Expected bump in enterovirus cases not a cause for alarm, CDC says

Oct. 22, 2014—Health officials at the Centers for Disease Control and Prevention (CDC) have developed a new, faster lab test for diagnosing enterovirus D68 (EV-D68), a respiratory illness that has sickened children since August and has now spread throughout the country.

Spread of the virus

As of mid-October, CDC had tested more than 1,100 specimens sent in by hospitals that treated people suspected of having the virus. The agency prioritized testing of those with severe symptoms but said there are likely many more people with milder forms of the illness.

Early on, EV-D68 seemed to be concentrated in the Midwest. But now, CDC and state health agencies have confirmed more than 922 cases in 46 states and the District of Columbia. Most of these occurred among children.

What better testing means

With the old test, it took several weeks to get results. But the new test can confirm a diagnosis in just days. It has greatly sped up testing of the roughly 1,000 specimens that were still awaiting CDC evaluation as of last week. Previously they averaged 40 per day; with the new test, it’s 180. CDC has now tested over 1,400 specimens total.

Test results don’t help determine treatment plans for specific patients—such as the use of oxygen as a form of supportive therapy. Instead, they’re intended to help health officials track cases of the virus and target their response.

Because of the accelerated testing, it may appear that there has been a sudden increase in new infections. That is not the case. CDC expects that, as with other enteroviruses, EV-D68 infections will likely begin to decline by late fall.

In fact, informal reports from some hospitals and states suggest the infections may already be decreasing.

The take-home message
The United States is currently experiencing a nationwide outbreak of EV-D68. It’s one of several enteroviruses and rhinoviruses that cause respiratory symptoms in millions of American kids each year. Although EV-D68 is not new, it has been diagnosed more frequently this year than in years past and has been most severe in children with asthma.

Infants, children and teenagers are at greater risk for getting the virus because they may not have been exposed to it in the past. As a result, they don’t have the immunity that many older people do. This means they’re less able to fight off the disease.

Symptoms of EV-D68 include:

  • Fever
  • Sneezing
  • Runny nose
  • Cough
  • Body and muscle aches

More severe symptoms include wheezing and difficulty breathing.

6 steps to prevent infection

You can help protect your children by encouraging your family to follow some basic prevention tips from CDC:

  1. Wash hands often with soap and water for at least 20 seconds.
  2. Avoid touching the eyes, nose and mouth with unwashed hands.
  3. Avoid close contact—such as kissing, hugging, and sharing cups or eating utensils—with people who are sick.
  4. Cover your coughs and sneezes with a tissue or shirt sleeve, not your hands.
  5. Clean and disinfect frequently touched surfaces, such as toys and doorknobs, especially if someone is sick.
  6. Stay home when you’re sick, and keep sick children out of school.

If your child has asthma

It’s a good time to review a child’s asthma action plan with his or her doctor. Go over all aspects of self-care with your child. It’s important to talk with the child’s teachers or caregivers as well.

Be sure to notify your child’s doctor immediately if he or she seems to develop new or worsening symptoms that do not improve by following the asthma action plan.

Call your child’s doctor if he or she is having trouble breathing or is experiencing worsening symptoms that are hard to control. Hospital care may be needed.


In the news: What you need to know about Enterovirus D68

Enterovirus D68 (EV-D68)

What are enteroviruses?
Enteroviruses are very common viruses that can cause respiratory illness, fever and rash, and neurologic illnesses, such as aseptic meningitis (swelling of the tissue covering the brain and spinal cord) and encephalitis (swelling of the brain); there are more than 100 types of enteroviruses.

Approximately 10 to 15 million enterovirus infections occur in the United States each year. Most people infected with enteroviruses have no symptoms or only mild symptoms, but some infections can be serious. Infants, children, and teenagers are most likely to get infected with enteroviruses and become sick.

Enterovirus D68 (EV-D68) is causing outbreaks of respiratory infection in multiple US states this year. The outbreaks are resulting in significant numbers of children requiring emergency department visits and hospitalizations, primarily for difficulties with breathing and severe asthma. Children with asthma appear to be more susceptible to serious illness from EV-D68.

How does enterovirus spread?
Because EV-D68 has been uncommon in the past, the ways it spreads are not as well- understood as other enteroviruses. EV-D68 causes respiratory illness, and the virus can be found in respiratory secretions such as saliva, nasal mucus, or sputum. The virus likely spreads from person to person when an infected person coughs, sneezes, or a person touches contaminated surfaces.
What are the symptoms of EV-D68?
EV-D68 has been reported to cause mild to severe respiratory illness (runny nose, cough, difficulty breathing) with and without fever. A minority of people may have more serious infections, particularly children with pre-existing asthma. Because EV-D68 has previously been uncommon in the US, we are still learning about the illness and risk factors for infection. As we learn more, information about EV-D68 infection will be updated. Most people with other enterovirus infections have mild illness that does not require medical care or evaluation.
Use the same judgment as usual about when to see (or take a child to see) a health care provider:
Anyone who has difficulty breathing or who appears seriously ill should be evaluated promptly by a healthcare provider. Persons with asthma should be sure their asthma symptoms are under control, and see a health care provider if they develop respiratory symptoms and their asthma worsens. Adults and children with non-severe enterovirus infections do not need to see a health care provider and do not need to be tested.
How is EV-D68 diagnosed and treated?
Many hospitals can test for enteroviruses in hospitalized patients, but they are probably not able to identify EV-D68. Public Health can assist with EV-D68 testing in hospitalized patients after consultation with health care providers. Patients who are not seriously ill do not need to be tested.

There is no specific treatment for EV-D68 infections. Some people with severe respiratory illness caused by EV-D68 may need to be hospitalized and receive intensive supportive therapy. Because children with asthma may be at increased risk for more serious EV-D68 infections, it is a good idea to be sure asthma symptoms are under control.

How can enterovirus infection be prevented?
There is no vaccine for enterovirus infections. To decrease the risk for enterovirus infections:
•    Wash hands often with soap and water for 20 seconds (alcohol hand gel is not as good as hand washing for enteroviruses)
•     Avoid touching eyes, nose and mouth with unwashed hands
•    Avoid contact with ill people
•     Do not go to day care, school or work while ill
•     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
•    Children and adults with asthma should be sure to have their asthma symptoms under control and see a health care provider if they develop a respiratory infection and their asthma worsens