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CDC Warns of Severe Respiratory Illness Associated With Enterovirus D68

Children affected in Missouri and Illinois

According to a recent announcement, the Centers for Disease Control and Prevention (CDC) is working closely with hospitals and local and state health departments to investigate recent increases in hospitalizations of patients with severe respiratory illness.

Enterovirus D68 (EV-D68) has been detected in specimens from children with severe illness in Missouri and Illinois. Investigations into suspected clusters in other jurisdictions are ongoing.

Enteroviruses are associated with various clinical symptoms ranging from mild to severe. EV-D68 causes primarily respiratory illness, although the full spectrum of disease remains unclear. EV-D68 was originally isolated in 1962 and, since then, has been reported rarely in the U.S. Small clusters of EV-D68 associated with respiratory illness were reported in the U.S. during 2009–2010. There are no available vaccines or specific treatments for EV-D68, and clinical care is supportive.

In August 2014, a children’s hospital in Kansas City, Missouri, and another one in Chicago, Illinois, notified the CDC of increases in pediatric patients examined and hospitalized with severe respiratory illness, including some admitted to pediatric intensive care units. Both hospitals also reported recent increases in the detection of rhinovirus/enterovirus in initial screenings with a respiratory virus panel. EV-D68 was identified in 19 of 22 specimens from Kansas City and in 11 of 14 specimens from Chicago. The CDC has been notified by various states of similar clusters of respiratory illness, although confirmation of EV-D68 in these potential clusters is still under way.

Of the severely ill patients who were confirmed to be positive for EV-D68 at both hospitals, all presented with difficulty breathing and with hypoxemia, and some with wheezing. Notably, most patients were afebrile at presentation and throughout the hospital course. Approximately two-thirds of the cases had a previous medical history of asthma or wheezing, but both hospitals reported some patients with no known underlying respiratory illness.

The patients’ ages ranged from 6 weeks through 16 years, with median ages of 4 and 5 years in Kansas City and Chicago, respectively. Most patients were admitted to the pediatric intensive care unit.

CDC recommendations for clinical care include:

  • Health care providers should consider EV-D68 as a possible cause of acute, unexplained severe respiratory illness, even in the absence of fever.
  • Although the findings to date have been in children, EV-D68 may also affect adults.

CDC recommendations for laboratory testing include:

  • Providers should consider laboratory testing of respiratory specimens for enteroviruses when the cause of respiratory infections in severely ill patients is unclear.
  • Confirmation of the presence of EV-D68 requires typing by molecular sequencing.
  • Providers may contact state or local health departments for further enterovirus typing. The CDC is available for consultation.

CDC recommendations for infection control include:

  • Routes of transmission for EV-D68 are not fully understood.
  • Infection control guidelines for hospitalized patients with EV-D68 infection should include standard precautions, or contact precautions in certain situations, as is recommended for all enteroviruses.
  • Because EV-D68 causes clusters of respiratory illness, similar to rhinoviruses, droplet precautions also should be considered as an interim recommendation until more definitive information is available on appropriate infection control.
  • Because EV-D68 is a non-enveloped virus, environmental disinfection of surfaces in health care settings should be performed using a hospital-grade disinfectant with an EPA label claim for any of several non-enveloped viruses (e.g., norovirus, poliovirus, or rhinovirus).

Source: CDC; September 12, 2014.

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