Enterovirus D68 outbreak in pediatric patients across 12 states

Submitted by Connie Cutler, MLH Director, Infection Prevention and Control; Mark Ingerman, MD, MLH Chair, Infectious Diseases; and Steven Gamburg, MD, MLH Chair Emergency Medicine

As of September 11, 2014, there is an outbreak of Enterovirus D68 in pediatric patients in twelve states (Colorado, Kansas, Oklahoma, Iowa, Missouri, Illinois, Ohio, Kentucky, North Carolina, Georgia, Alabama, and Utah). This is unusual and has not been seen previously. The signs and symptoms in pediatric patients include fever, runny nose, sneezing, cough, skin rash, mouth blisters, and body/muscle aches, which may progress to severe respiratory distress in those with underlying respiratory conditions such as asthma leading to hospitalization and need for intensive supportive therapy. There is no preventive vaccine or specific antiviral treatment. The diagnostic test is a nasopharyngeal aspirate as part of a Viral Respiratory Panel. In addition, an Enterovirus PCR test can be ordered. At this time, these tests will be referred to a reference laboratory; however, in the near future, viral respiratory testing will be available through MLHL.

Infection Prevention includes placing the patient in Droplet and Contact Precautions and the use of hand hygiene.

The health department issued the following information:

On August 19, 2014, CDC was notified by Children’s Mercy Hospital in Kansas City, Missouri, of an increase (relative to the same period in previous years) in patients examined and hospitalized with severe respiratory illness, including some admitted to the pediatric intensive care unit. An increase also was noted in detections of rhinovirus/enterovirus by a multiplex polymerase chain reaction assay in nasopharyngeal specimens obtained during August 5–19. On August 23, CDC was notified by the University of Chicago Medicine Comer Children’s Hospital in Illinois of an increase in patients similar to those seen in Kansas City. To further characterize these two geographically distinct observations, nasopharyngeal specimens from most of the patients with recent onset of severe symptoms from both facilities were sequenced by the CDC Picornavirus Laboratory. Enterovirus D68 (EV-D68) was identified in 19 of 22 specimens from Kansas City and in 11 of 14 specimens from Chicago. Since these initial reports, admissions for severe respiratory illness have continued at both facilities at rates higher than expected for this time of year. Investigations into suspected clusters in other jurisdictions are ongoing.

More information can be found by visiting this CDC page: http://www.cdc.gov/non-polio-enterovirus/about/EV-D68.html.

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