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November 2014
Patient Care and Science
EIN Update: Tracking the Enterovirus D68 Outbreak

The Emerging Infections Network (EIN) is a forum for infectious diseases consultants and public health officials to report information on clinical phenomena and epidemiological issues with public health significance. Any diagnostic or therapeutic recommendations and all opinions presented are those of the individual contributor. They do not necessarily represent the views of EIN, IDSA (EIN’s sponsor), or the Centers for Disease Control and Prevention (CDC), which funds EIN. The reader assumes all risks in using this information.

EIN members recently highlighted the network’s utility as an early warning system when several contributors noted an unusual increase in severe respiratory infections in children in August.

“We are seeing a lot of children with severe respiratory illness that for some has resulted in ICU admissions,” likely due to a rhinovirus/enterovirus, a member in Missouri wrote in an initial post. “In some children this has exacerbated their asthma, and in others it has appeared to cause an asthma-like illness with many requiring continuous albuterol.”

While some respondents noted no unusual activity in their communities at the time, members in Georgia, Illinois, Indiana, and Iowa, responded with similar reports of increased cases:

“We are also seeing this same phenomenon in our ICU,” the Illinois respondent wrote. “Many children with no (or very remote) history of wheezing at all are ending up intubated—one child is on extracorporeal membrane oxygenation (ECMO)—with severe asthma-like respiratory failure.”

A subsequent article published in the Sept. 12 Morbidity and Mortality Weekly Report (MMWR) described two clusters of enterovirus D68 (EV-D68) infections in Kansas City, Mo., and Chicago, and noted that investigations into other suspected clusters were ongoing. As of Oct. 27, the Centers for Disease Control and Prevention (CDC) reported that it or state public health laboratories had confirmed 1,035 people in 47 states and the District of Columbia with respiratory illness caused by EV-D68. (Additional EV-D68 resources for health professionals on clinical evaluation, reporting, treatment, laboratory testing, diagnostic methods, and infection control recommendations are available on the CDC website.)

In early October, following several reported cases of muscle weakness or paralysis in children following respiratory illnesses with EV-D68, an EIN member on the West Coast shared a perspective on the possibility of similar cases in adults.

“In California, we have been following what we think are very similar cases for approximately two years,” the member wrote. “While the majority of our cases are in the pediatric population, we are also seeing cases in the adult age group (approximately 25 percent of our cases are in adult patients). Adult ID clinicians should consider this in the differential if they are consulted about a patient with unexplained neurologic illness especially if there are spinal cord lesions.”

The California member cited two Oct. 10 MMWR articles as important sources of information for providers:

“If you do see an adult patient with a similar syndrome,” the member noted, “it’s important to test cerebrospinal fluid for enterovirus, but even more important to test for enterovirus in respiratory tract specimens. We have been requesting both nasopharyngeal and throat specimens.”

Email the Emerging Infections Network

The Emerging Infections Network (EIN) is a provider-based sentinel network designed to help the public health community detect trends in emerging infectious diseases.

A joint project of IDSA and the Pediatric Infectious Diseases Society (PIDS) with funding from the Centers for Disease Control and Prevention (CDC), EIN tracks emerging infectious diseases and keeps the public health community up to date with new disease trends, difficult cases, and other issues affecting members’ clinical practices. The Network provides a great opportunity for members to share knowledge quickly across large geographical distances. Both IDSA and PIDS members are eligible to join. Click here for more information or to join EIN.




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