Big Jump in Enterovirus-D68 Infections in Multisite Survey

Veronica Hackethal, MD

March 28, 2019

The Centers for Disease Control and Prevention (CDC) has found a substantial jump in enterovirus-D68 (EV-D68) infections in the last 2 years,.

Among children with acute respiratory infection (ARI) tested at seven sites in the CDC's New Vaccine Surveillance Network (NVSN), 0.08% tested positive for EV-D68 in 2017. That percentage jumped to 13.9% in 2018.

"Continued active, prospective surveillance is needed to better understand trends in EV-D68 circulation," write Stephanie Kujawski, PhD, of the CDC in Atlanta, Georgia, and colleagues. The researchers published their findings today in Morbidity and Mortality Weekly Report.

The agency recently started active surveillance of EV-D68 in NVSN centers. Surveillance includes children under age 18 who were seen in the emergency department or hospitalized with ARI between July 1 and October 31, when EV-D68 infections typically peak.

In 2017, just 2 (0.08%) of the 2433 children tested were positive for EV-D68.

In contrast, of 2579 children tested in 2018, 358 (13.9%) were positive for EV-D68. Cases peaked in September with 169 (47.2%) children testing positive that month.

Children who tested positive had a median age of 3 years (range, 1 month–17 years; interquartile range, 1.5–5 years), and 211 (58.9%) were male.

Because EV-D68 testing occurred during a limited time frame (July–October) and in just seven hospitals in the NVSN network, results may underestimate the true number of EV-D68 cases during 2017 and 2018.

Once rarely reported, EV-D68 infections appear to have increased since a recent US outbreak of EV-D68 in 2014. So far, cases have been reported in  California, Colorado, Florida, Illinois, Massachusetts, New York, Pennsylvania, Rhode Island, Texas, Virginia, Washington, and Minnesota.

Infections from EV-D68 can run the gamut, from minimal symptoms to severe respiratory symptoms. EV-D68 has also been linked to a rare but serious neurologic condition called acute flaccid myelitis (AFM), which causes sudden onset paralysis similar to polio. AFM most often affects children ages 2 to 8, and affects boys and girls about equally. Fever and/or respiratory illness of 3 to 10 days duration usually precedes paralysis. At least half of affected children do not fully recover.

The underlying cause of AFM remains unclear. But, at about the same time as the 2014 EV-D68 outbreak, reports of AFM increased. That has raised suspicions that the two may be linked. However, not all cases of AFM test positive for EV-D68, and in Colorado more AFM cases have been linked to a different type of enterovirus (EV-A71) than to EV-D68.

One or more authors reports CDC employee invention report filing, patents for tests for detecting enterovirus D68, and or personal fees from Quidel and GlaxoSmithKline. The other authors have disclosed no relevant financial relationships.

MMWR. Published online March 28, 2019. Full text

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