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Enterovirus-D68 in Orlando

In August of 2014, hospitals in Kansas City and Chicago reported an increase in the number of children hospitalized with severe respiratory symptoms to the CDC (Center for Disease Control). Testing performed by the CDC confirmed that 19 of the 22 Kansas patients and 11 of the 14 Chicago patients had enterovirus-D68. Enterovirus-D68 (EV-D68) is not a new infection as it was first isolated in 1962. However, known infections with enterovirus-D68 are rare. The last known EV-D68 infections in the United States occurred in 2010.

EV-D68 can cause mild respiratory symptoms (cough and runny nose), wheezing, rash, fever and even neurologic symptoms. Unfortunately, some patients (especially those with asthma) can quickly progress to respiratory distress. In the Kansas City cases, additional healthcare workers were called in to help in the over burdened pediatric intensive care unit.

EV-68 is spread direct contact with infected persons, contact with contaminated surfaces and contact with contaminated feces. There is no specific treatment for patients with EV-D68. Treatment is supportive (meaning treating the symptoms by providing fever reducers, breathing treatments, or even oxygen).

To date Colorado, Illinois, Iowa, Ohio, Kansas, Missouri and Oklahoma have reported the highest number of cases. Currently, their are “no reported” cases in Florida. “No reported” cases does not mean “no cases”. Unfortunately testing for enterovirus-D68 is difficult and must be sent to one of the few places that can do the testing. While our local hospitals are able to test for enteroviruses, none of the hospitals in Orlando are able to test specifically for enterovirus-D68.

This lack of available testing means that we are likely missing cases - especially mild cases. Up to now, all EV-D68 testing has been limited to severely sick children. In all likelihood enterovirus-D68 causes a spectrum of illness with most patients mildly ill and few severely sick. We will certainly learn more about EV-D68 once extensive testing is done on children with “mild” upper respiratory symptoms. While it is not time to panic, I expect we will have a confirmed case of EV-D68 in Florida before the end of the month.

What to do:

- Children with asthma should continue their preventative medications and get a flu vaccine.

- Parents should continue to encourage good hygiene and hand washing.

- Sick children (those with fever or significant coughs) should not go to daycare or school until well.

- Any person experiencing worse than usual respiratory symptoms should seek medical care.

 

Enterovirus-D68 Update 9/20/14

1.) Definitive testing (sent to the CDC) for EV-D68 takes at least 2 weeks. I hear that a few patients in Orlando area hospitals have been tested, but no results are back yet.
2.) 70% of children hospitalized with EV-D68 have asthma.
3.) Alcohol-based hand sanitizers do not kill enterviruses.
4.) To date, no deaths have been caused by EV-D68.
5.) To date, cases of EV-D68 have been found in 22 states.

Update 10/16/14

1.) The CDC announced a new “faster” enterovirus D68 test yesterday. The test which previously took “weeks” should only take “days”.
2.) Over 600 cases nationally (the number is expected to increased quickly secondary to having a quicker test)
3.) One known Florida case. (Polk County)
4.) The AAP report 5 children have died this year from EV D68
5.) Several cases in Colorado are still being investigated regarding limb weakness/paralysis.

 

Written September 2014 by
Gregory Gordon MD, Orlando Pediatrician

 


Source: CDC report “Severe Respiratory Illness Associated with Enterovirus D68 — Missouri and Illinois, 2014” September 8, 2014 / 63(Early Release);1-2.

 

 

 

 

 

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