This article is more than 5 years old. Information may no longer be current.
Enterovirus D68 identified in Midwest respiratory illness outbreak
Click Here to Manage Email Alerts
Clusters of severe respiratory illness that developed among children in Kansas City, Mo., and Chicago are associated with enterovirus D68, according to a CDC telebriefing earlier today.
An increase in ED admissions and hospitalizations for severe respiratory illness among children was reported to the CDC by hospital officials in Kansas City, Mo., and Chicago in August.
Specimens initially tested positive for rhinovirus and enterovirus, according to Anne Schuchat, MD, director of the CDC’s National Center for Immunization and Respiratory Diseases.
Anne Schuchat
Further testing indicated enterovirus 68 (EV-D68) in 19 of 22 specimens from Kansas City and in 11 of 14 specimens from Chicago. Patients are aged 6 weeks to 16 years. More than half of the patients have a history of asthma or wheezing.
Twelve additional states have reported clusters of severe respiratory illness. Investigations and laboratory testing are still underway, although several dozen cases have been identified as EV-D68, according to Schuchat. But not all illnesses within these clusters are caused by this specific strain.
EV-D68 is not a new strain but is fairly uncommon. “We don’t know as much about it as we do about some other common enteroviruses,” Schuchat said during the telebriefing.
“The situation is evolving quickly,” she said. “CDC and our colleagues are gathering information to better understand EV-D68 and the illness caused by this virus, how widespread EV-D68 may be, and which populations are most affected, and whether other states are experiencing severe respiratory illness, perhaps due to this virus.”
Although there is limited information on EV-D68, CDC officials said they believe that the virus is transmitted similar to other enteroviruses — through respiratory secretions such as saliva and mucus. It is likely the virus spreads from person to person via coughing, sneezing, and touching shared surfaces, according to Schuchat.
There is no specific treatment for EV-D68, but Schuchat said influenza vaccination should be encouraged because preventing respiratory infection is important to protect from other infections that may be spreading.
“It is important to follow the usual common sense steps: washing your hands often with soap and water for 20 seconds, disinfecting frequently touched surfaces like toys or doorknobs, especially if someone in the home is ill,” she said during the telebriefing.
Parents should seek medical attention if their child is having difficulty breathing.
“We want health care professionals to be aware that these clusters are occurring; and to be aware that EV-D68 may be a potential cause of clusters of severe respiratory illness, particularly affecting young children. We would like health care professionals to consider laboratory testing of respiratory specimens for enteroviruses when the cause of infection of severely ill patients is unclear,” Schuchat said.
Perspective
Back to Top
Samir S. Shah, MD, MSCE
Enteroviruses, members of the picornavirus family, are divided into four species, A through D, based on RNA sequence relatedness. Enterovirus D68 is not new. It was first described in the 1960s and small clusters of illness attributable to this virus were reported as recently as 2010. Many other cities across the US have reported clusters of illness similar to those in Kansas City and Chicago.
Enteroviruses are spread from person-to-person by either the respiratory or enteric route by specimens such as mucous and saliva. The clinical manifestations vary widely, though most patients in the current outbreak have presented with respiratory symptoms. The full spectrum of illness caused by enterovirus D68 remains to be determined, however, because testing is currently limited to those with respiratory symptoms or severe illness. It is likely that most patients with enterovirus D68 have few or no symptoms. As with any virus that affects the lungs, we expect that children with asthma and those exposed to tobacco smoke will experience more severe symptoms.
So, what should parents and physicians do? If you’re a parent, there is no need to panic. If your child has no symptoms, as always, it is prudent to practice good hand hygiene, which reduces the likelihood of virus acquisition. If your child does not have any symptoms, do not cancel routine well visits or influenza vaccination visits. However, unnecessary visits to the office or emergency department pose a risk as your child is exposed to many others with respiratory illness in these settings.
Unfortunately, antibiotics don’t affect this illness. At the moment, the only available treatment is what physicians call supportive care; this term refers to treatments such as additional oxygen for those with difficulty breathing. If your child has a respiratory illness, you should seek medical care if you are concerned that your child’s illness is severe, if your child has trouble breathing or is breathing faster than normal, or if he or she is not eating or drinking well and you are concerned about significant dehydration.
Click Here to Manage Email Alerts