fevers it causes are harmless.

So what is this virus, why is it showing up know, when to worry?

Enter the Enterovirus

The star of this epidemic is a group of viruses called the enteroviruses.   Entero just means gut, so it would be easier to call them the gutvirus, but that’s not how they were named.

The enteroviruses are amongst the most common and most constant viruses in the lives of our children, and ourselves.

They are, like the influenza virus, seasonal.   This means they tend to disappear during some parts of the year, or at least become far less frequent, and rage forth at other times.

In the Cleveland area, and most of the northern US, that season is late spring and summer, that is, now.

Every time May and June roll around these viruses appear.  No one knows how they suddenly appear across the entire country, but they do.

Which diseases can enteroviruses cause?

Unfortunately these viruses, which show up everywhere across the US, cause a wide range of illnesses, many of which most you have seen or heard about:

• Stomach flu.  Fever, vomiting, diarrhea, enteroviruses cause most of the summer time stomach flus.  (This is not the winter flu of flu shot fame).  This is in our region now.
• Hand-foot-mouth disease.  This is a famous illness, causing many cold sores in the mouth, and an often blistering rash on the palms and/or soles. Usually children with this have fever and rash on their body as well.  And a faint reddish bump rash can appear on the body, too.  This is in our region now.
• High fever with or without rash.  This is the epidemic we are seeing now.

There are other illnesses that enterovirus can cause, but they are less common than these, almost universally seen illnesses.

What About this High Fever Illness?

Many people wonder, why does my child suddenly get such a very high fever, where did it come from, why aren’t there other symptoms?

To answer these questions we need to look at how viruses work.

Viruses are bits of genetic material that are coated with proteins.  The proteins hold keys to enter the cell and inject the genetic material into the cell, allowing the viral genes to force the cell to stop what it’s doing and make copies of the virus.  The cell usually explodes as zillions of viruses are made, and the cycle continues, until the body destroys all cells containing any virus.

This saga of cellular destruction defines the symptoms of any viral illness.  If the enterovirus lands in the stomach there will be vomiting, if on the intestine, diarrhea.

Wherever it lands there will be fever because the destruction of all these cells and the body’s attack on the infected cells leads to the manufacture of various compounds of inflammation that lead the brain to turn the temperature up.

In the case of this high fever illness, the enterovirus lands mainly in the blood stream.  This generates a good stiff dose of inflammatory compounds that go right to the brain, really stepping up the fever.

As the viruses are destroyed by the immune system, the fever goes away, but circulating bits of dead cells and dead viruses can lead to spots of irritation, visible in the skin in what we call a rash.

So this high fever illness is mainly in the bloodstream, it causes fevers up to 105.8, but typically in the 103-105 range, and once the fever goes away often a rash erupts and then fades.

This illness does not cause trouble breathing, vomiting, diarrhea, runny nose, or cough.  Just high fever and sometimes rash.  Of course with high fever comes sadness, worry, and irritability.

A Word on Fever 

It is important to keep in mind that fever is not what it seems.

It seems to be the body out of control, “My child is burning up.”

It seems that the normal track of being at 98.6 is careening way out of control, and who knows where the heat will stop.

It seems a germ has taken hold and taken over.

But in fact, fever is every bit as controlled a situation as if your temperature is indeed still 98.6.

In fact, fever is created by the body, not the germ.  It is us who changes our temperature.

In fact, when the body resets its desired temperature, say from 98.6 to 104.8, the new temperature, 104.8 is planned for, represents a carefully controlled new set point, and is maintained as rigorously as 98.6 was.

Think about setting an oven for 325.6.  Impossible.   Maybe 320, or 325, but never 325.6, no oven in a home as that fine a control, but our body does.

Think about the fact that essentially no one with a fever from a mild viral illness goes above 105.8.  Why never to 106.2, or 106.5??

The reason is that fever is planned and very tightly controlled.

In fact, fever itself is harmless.  There are some young children who have febrile seizures, but it is the sensitivity of the brain to higher temperature, not an out of control thermostat that causes these.  And such events cause no harm either.

Some serious illnesses cause fever, like pneumonia, but if you don’t have pneumonia or a serious illness, if the illness is a mild virus, fever will be harmless.

What to Worry About

This high fever epidemic is scaring a lot of people, their child does feel very hot, when to worry?

As noted above, if only fever is present, and the temperature is 105.8 or lower, then watch for these signs:

1. Trouble getting air in and out of the chest.
2. Significant pain.
3. A stiff neck, that is, unable to turn the head.
4. Looking very dry with less urine, sunken eyes, limp and wilted appearance.

If your child seems fine when the fever drops, breathes easily, is in no pain, and can turn their head with ease, you likely are dealing with this high fever epidemic from this season’s enterovirus.

What to Do

1.   If the process seems viral as noted above, use ibuprofen to drop the fever a bit, don’t count on it getting rid of the fever, no drug can be counted on to that, but it might help.  Don’t give more than every 6 hours and at the recommended dose.  No reason to trade a harmless problem like fever for a harmful problem like drug overdose.
2. Keep your child comfy.
3. Give lots of liquids.
4. Call if trouble breathing, or significant pain, or looking dry, or a stiff neck appear.
5. Antibiotics only kill bacteria, they have no impact on viruses.

BOTTOM LINES

1. RIGHT NOW, there is a major epidemic of enterovirus sweeping across our region, as it does every year at this time of year.
2. RIGHT NOW, the enterovirus are causing a lot of cases of high fever, sometimes ending in a rash.
3.   Fever is harmless, very uncomfortable, but harmless.  As long as the illness does not indicate any signs of being more than a simple virus, simply keep your child comfortable.  Signs that this is not a simple viral illness are trouble breathing, stiff neck, significant pain, or looking too dry.
4.   Ibuprofen helps, but don’t count on it to get rid of fever.  It can reduce fever, sometimes to normal levels of temperature, but not every time.  Given that fever is harmless it makes it all the more important that not expose your child to an overdose of ibuprofen in an attempt to to get rid of a harmless fever.

The enteroviruses of 2017 are here, don’t be surprised if fevers of 103, 104, even 105 appear, they are happening all over our community.  Make sure nothing else that would raise concern is going in, and if not, keep comfortable as the virus passes.

To your health,
Dr. Arthur Lavin