Avian Flu Diary: New York State DOH: Confirms 39 Cases of EV-D68

Credit CDC

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Although it doesn't necessarily explain the recent uptick in Acute Flaccid Paralysis cases around the country (see More AFM Reports & Recent Studies On AFM) enterovirus D-68 is one of several non-polio enteroviruses (NPEVs) that have been linked to neurological complications, including AFM.

Acute flaccid myelitis (AFM) is a rare illness that affects a person’s nervous system - specifically the spinal cord - and can produce a polio-like paralysis. AFM may be due to a variety of causes, including infection by a number of different viruses, but often the cause is never identified.

Today, the New York State Department of Health has announced their detection of 39 cases of EV-D68 infection. They have not, however, confirmed any cases of Acute Flaccid Paralysis.

In 2014 we saw a nationwide outbreak of EV-68, which has been tentatively linked to a concurrent increase in AFM cases (see Eurosurveillance Review: Association Between Acute Flaccid Myelitis (AFM) & Enterovirus D68 (EV-D68)).

Since 2015, there have been scattered reports of EV-D68 around the country, but no large outbreaks. An increase in AFM was reported in the fall of 2016, but no similar increase in EV-D68 was reported.

While most EV-D68 infections are mild, for some children, it can become a serious respiratory illness. Very rarely, neurological complications can also occur.

NPEVs are very communicable, and so following the prevention advice offered by the CDC and this statement is key.

NYS Department of Health Confirms Cases of Serious Respiratory Virus

Reminds Parents to be Extra Vigilant in Preventing the Spread of the Virus EV-D68; Common Viral Symptoms are Not Life Threatening

ALBANY, NY (October 12, 2018) – The New York State Department of Health is advising parents/guardians, other caregivers and health care providers to be aware of the signs and symptoms of enterovirus EV-D68, which has now been confirmed in 39 children in New York State. The Department's Wadsworth Laboratory is the only laboratory in the state that can confirm EV-D68. Results are being shared with the Centers for Disease Control and Prevention (CDC) to assist in monitoring the circulation of the virus nationally.

EV-D68 can cause mild to severe respiratory illness, or no symptoms at all. EV-D68 infection most commonly results in mild symptoms such as runny nose, sneezing, cough, body aches and muscle aches. Severe symptoms, while less common, may include wheezing and difficulty breathing. In some rare instances, the virus can cause acute flaccid myelitis (AFM), a serious condition that causes weakness in the arms or legs. However, there are other causes of AFM besides EV-D68 and severe respiratory illness is a greater concern with this virus. NYSDOH reports suspect cases of AFM due to EV-D68 to CDC for further investigation, and no cases have been confirmed in New York State in 2018 thus far.

In general, infants, children and teenagers are most likely to get infected with EV-D68 and become ill because they do not yet have immunity from previous exposures to enteroviruses. Children with asthma may have a higher risk for severe respiratory illness caused by EV-D68 infection. Adults can get infected with enteroviruses, but they are more likely to have no symptoms or mild symptoms.

"All parents must take simple steps to protect their children, especially those who are immune-compromised or have respiratory problems, to avoid becoming infected," said New York State Health Commissioner Dr. Howard Zucker. "We will continue to work with our partners at the CDC and local health departments tomake surethat all New York families have the information they need to prevent their children and others from getting the virus."

Small numbers of EV-D68 have been reported regularly in the U.S. since 1987. Individuals are more likely to get infected with enteroviruses in the summer and fall. Because a mix of enteroviruses circulates every year, different types of enteroviruses can be common in different years.

In summer and fall 2014, New York and other states witnessed an outbreak of EV-D68 associated with severe respiratory illness. From mid-August 2014 to January 15, 2015, the CDC or state public health laboratories confirmed a total of 1,153 people in 49 states and the District of Columbia with respiratory illness caused by EV-D68. Almost all of the confirmed cases were among children, many of whom had asthma or a history of wheezing. Additionally, there were likely many thousands of mild EV-D68 infections for which people did not seek medical treatment and/or get tested. This was the first documented nationwide outbreak of EV-D68.

Recent cases in NYS have been confirmed among individuals who reside in Western and Central New York, the Capital Region and Long Island, and specimens have been received from other regions for specialized testing at Wadsworth.

Enteroviruses are transmitted through close contact with an infected person, or by touching objects or surfaces contaminated with the virus and then touching the mouth, nose or eyes. There is no specific treatment for EV-D68 infections other than management of symptoms, and no specific anti-viral medications are currently available for this purpose. It is important to take steps to protect yourself and others from all respiratory infections, including:

Wash your hands often with soap and water for 20 seconds.

Avoid touching your eyes, nose and mouth with unwashed hands.

Avoid kissing, hugging and sharing cups or eating utensils with people who are sick.

Disinfect frequently touched surfaces, such as toys and doorknobs, especially if someone is sick.

Use the same precautions you would use to prevent the spread of influenza.

These prevention steps are especially important for individuals or persons with family members who are infants, or who have chronic health conditions or compromised immune systems.

DOH will continue to work closely with the CDC, local health departments and health care providers to monitor the circulation of the virus in the State and across the U.S. Additionally, DOH has issued a health advisory with information and guidance regarding EV-D68 to health care providers across the state.

While EV-D68 is a credible suspect for causing this nationwide recent uptick in AFM, Colorado has reported an uptick in a different NPEV; EV-A71 (see MMWR Notes from the Field: Enterovirus A71 Neurologic Disease in Children — Colorado, 2018.