Thursday, October 16, 2014

CDC Update On Weekly EV-D68 Activity

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With the faster EV-D68 test now available (see CDC Announces A Faster EV-D68 Lab Test) the CDC is beginning to catch up on the backlog of submitted respiratory samples, and is beginning to get a rough handle on the level of EV-D68 activity around the country. 

 

EV-D68 is not a `notifiable’ disease, and only a small fraction of patients can be tested (even with this faster rt-PRC test), so the following information is based on fairly spotty information.

 

Thus far the CDC has identified 780 people in 46 states and the District of Columbia with respiratory illness caused by EV-D6, but the actual number of cases probably several orders of magnitude higher.  While most people who contract this enterovirus only experience mild to moderate `flu-like’ symptoms, the CDC does report:

 

EV-D68 has been detected in specimens from seven* patients who died and had samples submitted for testing. CDC is reporting test results to state health departments as we obtain them.

 

Additionally, the CDC is investigation several clusters of unexplained partial limb weakness or paralysis that have been reported over roughly the same time period as this outbreak, and which may be be due (in part) to the EV-D68 virus.  A causal link has not yet been established, but the latest update from Investigation of Acute Neurologic Illness with Focal Limb Weakness of Unknown Etiology in Children, Fall 2014 reads:

 

As of October 15, CDC has verified reports of 37 cases in 16 states that meet our case definition below. We are working with healthcare professionals and state and local officials to investigate all of these cases.

We are also in the process of verifying more than a dozen additional reports. These investigations take time and are in the early stages. Therefore, the number of cases will likely increase further as we update these numbers weekly on Thursday starting next week, but the increase will not necessarily reflect changes in occurrence of cases in real time.

 

The CDC has posted the following update showing the trends for EV-D68 cases across the country over the past week.

 

Activity of Enterovirus D68-like Illness in States

For the week of October 5-11, 2014, 44 states and the District of Columbia have submitted assessments to CDC of activity of EV-D68-like illness.

  • 32 states and the District of Columbia reported low or declining activity
  • 12 states reporting increasing or elevated activity

Activity of enterovirus-D68-like infections in reporting states is described as: decreased in Alabama, low and similar for Alaska, low and similar for Arkansas, low and similar for Arizona, elevated for California, decreased for Colorado, decreased for Connecticut, decreased for District of Columbia, low and similar for Florida, decreased for Georgia, low and similar in Hawaii, decreased in Idaho, elevated for Illinois, low and similar for Indiana, low and similar for Kansas, decreased for Kentucky, low and similar for Louisiana, elevated for Maine, elevated for Massachusetts, decreased for Michigan, decreased for Minnesota, low and similar for Missouri, low and similar for Mississippi, low and similar for Nebraska, decreased for New Jersey, elevated for New Hampshire, low and similar for New Mexico, decreased for New York, low and similar for North Carolina, elevated for North Dakota, low and similar for Ohio, low and similar for Oregon, increased for Pennsylvania, low and similar for Rhode Island, increased for South Carolina, low and similar for South Dakota, low and similar for Tennessee, low and similar for Texas, elevated for Utah, increased for Virginia, low and similar for Vermont, elevated for Washington, increased for West Virginia, and decreased for Wisconsin.

Activity of enterovirus-D68-like illness in reporting states  [1 page]

Since this is the first week that we have posted the map, we cannot compare activity of EV-D68-like illness across the United States with previous weeks.

The state assessments are based on data that are currently available, which may include

  • laboratory test results for EV-D68 and other enteroviruses and rhinoviruses,
  • emergency department visits by patients who had respiratory illnesses similar to those caused by EV-D68 infection, and
  • reports from doctors and healthcare facilities.

The state assessments are estimates and take into consideration the following:

  • Enterovirus infections commonly occur in the United States in summer and fall. Right now, enteroviruses and rhinoviruses are likely contributing the most to the increases in respiratory illnesses. This year, the most common type of enterovirus detected has been EV-D68.
  • Many viruses can cause similar respiratory illnesses and can only be identified with laboratory testing. However, many people with respiratory illness who go to the doctor are not tested.
  • Many people with mild respiratory illness may not go to the doctor.
  • By the end of fall, enterovirus infections are expected to decline. At about the same time, respiratory illnesses caused by other viruses, like influenza and respiratory syncytial virus (RSV), will become more common. Therefore, it will be more difficult for states to infer that respiratory illnesses reflected in this map are due to EV-D68. At that time, the map will be removed.

The state health departments submit this information to CDC voluntarily. Updates will be posted every Thursday.

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