Going Viral: What’s Trending in the Viral Scene?

Author: Deva Rea, MPH, BSN, BS, RN, CIC

Another New Year and back to the daily grind we go! Time to get back into our routines, meet up at the watercooler, swap holiday stories, and discuss what’s “going viral” right now. For this epidemiologist, “going viral” has a nerdier connotation and is truly a discussion about viruses. Viruses, although not technically “living”, have quite a reputation due to their impact on the living. Viruses make viral news routinely because they are critically provocative & significant to life and their viral effects are routinely highlighted in the media. Here are some of the top trending viral viruses in the country right now:

Adenovirus

One of the most newsworthy viruses this past year was adenovirus. The New Jersey Department of Health (DOH) is continuing to investigate deadly outbreaks at two facilities that care for immune-compromised children. As of December 24^th, the New Jersey DOH had reported 11 deaths & 37 cases. The outbreaks at these facilities were not considered related, as two different adenovirus strains, type 7 & 3, were detected.¹

What is it? Adenovirus typically causes mild respiratory illness. However, some people can develop more severe illness, including pneumonia. There are over 50 types of adenovirus & some can also cause gastroenteritis, conjunctivitis, and cystitis.² Adenovirus is a hardy non-enveloped virus, which means it’s more resistant to disinfectants, and can survive in the environment for extended periods of time. It’s transmitted via droplets from coughing or sneezing, or via contact with an infected individual or contaminated environment. Shedding of the virus can continue for a prolonged period of time, especially with immune compromised people. Because of these attributes, controlling an outbreak can be difficult if proper infection control actions are not taken quickly.²

Acute flaccid myelitis (AFM): Enterovirus

Possibly the most talked about illness this year has been acute flaccid myelitis (AFM). AFM affects the nervous system and causes muscle/ reflex weakness. This rare, but serious condition has been increasing since 2014. The Centers for Disease Control and Prevention (CDC) states that more than 90% of patients had a mild respiratory illness or fever consistent with a viral infection prior to the onset of AFM.³ The cause of this new uptick in AFM is thought to be from enteroviruses. Enteroviruses are non-enveloped viruses that are spread from contact with an ill person who coughs, sneezes, or touches a surface that is then touched by others. Enteroviruses commonly cause mild respiratory illness similar to a cold, and occur mostly in children. The CDC is continuing to investigate why a small number of people, typically children, develop AFM. For 2018 (updated December 28, 2018), there have been 186 confirmed cases of AFM from 38 states.³

Hepatitis A

The ongoing Hepatitis A outbreak has also been a prominent topic in the media. The CDC has been investigating outbreaks in multiple states. More than 2,500 hepatitis A infections across the United States have been reported to the CDC from January 2017 to April 2018.⁴ Of these cases, more than 68% reported drug use, homelessness, or both.

What is it? Hepatitis A is a vaccine preventable illness. It is spread person-to-person via the fecal-oral route (ingesting of something contaminated by the infected person’s feces). People are contagious prior to the onset of symptoms, and shedding slows after the development of jaundice.⁴ It typically takes about 28 days after exposure to develop symptoms, but it can be up to 50 days. Hepatitis A affects the liver and can cause symptoms such as: fever, nausea, vomiting, fatigue, loss of appetite, abdominal pain, dark urine, clay colored bowel movements, joint pain, and jaundice. Severe infections leading to fulminant hepatitis and death are not as common, but do occur.⁴

Influenza (flu)

Influenza is typically found trending in the news during this time of year. The most recent report from the CDC (week ending December 22, 2018), showed influenza activity to be increasing. Most states are reporting widespread or regional activity.⁵ The flu gains much exposure due to its potential severity and somewhat unpredictable nature. For most people, the flu causes an abrupt onset of respiratory symptoms including: fever, sore throat, cough, headache, muscle/body aches, runny nose, and malaise.⁵ For others, the flu can be significantly more severe leading to pneumonia or other complications. The time from exposure to infection is 1-4 days, and people can be infectious a day prior to symptom onset until a week after symptoms resolve. Influenza is transmitted via respiratory droplets from when an infected person sneezes or coughs. Transmission can also occur when contact is made with contaminated surfaces.⁶ So far into the 2018-2019 flu season there have been 11 pediatric deaths.⁵ Although that number seems alarming, there were 185 pediatric deaths in the last flu season (2017-2018), which was also an unfortunate record breaker.⁵

Norovirus

Norovirus is one of the most highlighted viral viruses each year due to its superb ability to cause major outbreaks. Norovirus is the most common cause of outbreaks related to food. It causes 56,000 to 71,000 hospitalizations and 570 to 800 deaths annually.⁷ The winter season is typically when this virus goes into high gear, hence its alias “winter vomiting bug”. As the alias suggests, Norovirus most often causes vomiting, diarrhea, abdominal pain, and nausea. These symptoms occur within 12-48 hours after exposure and last up to 3 days. It is incredibly contagious—hence spreading easily from contact with an infected person, contact from contaminated surfaces, or ingesting contaminated food. Norovirus is another sturdy non-enveloped virus that can linger on surfaces for weeks.⁷

How do we protect ourselves amidst the viral onslaught we repeatedly face in our day to day lives? Let’s breakdown some prevention strategies:

1. Wash your digits! Hand hygiene is one of the biggest prevention methods we have to protect ourselves from viruses. We wash our hands with soap and water, use alcohol hand based rubs, or alcohol based hand wipes to protect ourselves from coming in contact with viruses. We also do hand hygiene to protect others from us when we’re sick. Some non-enveloped viruses are more resistant to alcohol-based hand rubs. In those situations, soap and water are best to use for hand hygiene. Alcohol based hand wipes are another great alternative when soap and water is not available.
2. Don’t spread the ick! Being sick and going boldly into work or other activities is not noble, it’s wrong! Allow yourself to rest, protect others, and stay home. And resist that urge to “sweat it out” or do a lot of rigorous exercise. Rest is needed for the body to recuperate.
3. Practice excellent respiratory hygiene and cough etiquette! Cover your cough & sneezes with a tissue or your sleeve. Perform hand hygiene after blowing your nose. Wear a mask if you are coughing and in a healthcare facility or another area with vulnerable populations.
4. Clean and disinfect your environment! Environmental cleaning is an immensely important part of containing viral illnesses. Ensure the products you are using are virucidal (kill viruses). Additionally, for some outbreak situations, a more robust product should be used, such as bleach. Always consult the CDC for guidelines to assist in the decision making process for choosing germicidals.
5. Get vaccinated because they work! Whether it be for the flu or for another vaccine preventable illness, such as Hepatitis A. If you meet the risk factors for the Hepatitis A vaccination, it is important to receive it and protect yourself. And it’s good to remember that you cannot get the flu from the vaccine because the vaccine is inactivated. This is a common misconception.
6. Stay away from sick people! It’s easier said than done, but if you see an obviously sick person, just keep your distance. Many of the common viruses are spread by contact with a sick person or from being close to them when they sneeze, cough, vomit, etc. So, it’s ok to do a beeline & wave from a distance when you notice your bff is sneezing into a stack of tissues.

Begin this New Year as an infection prevention advocate! Protect yourself and others by being aware of infection prevention measures to help prevent the spread of illness, as well as the common viruses currently circulating and going viral within the country.