Clusters of Acute Respiratory Illness Associated With Human Enterovirus 68

Asia, Europe, and United States, 2008-2010

Tadatsugu Imamura; Akira Suzuki, MD, PhD; Adam Meijer, PhD; Hubert G.M. Niesters, PhD; Janette C. Rahamat-Langendoen, MD; Jose Lojo, MPH; Richard L. Hodinka, PhD; Susan Coffin, MD; Stephen M. Ostroff, MD; Colleen S. Kraft, MD; John T. Redd, MD; Dean D. Erdman, DrPH; Xiaoyan Lu; Mark S. Oberste, PhD; Lauren J. Stockman, MPH; Gregory L. Armstrong, MD; Lara M. Jacobson, MD; Catherine Y. Yen, MD


Morbidity and Mortality Weekly Report. 2011;60(38):1301-1304. 

In This Article

United States


In September 2009, a hospital in Atlanta started using a new, multipathogen testing system (Luminex xTAG Respiratory Viral Panel [RVP], Luminex Corporation, Austin, Texas) for respiratory viral testing in its laboratory. The system can detect several respiratory viruses, including HRVs and enteroviruses, which are identified by the system only as "entero-rhinovirus." During the next respiratory illness season, September 2009–April 2010, adult patients at the Atlanta hospital facility who were diagnosed with "entero-rhinovirus" appeared to be more ill than those diagnosed with HRV in previous seasons. Nucleic acid sequencing of 68 specimens from the 2009–2010 season revealed that 62 (91.2%) contained HRV and six (8.8%) contained HEV68. Among the six patients with HEV68 (Table), three were aged >50 years and two were immunocompromised. Five patients had fever and four had cough. One patient had abnormal findings on chest radiography that were attributed to cryptococcosis. No other cases were associated with coinfections. Three patients were hospitalized for a median of 4 days. None of the patients required admission to an intensive-care unit (ICU), and none died.


In mid-September 2009, a pediatric hospital in Philadelphia noted more than twice the proportion of respiratory specimens testing positive for HRV by RT-PCR compared with those seen during previous fall HRV seasons. An investigation identified 390 children treated at the hospital during August–October 2009 from whom at least one respiratory specimen was positive for HRV. Respiratory specimens from 66 of these children were sent to CDC for further molecular characterization. HEV68 was identified in 28 (42%) of the specimens. Among the 28 patients with HEV68 infection, 15 (54%) were aged 0–4 years (Table), and 15 were admitted to the ICU. The median duration of hospitalization was 5 days, and none of the patients died.


During August–September 2010, hospital officials at an isolated community hospital in rural Arizona noted an increase in pediatric admissions for lower respiratory tract illness. During this time, 43% of pediatric admissions were for respiratory illness, compared with a mean of 17% during the same period in the 3 previous years, a statistically significant difference. Similar illness, characterized by cough and tachypnea or hypoxemia, occurred in 18 patients. Abnormal lung examination result and wheezing, particularly new-onset wheezing, were noted. At least half of children with available chest radiographs had infiltrates. Hospitalization lasted a median of 1.5 days, and no deaths were reported. Despite viral testing and blood cultures performed at the Arizona Department of Health Services on patients with specimens available, no pathogen was detected. Nasopharyngeal specimens of seven patients were sent to CDC for further testing, and HEV68 was identified in five of the patients, one of whom also was positive by RT-PCR testing for Streptococcus pneumonia.


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