Since the first outbreak of EV-D68 over 50 years ago, there have only been 79 cases reported between the years 2009 and 2013. Small clusters were reported between 2009 and 2010, but there’s never been a major outbreak of EV-D68 in the US – until now.
ABC News reported on September 8, 2014 that 1,000 children in the US (10 states) had been struck with the rare virus (EV-D68) since mid-August 2014.
It all began in Missouri with the first 300+ cases. Children’s Mercy Hospital in Kansas City, Missouri was the first to report the outbreak. According to a “41 Action News” report on August 29, 2014, the hospital was seeing 25-30 new patients a day and had been forced to ban children ages 12 and under from the emergency room in an effort to prevent spreading the infection further.
This severe respiratory virus then jumped over state lines in what many medical professionals claim is an epidemic. Other states reporting children with this “rare” disease include Colorado, Kansas, Ohio, Illinois, Iowa, Oklahoma, North Carolina, Alabama, Kentucky and Georgia.
CDC Reports 97 Cases of EV-D68 in Six States
The infection has spread to six states according to the CDC; however, the number of cases the CDC is reporting are drastically lower than the news media reports. The CDC website states that from mid-August to September 12, 2014, a total of 97 children in six states were “confirmed” to have respiratory illness caused by EV-D68. That means that the EV-D68 test results have been processed and analyzed conclusively as positive for those 97 children. (2)
On September 12, 2014, the CDC updated the information about the “suspected virus” – Enterovirus D68 (EV-D68). In a Q&A section, the last question posted reads:
Q: What is CDC doing about EV-D68?
A: CDC is helping states with diagnostic and molecular typing for EV-D68. CDC is also working with state and local health departments and clinical and state laboratories to
– Enhance their capacity to identify and investigate outbreaks, and
– Perform diagnostic and molecular typing tests to improve detection of enteroviruses and enhance surveillance.
Symptoms and How the Virus Spreads
The CDC states, “Routes of transmission for EV-D68 are not fully understood.” It is believed to be spread by coming in contact with someone infected through coughing, sneezing and touching contaminated surfaces. This makes it very difficult to prevent the spread among children, especially young ones.
Enterovirus infection symptoms, include:
– Mild respiratory illness
– Febrile (fever) rash illness
– Neurologic illness (aseptic meningitis and encephalitis)
However, the EV-D68 primary symptom is respiratory illness.
-Asthmatic children especially vulnerable
– Seek medical help if child experiences difficulty breathing
The CDC cautions about the symptoms stating, “The full spectrum of disease remains unclear.” Not every patient runs a fever. In fact, out of 19 specimens the CDC sequenced that showed EV-D68 from Children’s Mercy Hospital in Kansas City, Missouri (August 19, 2014), only 5 patients had a fever and 13 had histories of asthma and wheezing.
The CDC sequencing of the 11 identified cases of EV-D68 from University of Chicago Medicine Comer Children’s Hospital in Illinois (August 23, 2014) showed similar results. Only 2 had a fever and 8 had histories of asthma or wheezing.
Treatments for EV-D68
There is neither a vaccine nor any antiviral medications for EV-D68. The CDC does offer a few possible treatments:
– For mild respiratory illness, help relieve symptoms by taking over-the-counter medications for pain and fever.
– Aspirin should not be given to children.
– Some people with severe respiratory illness may need to be hospitalized.
The best way to prevent the spread of the virus is to avoid contact with anyone infected with the virus. The next best prevention is good hygiene practices of hand-washing and avoiding touching eyes, ears, nose and mouth with your hands. The latter is nearly impossible since according to Livescience, the average person touches her face “3.6 times per hour and common objects 3 times per hour”. (3)
The CDC advises:
– Wash hands often with soap and water for 20 seconds, especially after changing diapers.
– Avoid touching eyes, nose and mouth with unwashed hands.
– 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.
Health care providers are advised to “consider EV-D68 as a possible cause of acute, unexplained severe respiratory illness, even in the absence of fever”. While so far the findings have been only in children, that doesn’t mean that adults are immune to the virus. Adults should be vigilant in their own hand-washing and other good hygiene practices.
Is the CDC Really Ignoring EV-D68?
When examining the facts, the CDC hasn’t ignored the outbreak of EV-D68 at all. In fact, the CDC seems to working relentlessly in educating the healthcare community and general public as well as coordinating a clearinghouse for epidemic reporting, analysis and fact-finding.
The CDC states that while many diseases are required to be reported to the CDC, EV-D68 and other Enterovirus infections aren’t. These laboratories do voluntarily report the viruses to the CDC managed, National Enterovirus Surveillance System. However, these are reported on a monthly basis. This means that unless the infection is reported directly to the CDC, there could a month or more lag time. (4)
In a September 8, 2014 Press Briefing Transcript of the CDC Telebriefing where reporters were able to question the CDC representative Dr. Schuchat, more information was given. Dr. Schuchat reminded, “We want healthcare professionals to be aware that these clusters are occurring and to be aware that EV- D68 may be a potential cause of clusters of severe respiratory illness, particularly affecting young children.” (5)
Dr. Schuchat went on to say that the CDC had issued “an Epi-X (The Epidemic Information Exchange)” to ask about “clusters of respiratory illness and alert them to what was going on in the Kansas City area”.
It was through this system that the CDC has been contacted by “about a dozen states”. The reporting, investigation and analysis process is ongoing. “Some of those states are still in the process of investigating their clusters and some of the laboratory testing — in fact, pretty much all of the laboratory testing is still in process,” Dr. Schuchat explained further. “The testing is not simple and it’s not widely available, so that would make the specific viral testing as a condition for reporting somewhat difficult.”
When asked about the spread of the virus, Dr. Schuchat said, “This is a dynamic situation, unusual virus… we are just beginning to understand the clusters in Kansas City and Chicago.” In conclusion, Dr. Schuchat said, “So we’re in a stage where it’s difficult to say just how big this is, how long it will go on for, and how widespread it will be. But we do plan to make sure that we update people and that we work closely with the state and local health departments as they support the clinical communities in understanding what’s going on nearby…We know that flu transits the country pretty quickly…so we want people to be on the lookout.”
Any outbreaks or suspected clusters are to be reported first to the local or state health departments. The CDC’s Picornavirus Laboratory can assist these agencies in diagnostic testing.