Following confirmed clusters of enterovirus D68 in Kansas City and Chicago, the Centers for Disease Control and Prevention is encouraging healthcare providers to consider enterovirus D68 as a possible cause of acute, unexplained severe respiratory illness and to report suspected clusters or outbreaks to local or state health departments. The agency is currently investigating suspected outbreaks in several states.
A report release Sept. 8 on the Morbidity and Mortality Weekly Report website, said in August the CDC was alerted by Children’s Mercy Hospital in Kansas City, Mo., 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 ICU, and by the University of Chicago Medicine Comer Children’s Hospital in Illinois of an increase in patients with similar symptoms. 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, the report stated. Investigations into suspected clusters in other jurisdictions are ongoing.
There have been no confirmed fatalities attributed to the virus. There are no available vaccines or specific treatments for EV-D68, and clinical care is supportive.
Of the 19 patients from Kansas City, 13 patients (68%) had a previous history of asthma or wheezing, and six patients (32%) had no underlying respiratory illness. All patients had difficulty breathing and hypoxemia and four (21%) also had wheezing. All patients were admitted to the pediatric ICU, and four required bilevel positive airway pressure ventilation.
Of the 11 patients from Chicago, eight patients (73%) had a previous history of asthma or wheezing. Ten patients were admitted to the pediatric ICU for respiratory distress, two required mechanical ventilation (one of whom also received extracorporeal membrane oxygenation), and two required bilevel positive airway pressure ventilation.
The patients at the two hospitals ranged in age from 6 weeks to 16 years old.
Enteroviruses are associated with various clinical symptoms, including mild respiratory illness, febrile rash illness, and neurologic illness, such as aseptic meningitis and encephalitis, according to the report. EV-D68, however, primarily causes respiratory illness, although the full spectrum of the disease remains unclear, according to the report. EV-D68 is identified using molecular techniques at a limited number of laboratories in the United States.
See the full report: http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6336a4.htm?s_cid=mm6336a4_w