Be on Lookout for Enterovirus-D68, CDC Says

At least 30 children in Chicago, Illinois, and Kansas City, Missouri, have been sickened by enterovirus-D68 (EV-D68), and the Centers for Disease Control and Prevention (CDC) is investigating whether the rare virus is responsible for outbreaks of acute respiratory illness in 9 other states, the agency announced today.

The virus also can cause neurological problems in children that resemble polio, but no such complications have been reported, said Anne Schuchat, MD, director of the CDC's National Center for Immunization and Respiratory Diseases, at a news briefing today. The virus has sent many children to the hospital with breathing problems, said Dr. Schuchat. So far, there have been no deaths.

"The situation is evolving quickly," she said. "We want to make sure that clinicians around the country are on the lookout for this."

Enteroviruses in general are ubiquitous, but not EV-D68, first isolated in California in 1962. It is so much a relative clinical stranger that scientists don't fully understand it, said Dr. Schuchat.

"We know that it can cause mild or severe respiratory illness, yet the full spectrum of all the illnesses that it can cause are not well defined," she said. "We believe that it's spread similar to ways that other enteroviruses are spread, through respiratory secretions like saliva and mucus."

Most Children Hospitalized Had Underlying Respiratory Issues

The outbreak in Kansas City has centered on Children's Mercy Hospital, which recently experienced more than 300 cases of respiratory illness, according to an August 29 news release from the Missouri Department of Health & Senior Services. Roughly 1 in 7 children were treated in an intensive care unit. Using a polymerase chain reaction assay, the CDC identified EV-D68 in 19 of 22 nasopharyngeal specimens from patients with a recent onset of symptoms there, according to the latest issue of Morbidity and Mortality Weekly Report (MMWR).

CDC testing of specimens taken from patients at the University of Chicago Medicine Comer Children's Hospital turned up EV-D68 in 11 of 14 cases.

The ages of the children at both hospitals who tested positive ranged from 6 weeks to 16 years, according to MMWR. Seventy percent had a history of asthma or wheezing.

The CDC also is testing specimens from clusters of pediatric respiratory illness in Alabama, Colorado, Georgia, Iowa, Kansas, Kentucky, Oklahoma, Ohio, and Utah, according to the agency. A cluster, said Dr. Schuchat, amounts to a level of illness that exceeds what is normal for this time of year.

There is no vaccine for EV-D68, she said, but good hygienic practices such as frequent hand washing can reduce its spread.

Mild cases can resolve on their own, said Dr. Schuchat. "Others who have more severe illness may need to be hospitalized and require supportive care."

"If there is difficulty breathing," Dr. Schuchat said in a message to parents, "seek medical help."

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Cite this: Be on Lookout for Enterovirus-D68, CDC Says - Medscape - Sep 08, 2014.

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