Enterovirus-D68 Is Now Coast to Coast

September 19, 2014

Updated September 22, 2014 — Editor's note: The story has been revised so that it no longer suggests that the EV-D68 and Ebola outbreaks are comparable in terms of severity, which was never our intention.

The once-rare type of enterovirus that has landed hundreds if not thousands of children in the hospital with acute respiratory problems has spread coast to coast to 22 states, up from 6 just a week ago, according to the Centers for Disease Control and Prevention (CDC).

For all its explosive growth, enterovirus-D68 (EV-D68) has not resulted in any deaths. That is one positive. Another positive, according to 2 infectious disease experts, is that the nation's public health infrastructure has been able to handle the outbreak.

"It's fairly assuring when you know there are enough resources, skill, and expertise to respond rapidly to the emergence of a new epidemic," said Daniel Johnson, MD, a pediatric infectious disease specialist at the University of Chicago Medicine Comer Children's Hospital in Illinois, one of the first hospitals to treat a wave of children infected with EV-D68.

First identified in 1962, EV-D68 differs from other enteroviruses in that patients do not necessarily present with a tell-tale fever.

It was just 11 days ago that the CDC announced that it had confirmed 30 cases of EV-D68 at Children's Mercy Hospital in Kansas City, Missouri, and Comer Children's Hospital. Most of the children had a history of asthma or wheezing, and most were treated in the intensive care unit, some with mechanical ventilation and continuous positive airway pressure, according to the agency.

By September 12, the case count had risen to 97 confirmed cases in Colorado, Illinois, Iowa, Kansas, Kentucky, and Missouri. Today, the CDC's running total reached 160 cases in 22 states. The additional 16 states are Alabama, California, Connecticut, Georgia, Indiana, Louisiana, Michigan, Minnesota, Montana, Nebraska, New Jersey, New York, Oklahoma, Pennsylvania, Virginia, and Washington.

The number of confirmed cases belies the true extent of the outbreak.

Most children coming down with the virus probably aren't being tested, according to the CDC. In the first sample of patients tested at the hospitals in Kansas City and Chicago, 83% had EV-D68. Some hospitals, such as Children's Mercy in Kansas City, have been deluged with hundreds of children with respiratory illness.

"I'm sure there are probably thousands of cases at this point," said Mark Schleiss, MD, director of pediatric infectious diseases at the University of Minnesota Medical School.

"The System Worked Well"

The EV-D68 outbreak is still going strong at Comer Children’s Hospital in Chicago, said Dr. Johnson, also an associate professor of infectious diseases at the University of Chicago Pritzker School of Medicine.

"Our emergency room continues to see an increasing number of patients," he said. The crush has gotten to the point that the emergency department (ED) went on bypass — flagging ambulances on to other hospitals — three times in the past 2 weeks. "We haven't had to go on bypass for 10 years," Dr. Johnson said. ED clinicians are working overtime, one example of how the virus is taxing the resources of the hospital.

Lacking any antiviral to treat EV-D68, clinicians are giving patients supportive care that includes bronchodilators and oral or intravenous steroids, according to Dr. Johnson. One child with a very severe infection remains on a heart-lung bypass machine.

The ability of the CDC and other public health agencies to track the spread of the virus and keep clinicians posted "improves our ability to deal with this epidemic," said Dr. Johnson.

Dr. Schleiss echoed his comments.

"The public health response to the outbreak is generally pretty good," Dr. Schleiss said. "The system worked well."

"It's an excellent example of why the continued investment in public resources at both the state and federal level is absolutely essential. When outbreaks like this come along, it's hugely important to have the ability to make these kinds of responses."

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