Consider EV-D68 when treating severe respiratory infections

doi:10.1542/aapnews.20140909-1

As hospitalizations for severe respiratory infections in children climb at some U.S. hospitals, the Centers for Disease Control and Prevention (CDC) has confirmed dozens of cases of human enterovirus D68, or EV-D68.

In August, hospital officials in Kansas City, Mo., and Chicago contacted the CDC after finding higher than usual numbers of admissions due to respiratory infections. The CDC then confirmed 19 of 22 specimens from Kansas City hospital and 11 of 14 specimens from Chicago were found to be EV-D68. The strain was not new, however.

The CDC continues to investigate possible clusters around the country, and testing is ongoing, said Anne Schuchat, M.D., director of the CDC National Center for Immunization and Respiratory Diseases, in a CDC telebriefing held Sept. 8.

Clinicians are urged to be aware of EV-D68 as a possible cause of acute, unexplained severe respiratory illness in children.

There are more than 100 types of enterovirus infections, with 10 to 15 million cases every year. EV-D68, however, is less common. Small clusters of EV-D68 were reported in the United States in 2009-2010.

Children from 6 weeks to 16 years, and with a median age of 5 years, have been most affected by the current outbreak, especially those with a history of asthma or wheezing. Some children have been admitted to intensive care units. At Children’s Mercy Hospital in Kansas City, for example, officials called in extra providers to help care for an unprecedented influx of children needing intensive care.

Health care professionals should consider lab testing when the cause of infection is unclear in severe cases. The CDC recommends that cases be reported to local or state health departments.

EV-D68 can be identified with molecular techniques at a small number of U.S. laboratories. While enterovirus infections, are not reportable, lab detections of enterovirus and parechovirus types are reported voluntarily to the National Enterovirus Surveillance System, managed by the CDC.

The respiratory illness is affecting children in multiple states just as the new school year begins and asthma symptoms peak. Among the states reporting higher than usual outbreaks are Missouri, Colorado, Illinois, Iowa, Ohio, Kansas, and Oklahoma.

The onset of symptoms can be quick. Within hours, typical cold systems have turned into breathing difficulties, sometimes accompanied by wheezing, cough, rash or fever. Some EV-D68 infection can be serious and rarely result in neurologic illness, including meningitis.

Enteroviruses are spread by close contact with infected persons or by touching contaminated objects. According to the Red Book, enterovirus infections also can be spread by fecal-oral routes, so parents should be mindful about swimming pool hygiene.

Parents concerned about wheezing or breathing difficulties in their child should contact their pediatrician or health care professional as soon as possible. Regular precautions regarding hygiene are being advised, including hand washing for at least 20 seconds. Patients also should be reminded to avoid touching eyes, nose and mouth with unwashed hands; to stay home when ill, to disinfect surfaces, especially if someone is sick; and to be sure to receive influenza vaccine. Although children never should be exposed to secondhand smoke, it’s important to prohibit smoking in homes where asthmatics reside.

It’s also critical for children and teens with asthma to ensure that their asthma is well-controlled, said Dr. Schuchat.

For more information, read Severe Respiratory Illness Associated with Enterovirus D68 — Missouri and Illinois, 2014 in Sept. 8 Morbidity and Mortality Report at http://1.usa.gov/1Arit84.

Read the Red Book chapter on enteroviruses at http://bit.ly/1ArtHJM.

For assistance with diagnostic testing, contact CDC’s Picornavirus Laboratory at wnix{at}cdc.gov.