Enterovirus Cases Spread to the Northeast

The respiratory virus that hospitalized hundreds of children in the Midwest and the South has now reached the Northeast.

Hospitals in New York and Connecticut recently announced that dozens of children in the region have been hospitalized with illnesses considered to be enterovirus D68 (EV-D68), bringing the total number of states reporting confirmed or suspected cases to 21.

EV-D68 causes symptoms similar to those of a severe cold, including respiratory illness, febrile rash illness, and neurologic illness, such as aseptic meningitis and encephalitis.

The outbreak thus far has mostly affected children, especially those suffering from asthma, according to the US Centers for Disease Control and Prevention (CDC).

"It is important that we follow common sense rules to prevent the spread of this virus, as we do for flu and other contagious illnesses," said Acting New York State Health Commissioner Howard Zucker, MD, in a press release. "Because there is no specific treatment or vaccination against this virus, our best defense is to prevent it by practicing proper hygiene."

Confirmed cases of the virus have been reported in more than a dozen children in New York. Because EV-D68 is found in bodily secretions, it appears to be spread through close contact with infected patients.

The current outbreak was first reported on August 19, 2014, when a hospital in Missouri recorded more than 300 cases of respiratory illnesses at its facility, with approximately 15% of those cases resulting in children being placed under intensive care. Subsequent testing of the specimens at a specialized CDC laboratory found 19 of the 22 tested specimens were positive for EV-D68.

On August 23, 2014, the University of Chicago Medicine Comer Children’s Hospital in Illinois reported a similar increase in patients with respiratory illness. Soon after, a hospital in Colorado reported admitting more than 900 children with EV-D68 symptoms to its emergency room since August 2014.

The patients who tested positive for EV-D68 all presented with symptoms that included difficulty breathing, hypoxemia, and some with wheezing, the CDC said. Approximately two-thirds of the patients had a previous medical history of asthma or wheezing.

Most of the patients did not have a fever at presentation and throughout treatment at the hospital. The age range of patients ran from 6 weeks up to 16 years, with median ages of 4 years and 5 years in Missouri and Illinois, respectively.

Of the patients confirmed to be positive for EV-D68, 2 required mechanical ventilation and 6 required airway pressure ventilation.

There are more than 100 different strains of the enterovirus, which are estimated by the CDC to impact 10 million to 15 million people each year. The EV-D68 strain, however, is fairly uncommon. There were 79 reported cases of EV-D68 from 2009 to 2013, while small clusters of the strain associated with respiratory illness occurred in 2009 and 2010.

The main warning sign of the illness is difficulty breathing. The CDC estimated that the course of a typical enterovirus lasts roughly one week, though less is known about the course of the EV-D68 strain.

“Enterovirus infections are common in the summer and fall months,” said Onondaga County New York Health Department Medical Director Quoc Nguyen, MD, in a press release. “Most people infected with EV-D68 do not have symptoms, or have mild flu-like symptoms. However, infants, children, and teenagers are most likely to get infected with enteroviruses and may become sick, especially those individuals with a history of asthma or wheezing.”