Dealing with Viral Fever in Summers

key facts:-

• Non-polio Enteroviruses are the most common cause of viral fever in the summer ¹(Rhinovirus in winter)
• Children are at risk and more prone to develop Viral fever as compared to adults⁵
• Usually, Most viral fevers in summer are mild but some cases may get serious².
• Washing hands properly and at all key times along with respiratory etiquette and avoiding close contact can prevent the spread of infection
• AYUSH department, Govt of India, recommends some prophylactic measures to boost immunity and thus prevent viral and other diseases. (given in the article)
• Plenty of fluid is the main advice and that can be met by drinking a lot of water and adding some fruits and vegetables with great water content (>90%) to the diet. (list given in the article)
• A temperature of 99^oF in the axilla or 99.5^oF in the mouth is labelled as a Fever in children⁵ (children have a higher normal body temperature than adults)
• Fever without any foci in Neonates (age below 1 month) is a Medical Emergency and should be hospitalized till afebrile⁵.

In the summers we see a surge in cases of viral fever mainly among children. Let’s know in detail about the viral fever of summer. 

Most Common Cause of Viral Fever in Summers

As the name suggests it is caused by a virus. There is a huge list of viruses that can cause fever in humans. But the most common cause of viral fever in summer is Non-polio Enterovirus¹. They are the second most common type of virus infecting humans after Rhinovirus. Rhinovirus usually infects in winter as they are known to survive best in winter. In summer therefore non-poliovirus replaces Rhiniviruses from top position. There are more than 60 non-polio enteroviruses that can infect humans.

At the risk of viral fever

• Infants
• Children and 
• Teenagers 

They are more prone than adults to get infected and become sick because they do not yet have immunity gained from previous exposures to the viruses

Clinical Features of Non-Polio Enterovirus Infection

Children who have no immunity from previous exposures to the viruses are more prone to enterovirus infections and develop symptoms.

Symptoms of mild infection usually include²:-

• Fever itself
  • usually sudden in onset
  • may range from 101^oF to 104^oF
• Runny nose, sneezing and/or cough
• There may be body aches
• Skin rash

But Some non-polio enteroviruses can involve:-(particularly in people with weak immune systems)

• Eye
  • Viral conjunctivitis (pink/redness of eye)
• Brain
  • Viral meningitis
  • Viral encephalitis
• Heart
  • Myocarditis
  • Pericarditis
• Hand, foot and mouth disease.
• Sepsis, though rare.

*non-polio enteroviruses are known to be associated with the development of type 1 diabetes Mellitus in children²

Transmission Of Viral Fever

Non-polio Enterovirus is found in a patient in the patient’s body secretions, faeces and fluid of blister².

One can get the infection when anything containing these viruses gains entry into a healthy individual through the eye, nose or mouth.

• Close contact with the patient- shaking hand
• Touching surroundings or personal belongings of the infected person, like- phone, doorknob etc and not washing hands thereafter. (one may touch eyes, or nose or eat something with unwashed hands)
• Even drinking water with the virus in it may infect a healthy person.

the Infected person can spread the infection for a few weeks even in the absence of symptoms.

Prevention from viral fever

• Wash your hands properly:-
  • With soap and water for 20 seconds following all steps
  • If using a sensitizer to clean the hands-All steps of hand washing are followed
  • Wash hands at all key times
    • Using toilet
    • Changing diaper
    • Preparing food (before and after)
    • Eating something (before and after)
    • Taking care of any sick person (before and after)
• Disinfect frequently touched objects- for example, doorknobs
• Avoid close contact as much as possible without being rude to the patient. Like wishing Namaste or waving Hi! instead of handshake
• Follow respiratory etiquette- cover your mouth when coughing or sneezing.

AYUSH Recommendations on Viral Fever

The holistic approach of AYUSH systems of medicine gives focus on prevention through⁴:-

• lifestyle modification,
• dietary management, 
• prophylactic interventions for improving immunity and 
• simple remedies based on presentations of the symptoms. 

Single medicinal plants like:-

• Tulsi juice or infusion(Ocimum sanctum), 
• Guduchi juice/decoction with honey (Tinospora cordifolia), 
• Ginger juice/decoction with honey(Zingiber officinale) and 
• Turmeric powder in honey or warm milk (Curcuma longa)

are useful⁴ and Can be used to enhance immunity. Emphasis on avoidance of causative factors and enhancing the immunity against the host of infections are characteristics of Ayurveda management.

One can get free consultations from Ayurvedic Doctors at govt Ayurvedic health centres or hospitals.

Treatment of Common Viral Fever in Summers

• Usually, they don’t require any specific treatment. the patient improves on their own and may take up to 1 week
• Only supportive and symptomatic treatment is provided
  • Plenty of fluid intake:-
    • Plain water is the single best option. Since fever causes insensible loss of water from the body, one should be liberal in water intake, except in some conditions where the doctor advised restricting water. (Most recommendations are for 3-4 litres of fluid for a healthy adult person.)
    • Fruits and vegetables with high water content
      • Watermelon
      • Musk melon
      • Oranges
      • Coconut water
      • Cucumber
      • Tomatoes
      • Peach
      • Grapefruit (chakotra)
    • Broth and soups
    • Skimmed milk or simple milk
    • Plain curd 

• Resting in bed
• Taking fever-lowering medicines (antipyretics):-
  • Paracetamol
  • Ibuprofen
• Lukewarm saline gargles

 (Although Japanese health authorities have long recommended gargling to prevent respiratory infections, its effectiveness among children is not clear.³)

• Using normal saline nasal drops for nasal congestion

• There is no role of antibiotics in viral fevers unless any superadded bacterial infection is suspected.
•  Anti-virals are not recommended.

Pregnancy & Non-Polio Enterovirus Infection

Non-polio enteroviruses are very common, so a pregnant woman is likely to be exposed at some point in her pregnancy to someone who is infected, especially in the summer

• But most pregnant women, like other adults, have immunity (protection) from previous exposures to non-polio enteroviruses
• If infected shortly before delivery, there is a chance she can pass the virus to her baby. These babies usually have only mild illnesses, but in rare cases, they may have severe infections.
• There is No clear evidence that non-polio enterovirus infection during pregnancy increases the risk of severe complications like miscarriage, stillbirth, or congenital defects².

FAQs

When to Visit a Doctor?

We cannot decide whether it’s viral or bacterial or some other infection causing the fever. Therefore it is always advised to visit a doctor for consultation. Doctors depending upon signs and symptoms may advise you only antipyretics and supportive treatment at home in case of probable viral fever. Sometimes lab investigations are ordered to rule out other infections or support the diagnosis. It is recommended to follow the advice of a doctor

How do We Define Fever in Children?

A controlled increase in body temperature over the normal values for an individual is called fever⁵.

• The normal body temperature of children is higher than adults. it varies between 97-100^oF (Rectal temperature), maximum in the evening (5-7 pm) and least between midnight to 6 AM. Rectal temperature is the most accurate method of measuring temperature (closest to core body temperature)⁵ [though it may not be practical in children above 3-4 years of age and when such accuracy in temperature is not required as in the case of viral fever]
• A temperature of 99^oF in the axilla or 99.5^oF in the mouth is labelled as a fever. (as the axillary temperature is 1 to 2^oF lower and oral temperature is 0.5 to 1^oF lower than rectal temperature⁵

How Long Does it take to resolve viral fever?

The majority of illnesses caused by non-polio enteroviruses are mild and self-limited and symptoms usually resolve within a week (range is 1 to 2 weeks) with a full recovery.

Viral Fever Vs Heat illness

In response to viral infection endogenous pyrogens (fever-producing chemicals) are produced in the body (like IL-1, IL-6, TNF-alpha, interferon-gamma, PG-E2) all these pyrogens alter the temperature regulation mechanism of the body (hypothalamus of the brain) and the temperature of the body is thus raised.

whereas in the case of heat illnesses temperature regulation mechanism is Not disturbed, it remains set at a normal point, but the body is not able to dissipate the heat (like in the case of heat stroke) or excess heat is generated in the body. like in the case of hyperthyroidism, in response to some drugs like anticholinergic, or malignant hyperthermia. the temperature here may rise even up to 106^oF

Is there Any Vaccine for the Prevention of Viral Fever?

currently, there is no vaccine for illnesses caused by non-polio enteroviruses.

What are the Various Causes of Fever?

Fever can be caused by multiple causes including:

infections, tissue injury, vaccines administration, malignancy, autoimmune diseases (juvenile RA, SLE, Kawasaki disease, IBD etc), some drugs, granulomatous diseases, metabolic disorders (gout) and even genetic disorders (familial Mediterranean fever)

How Do We Approach a Neonate (age <1 month) with a Fever?

Fever in the neonate is usually a medical emergency as:-

• there remains a significant risk of 5-15% of serious infections like sepsis, meningitis, UTI and pneumonia
• Neonate may look well in spite of serious infection
• consequences of missing serious infections can be very dangerous.

therefore all neonates with fever should be hospitalized, evaluated, put on I/V antibiotics depending on lab results and observed till afebrile⁵.

Even All toxic/sick-looking infants aged 1-3 years should be evaluated and managed as neonates (< 1 month)⁵

Sometimes neonates may have high fevers due to over clothing and warm weather. in such situations mother is advised to breastfeed frequently and nurse in a less warm environment.