The EV-D68 virus which first gained national attention when it caused outbreaks in Kansas City & Chicago a month ago has been mainly associated with children and adolescents, although there have been anecdotal reports suggesting adults were falling ill as well (see comment section of this blog).
Children, who appear to be the most severely affected, are also the most likely to be hospitalized and tested, and so some bias in the demographics is to be expected.
The full spectrum of illness produced by EV-D68 still isn’t completely understood, but most cases appear to produce mild to moderate `flu-like’ symptoms – although fever isn’t always reported. That said, there are plenty of other respiratory viruses circulating right now (Rhinoviruses, adenoviruses, etc.), and so you can’t necessarily assume your early season `cold’ is EV-68.
Although it has been expected to occur, today the state of Rhode Island has announced their first positive EV-D68 lab test in an adult patient who was hospitalized, but has now been released. A hat tip to Pathfinder on FluTrackers for the link to the following press release, after which I’ll have a bit more.
The Rhode Island Department of Health today received confirmation from the Centers for Disease Control and Prevention (CDC) of a confirmed case of enterovirus D68 infection (EV-D68) involving an adult. The adult, who was recently hospitalized, has since improved and been discharged.
This confirmed case of EV-D68 was part of a batch of specimens sent to the CDC on September 15. There have been no deaths in Rhode Island or in the United States associated with EV-D68. The Rhode Island Department of Health announced last week that EV-D68 was most likely already in Rhode Island and issued the following precautions:
The Rhode Island Department of Health (HEALTH) advises all parents and healthcare providers to be aware of symptoms of respiratory illness caused by Enterovirus D68 (EV-D68) and to promote good hand hygiene to protect against EV-D68, as well as other seasonal illnesses such as influenza (flu).
Mild symptoms may include fever, runny nose, sneezing, cough, and body and muscle aches. Patients who are very ill with EV-D68 have difficulty breathing, and may or may not have fever or wheezing. Many children with severe illness have had asthma or wheezing in the past. Parents whose children are sick with a cold and have difficulty breathing, or see symptoms getting worse, should contact their healthcare provider right away. Parents with children who have asthma should have a care plan in place with their healthcare provider to follow in the event of any illness.
The latest update from the CDC now lists 30 states with confirmed infections, although it is now likely found in just about every state of the nation.
From mid-August to September 23, 2014, a total of 213 people from 30 states were confirmed to have respiratory illness caused by EV-D68. The 30 states are Alabama, Arkansas, California, Colorado, Connecticut, District of Columbia, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Montana, Nebraska, New Jersey, New York, North Carolina, North Dakota, Oklahoma, Pennsylvania, Virginia, Utah, Washington, and West Virginia. The cases of EV-D68 infection were confirmed by the CDC or state public health laboratories that notified CDC. So far, all the cases have been among children, except for one adult.
In the upcoming weeks, more states will have confirmed cases of EV-D68 infection.
- The primary reason for increases in cases is that several states are investigating clusters of people with severe respiratory illness, and specimens are still being tested for EV-D68. It can take a while to test specimens and obtain lab results. That’s because the testing is complex and slower, and can only be done by CDC and a small number of state public health laboratories. As the backlog of specimens is processed, the number of states and confirmed cases will likely increase. These increases will not necessarily reflect changes in real time, or mean that the situation is getting worse.
- Some of the increase will be from new EV-D68 infections since people are more likely to get infected with enteroviruses in the summer and fall. We are currently in the middle of the enterovirus season.
As investigations progress, we will have a better understanding of the trends for EV-D68 infections