In today’s world of brilliant minds and astounding technology, it may seem like we have invented a vaccine, treatment, or cure for nearly all of the pediatric infectious diseases that affect children on a global scale. However, an emerging pathogen has proven that even life-threatening viruses may have no vaccine or treatment. This emerging pathogen is Enterovirus D-68. Chances are that you may not have heard of Enterovirus D-68 until the autumn of 2014. You may wonder how a virus that never previously appeared in a widespread outbreak is suddenly concerning to parents, children, doctors, and hospitals across the country. The answer to this lies in the fact that there is no vaccine or treatment currently available for Enterovirus D-68, even though children are admitted to Intensive Care Units and some children have even become paralyzed as a result of contracting this virus (Cha). Although it seems like a vaccine is necessary to treat this virus, a vaccine is simply not feasible, due to multiple logistic and scientific challenges that are presented in treating pediatric infectious diseases.

Enterovirus D-68 (EV-D68) was first discovered in California in 1962, and subsequently appeared in small sporadic and isolated outbreaks in several countries ("Clusters of Acute Respiratory" 1301-1304). EV-D68 is a respiratory virus and is a member of the Picornavirus family, linking it to other respiratory viruses that cause the common cold, as well as the Poliovirus ("Enterovirus D68"). Genetically, EV-D68 is an RNA based virus, which means that it naturally evolves and mutates at higher rates ("RNA Viruses"). Enteroviruses are in fact common viruses, resulting in symptoms such as coughing, runny noses, fever, and body aches. However, extreme symptoms including difficulty breathing and wheezing appeared in the 2014 outbreak ("Enterovirus D68"). EV-D68 has been found in the spinal fluid of children who became paralyzed after contracting EV-D68 and could be linked to several fatal cases (Cha). These alarming symptoms and results highlight the dangers of Enterovirus D-68 as well as illustrating the need for a treatment to prevent these life-threatening symptoms.

The development of vaccines is a complex process, and there are multiple obstacles that are presented. The first of these obstacles is the priority of vaccine creation based on disease burden, which prioritizes vaccines for diseases that have large mortality and morbidity (Berry). Another obstacle is the lack of knowledge on the market for the vaccine. Specific groups must be known, such as age, and if there is little knowledge on this information, it is difficult to create an effective vaccine (McMillan). Finally, one of the biggest challenges is the cost of development as well as interest in a vaccine. If no company wants to spend resources and is not interested in developing a vaccine, then a vaccine will not be considered for development (Berry). In the case of EV-D68, not enough information is known about it and there is minimal interest since there has only been one outbreak. From a logistical standpoint, a vaccine is currently not feasible for EV-D68.

Scientific challenges are also presented in vaccine development, but these challenges are usually specific to the nature of the virus. In the case of EV-D68, specific antibodies that treat EV-D68 must be introduced, and a method to do so would have to be developed (McMillan). Additionally, genetic mutations that change surface proteins and alter the genetic makeup of the virus provide a challenge to vaccine development because a vaccine must be created that is effective against multiple strains of the same virus (Kaufmann et al.). Scientifically, a vaccine for EV-D68 would not be feasible, because more research would have to be conducted on the virus.

If a vaccine is not feasible, then how can Enterovirus D-68 be treated if another outbreak circulates in the future? Alternative methods should be researched instead, such as antiviral medications which destroy the virus and immunoglobulin injections, which introduce antibodies from people that have successfully fought against the virus (McMillan). It should be understood that even in this day and age, pediatric infectious diseases will not always have a cure or treatment. When challenges are presented that make vaccines not feasible for pediatric infectious diseases, then alternative methods of treating these viruses should instead be researched.

Works Cited
Berry, Andrea. Personal interview. 10 Dec. 2014.
Cha, Ariana Eunjung. “Spread of enterovirus D68 takes an alarming turn with reports of paralysis: What we know and don’t know.” The Washington Post [Washington, DC] 30 Sept. 2014: n. pag. The Washington POst. Web. 2 Oct. 2014. .
“Clusters of Acute Respiratory Illness Associated with Human Enterovirus 68--- Asia, Europe, and United States, 2008--2010.” Morbidity and Mortality Weekly Report 38th ser. 60 (2011): 1301-04. Centers for Disease Control and Prevention. Web. 23 Oct. 2014.
“Enterovirus D68.” Centers for Disease Control and Prevention. N.p., 25 Sept. 2014. Web. 2 Oct. 2014. .
McMillan, Julia. Personal interview. 5 Dec. 2014.