Q: Where have all the (other) viruses gone?
A: I ask this question, after another day of newspaper- and airwave-filling reports on the dreadful Ebola virus epidemic in Africa. There are some other viruses worth considering, for their effects on children and adults.
I conducted an undeniably non-scientific study last week, asking as many of my nurse and doctor co-workers at our clinic to tell me which 10 on a list of 18 viruses were the ones they feared the most. I did not specify what I meant by “feared most,” leaving it up to them. In this column and the next, I will give you their answers, in reverse order like on a late-night TV talk show. Because of some ties, I chose the top 12 “contestants.”
12. EBOLA VIRUS: You’ve read a lot about this awful scourge, but the chances of it establishing itself in the U.S. are very remote. If you lived in West Africa, there’s no question it would be #1 on your list. Several drug firms are reportedly working on a vaccine for Ebola, but none is ready for use yet. Most problematically, West Africa is unlikely to be able to afford it – the countries affected are among the most resource-poor in the world.
11. ENTEROVIRUS D68 AND OTHER ENTEROVIRUSES: There are a great many enteroviruses; indeed polioviruses are classified among them. Some cause very serious disease, like polio, some just a bothersome rash, like the enterovirus that causes hand-foot-mouth disease. Enterovirus D68 is a new player on the scene and has caused some severe disease, especially in children, making those few have severe respiratory problems needing breathing machines, and two children have died from the disease, as of this writing. At this point, there isn’t enough information about the virus to determine if it should move up on our personal lists of viral culprits, but stay tuned.
10. HEPATITIS B: HepB causes mild to severe liver disease in adults and children, and is a leading cause of liver cancer. The vaccine against HepB has been very successful in reducing the disease, especially its transmission from mothers to their newborn infants. Most people get HepB through contact with infected blood or blood products or sexual contact and get rid of the virus by themselves, but others go on to develop liver damage or cancer. This virus is probably low on our list because of the vaccine, our first that prevents cancer (for the second, see my newspaper column in two weeks).
9. HERPES SIMPLEX VIRUS: (not to be confused with herpes zoster/chickenpox virus) Infected persons get painful sores on their genitals or around their mouths. By far the worst of all of its effects is what can happen to infected newborns – a devastating brain infection, encephalitis, that can destroy large parts of the brain.
8. WEST NILE VIRUS: We don’t live very close to the Nile, do we? It’s even farther away than Liberia, Sierra Leone and Guinea! Nevertheless, the virus got here in 1999, first noticed in the U.S. with massive bird die-offs in the New York area, followed by human infections, spread by mosquitoes. Most infected humans either have no symptoms or recover after a few days of fever, headache and muscle pain, but some develop encephalitis, not usually as bad as herpes simplex encephalitis, but occasionally quite damaging. West Nile virus infection has been seen in New Mexico residents, including an acquaintance of mine who was very ill with the disease. Unfortunately, there is no vaccine, and no specific treatment for it.
7. RESPIRATORY SYNCYTIAL VIRUS: I have written about RSV before, mentioning that to pediatricians, the winter months are often known as RSV season rather than influenza season. The reason for this is that during these months, this nasty virus causes more infant admissions to hospitals than any other infectious disease. Almost entirely a disease of babies – a few older people also get a bad infection – RSV makes those babies wheeze and cough through usually temporary damage to the breathing passages. Some have difficulty getting enough oxygen into their blood from those damaged airways, a few need breathing machines, and a very few die.
There is a very expensive preventive medication, palivizumab, given to those babies at highest risk (very small premature infants and those with chronic lung and heart conditions), but as yet there is no vaccine.
The viruses that were left out of the list of 12? Cytomegalovirus (a cause of hearing loss in newborns), rhinovirus (usually causes the common cold, but can be more severe), norovirus (the cause of most cruise ship diarrhea outbreaks and other diarrhea cases), hepatitis A (common in other countries, causing liver illness lasting weeks, but most recover), rotavirus (formerly the cause of more diarrhea hospital admissions in children than anything else) and rubella (usually mild, but if it occurs during pregnancy, the cause of very severe birth defects). It’s important to note that hepatitis A, rubella and rotavirus, as well as hepatitis B, would probably be higher on the list if we couldn’t prevent them with very effective vaccines.
You can argue with my survey methods and rearrange the order of the viruses, but it should be clear that Ebola isn’t the only virus we have to worry about. Tune in again in two weeks for the “winners,” the six viruses my co-workers fear most.
Lance Chilton, M.D., is a pediatrician at the Young Children’s Health Center in Albuquerque, associated with the University of New Mexico. Send questions to firstname.lastname@example.org.