43 states and the District of Columbia
It has been just over a month since the first reports of a rarely seen enterovirus (EV-D68) outbreak began to emerge from Missouri and Chicago (see Kansas City Outbreak Identified As HEV 68 & Enterovirus D-68 (HEV-D68) Update), and in that time the virus has managed to pretty much blanket the country.
The few states not reporting the virus likely have it – but testing is currently backlogged.
Although adults are susceptible, it is mostly kids who are falling ill. Most of them only endure a `bad cold’, but for a small percentage, this viral infection has produced serious respiratory infections requiring hospitalization. This week the CDC announced they were investigating four deaths associated with (but not necessarily due to) EV-D68 infection.
Another concern – which we see with many enteroviruses – is that they are sometimes linked to neurological illnesses, including limb weakness or AFP (Acute Flaccid Paralysis). Last winter, a small clustering of neurological illness was tentatively linked to EV-D68 (see Acute Flaccid Paralysis Cases In California), and a week ago, similar reports began to emerge from Colorado.
While these neurological cases have emerged coincident with the EV-D68 outbreak, a causal link to this enterovirus has not yet been established.
Last Friday we saw a CDC HAN: Acute Neurologic Illness with Focal Limb Weakness of Unknown Etiology in Children released and later today (2pm EDT) the CDC will hold a COCA call on Neurologic Illness with Limb Weakness in Children.
Here then is the latest update (posted yesterday) from the CDC’s EV-D68 website:
What We Know
From mid-August to October 2, 2014, a total of 514 people in 43 states and the District of Columbia have been confirmed to have respiratory illness caused by EV-D68. Learn more about states with confirmed cases.
- EV-D68 infections have recently been documented across the United States.
- From mid-August to October 2, 2014, CDC or state public health laboratories have confirmed a total of 514 people in 43 states and the District of Columbia with respiratory illness caused by EV-D68. Learn about states with confirmed cases. This indicates that at least one case has been detected in each state listed but does not indicate how widespread infections are in each state.
- Enteroviruses commonly circulate in summer and fall. We’re currently in middle of the enterovirus season, and EV-D68 infections are likely to decline later in the fall.
- Many state health departments have reported increases this year in cases of severe respiratory illness in children.
- This increase could be caused by many different viruses that are common during this time of year. EV-D68 appears to be the predominant type of enterovirus this year and may be contributing to the increases in severe respiratory illnesses.
- Hospitals in Missouri and Illinois were the first to document this increase that was later identified to be caused predominantly by EV-D68 infection. Read more.
- CDC is prioritizing testing of specimens from children with severe respiratory illness. There are likely many children affected with milder forms of illness. Of the specimens tested by the CDC lab, about half have tested positive for EV-D68. About one third have tested positive for an enterovirus or rhinovirus other than EV-D68. See map of states with lab-confirmed EV-D68 infections for more information.
- Almost all the confirmed cases this year of EV-D68 infection have been among children. Many of the children had asthma or a history of wheezing.
- EV-D68 has been detected in specimens from four* patients who died and had samples submitted for testing. The role that EV-D68 infection played in these deaths is unclear at this time; state and local health departments are continuing to investigate.
*Investigations are ongoing; CDC will review and update available data every Wednesday.
There are other respiratory viruses circulating this time of year, and so simply having a `cold’ – even a bad one – doesn’t mean you necessarily have EV-D68.
We are also starting to see some early reports of influenza, making now the time to start taking extra steps to observe good `flu hygiene’; wash your hands often, cover coughs and sneezes, avoid touching your face with unwashed hands, and stay home if you are sick.