Non-Polio Enterovirus Enterovirus D68 in the United States, 2014
Share What We Know In 2014, the United States experienced a nationwide outbreak of enterovirus D68 (EV-D68) associated with severe respiratory illness. From mid-August 2014 to January 15, 2015, CDC or state public health laboratories confirmed a total of 1,153 people in 49 states and the District of Columbia with respiratory illness caused by EV-D68.
Almost all of the confirmed cases were among children, many whom had asthma or a history of wheezing. Additionally, there were likely millions of mild EV-D68 infections for which people did not seek medical treatment and/or get tested. CDC received about 2,600 specimens for enterovirus lab testing during 2014, which is substantially more than usual. About 36% of those tested positive for EV-D68. About 33% tested positive for an enterovirus or rhinovirus other than EV-D68.
EV-D68 was detected in specimens from 14 patients who died and had samples submitted for testing. State and local officials have the authority to determine and release information about the cause of these deaths. CDC's Role CDC worked with state and local health departments and clinical and state laboratories to enhance their capacity to identify and investigate outbreaks, perform diagnostic and molecular typing tests to detect enteroviruses, and enhance surveillance for enteroviruses to monitor seasonal activity.
CDC developed, and started using on October 14, 2014, a new, faster lab test for detecting EV-D68, allowing CDC to test and report results within a few days of receiving specimens. CDC’s lab test is a “real-time” reverse transcription polymerase chain reaction, or rRT-PCR, and it identifies all strains of EV-D68 that circulated during summer and fall 2014. It has fewer and shorter steps than the test that CDC and some states were using previously during this EV-D68 outbreak. CDC has made the protocols publicly available on its EV-D68 for Health Care Professionals web page and is exploring options for providing test kits to state public health labs.
CDC obtained one complete genomic sequence and six nearly complete genomic sequences from viruses representing the three known strains of EV-D68 that are causing infection at this time. Comparison of these sequences to sequences from previous years shows they are genetically related to strains of EV-D68 that were detected in previous years in the United States, Europe, and Asia. CDC has submitted the sequences to GenBank to make them available to the scientific community for further testing and analysis. CDC provided information to healthcare professionals, policymakers, general public, and partners in numerous formats, including Morbidity and Mortality Weekly Reports (MMWRs), health alerts, websites, social media, podcasts, infographics, and presentations.
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How do you catch it? (Web MD)
The bad news is that enteroviruses, which are thought to cause between 10 million and 15 million infections in the U.S. each year, are pretty hardy, says Stephen Morse, PhD. He's an infectious disease expert at Columbia’s Mailman School of Public Health, in New York City.
The “entero-“ part of their name means the viruses can survive stomach acid and infect the gut, as opposed to their cousins, the rhinoviruses, which can’t.
He says these germs can live on surfaces for hours and maybe as long as a day, depending on the temperature and humidity.
“It is a pretty tough virus,” he says.
The virus can be found in saliva, nasal mucus, or sputum, according to the CDC.
Touching a contaminated surface and then rubbing your nose or eyes is the usual way someone catches it. You can also get it from close person-to-person contact.
Protect yourself with good hand-washing habits. Tell kids to cover their mouth with a tissue when they cough. If no tissue is handy, teach them to cough into the crook of their elbow or upper sleeve instead of their hand.
Common disinfectants and detergents will kill enteroviruses, Morse says, so clean frequently touched surfaces like doorknobs and toys according to manufacturers’ directions.
In an article published in the Jan. 9 issue of the Morbidity and Mortality Weekly Report, the CDC said a test of the cerebrospinal fluid (which bathes the brain) in 71 patients with limb weakness showed they didn't have EV-D68 or any other pathogen. But when the CDC tested upper respiratory tract samples in a group of patients, EV-D68 was found in some of them.
Every year, children get limb-weakening neurologic illnesses caused by, among other things, viral infections, environmental toxins, genetic disorders, and Guillain-Barré syndrome, according to the CDC. In many cases, the cause is never identified.
SOURCES:News release, CDC.Mary Anne Jackson, MD, division director of infectious disease, Children’s Mercy Hospital, Kansas City, MO.Andi Shane, MD, medical director, hospital epidemiology; associate director of pediatric infectious disease, Children’s Healthcare of Atlanta.Roya Samuels, MD, pediatrician, Steven & Alexandra Cohen Children’s Medical Center, New Hyde Park, NY.Stephen Morse, PhD, professor of epidemiology, Mailman School of Public Health, Columbia University, New York.William Schaffner, MD, infectious disease specialist, Vanderbilt University, Nashville, TN.
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