A Rare Enterovirus Strikes Illinois

Children with a history of asthma or wheezing are especially hard hit

Non-polio enteroviruses are nothing new and, in fact, are very common, especially in the fall and winter months. The Centers for Disease Control and Prevention (CDC) estimates 10 to 15 million infections occur in the United States each year. But now a rare type—enterovirus D68 (EV-D68)—appears to be spreading across the U.S., exacerbating respiratory problems in children with asthma. And Illinois was one of the first states to be affected.

On Aug. 19, Children’s Mercy Hospital in Kansas City, MO, alerted the CDC to an increase in children examined and hospitalized with a severe respiratory illness. Four days later, on Aug. 23, the University of Chicago Medicine Comer Children’s Hospital also reported an increase in children with symptoms similar to those in Kansas City. EV-D68 was identified in 19 of 22 specimens from Kansas City and 11 of 14 specimens from Chicago.

Similar to other enteroviruses, EV-D68 spreads like the common cold—and as quickly—and can trigger minor symptoms such as a runny nose, fever, cough and muscle aches. But many of the children who have gotten very ill had difficulty breathing and wheezing. In fact, of the first 30 children hospitalized with EV-D68 in Missouri and Illinois, 70% had a history of asthma or wheezing.

EV-D68 was first identified in California in 1962 but has rarely been seen since then. Some experts speculate that one reason it is spreading so quickly is because children have not built up an immunity to the virus. It is unclear why the virus is currently affecting children and not adults.

There are no vaccines or treatments specific to the virus. But most cases are not fatal. Intensive treatment and supportive care, including oxygen, provided in a hospital setting all help. And in the confirmed cases of EV-D68 from 2008 to 2010, the median length of time patients were hospitalized ranged from 1.5 to five days.

But the virus is spreading and spreading rapidly. As of Sept. 11, the CDC had confirmed more than 80 cases of EV-D68 in six states: Colorado, Iowa, Illinois, Kansas, Kentucky, and Missouri. New York also announced on Sept. 12 that it had more than a dozen confirmed cases of the virus. By Sept. 16, the CDC confirmed that a total of 130 people in 12 states had a respiratory illness caused by EV-D68.

The CDC recommends that physicians consider EV-D68 as a possible cause of acute, unexplained severe respiratory illness, even if the child does not have fever. Physicians should also consider testing to confirm the presence of EV-D68. State and local hospitals and health departments, as well as the CDC, can help with testing. Because EV-D68 is not nationally notifiable, clinicians should contact their local or state department of health. For more guidance on submitting samples and to obtain a patient summary form, visit the CDC website at www.cdc.gov.

Meanwhile, the CDC is helping states with diagnositc and molecular typing for EV-D68. The agency is also working with state and local health departments and clinical and state laboratories to enhance their capacity to identify and investigate outbreaks and to perform diagnostic and molecular typing tests to improve detection of enteroviruses.