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Monday, October 27, 2014


Enterovirus D68 Tops 1000 CASES IN U.S.

What We Know

Activity of Enterovirus D68-like Illness in States

Activity of enterovirus-D68-like infections in reporting states is described as: decreased in Alabama, low and similar for Alaska, low and similar for Arkansas, low and similar for Arizona, elevated for California, decreased for Colorado, decreased for Connecticut, decreased for District of Columbia, low and similar for Florida, decreased for Georgia, low and similar in Hawaii, decreased in Idaho, elevated for Illinois, low and similar for Indiana, low and similar for Kansas, decreased for Kentucky, low and similar for Louisiana, elevated for Maine, elevated for Massachusetts, decreased for Michigan, decreased for Minnesota, low and similar for Missouri, low and similar for Mississippi, low and similar for Nebraska, decreased for New Jersey, elevated for New Hampshire, low and similar for New Mexico, decreased for New York, low and similar for North Carolina, elevated for North Dakota, low and similar for Ohio, low and similar for Oregon, increased for Pennsylvania, low and similar for Rhode Island, increased for South Carolina, low and similar for South Dakota, low and similar for Tennessee, low and similar for Texas, elevated for Utah, increased for Virginia, low and similar for Vermont, elevated for Washington, increased for West Virginia, and decreased for Wisconsin.
October 12-18, 2014. 
  • Over the last several months, the United States has experienced a nationwide outbreak of enterovirus D68 (EV-D68) associated with severe respiratory illness.
    • From mid-August to October 27, 2014, CDC or state public health laboratories have confirmed a total of 1,035 people in 47 states and the District of Columbia with respiratory illness caused by EV-D68.
    • CDC expects that, as with other enteroviruses, EV-D68 infections will likely begin to decline by late fall.
    • CDC has received informal reports from some hospitals and states that are seeing signs of decreasing EV-D68 infections. CDC is gathering more information from states and assessing whether this represents a national trend. See latest report from states on activity of enterovirus D68-like illness.
  • Every year, enteroviruses and rhinoviruses cause millions of respiratory illnesses in children. This year, EV-D68 has been the most common type of enterovirus identified, leading to increases in illnesses among children and affecting those with asthma most severely. Other rhinoviruses and enteroviruses continue to be detected as well. 
  • CDC has received substantially more specimens for enterovirus lab testing than usual this year, due to the large outbreak of EV-D68 and related hospitalizations.
    • CDC has prioritized testing of specimens from children with severe respiratory illness. There are likely many children affected with milder forms of illness. 
    • Of the more than 2,000 specimens tested by the CDC lab, about half have tested positive for EV-D68. About one third have tested positive for an enterovirus or rhinovirus other than EV-D68. 
    • Almost all the confirmed cases this year of EV-D68 infection have been among children. Many of the children had asthma or a history of wheezing.

  • EV-D68 has been detected in specimens from eight* patients who died and had samples submitted for testing. CDC is reporting test results to state health departments as we obtain them. 
    • State and local officials have the authority to determine the cause of death, including the role that EV-D68 may have played. They also have the authority to determine the appropriate information to release, and the time to release it. CDC will defer to states to provide this information.
*Investigations are ongoing; CDC reviews and updates available data every Thursday.

What CDC Is Doing about EV-D68

CDC is 

  • continuing to collect information from states and assess the situation to better understand
    • EV-D68 and the illness caused by this virus and 
    • how widespread EV-D68 infections may be within each state and the populations affected.
  • helping states with diagnostic and molecular typing for EV-D68. 
  • 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.
  • providing 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.
  • CDC has 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 has developed, and started using on October 14, a new, faster lab test for detecting EV-D68 in specimens from people in the United States with respiratory illness.
    • This new lab test will allow CDC to rapidly process the remaining specimens received since mid-September. As a result, the number of confirmed EV-D68 cases increased substantially and will likely continue to increase in the coming days. These increases will not reflect actual changes or mean the situation is getting worse.
    • CDC’s new lab test is a “real-time” reverse transcription polymerase chain reaction, or rRT-PCR, and it identifies all strains of EV-D68 that we have been seeing this summer and fall. It has fewer and shorter steps than the test that CDC and some states were using previously during this EV-D68 outbreak. 
    • Faster testing will help to better show the trends of this outbreak since August and to monitor changes occurring in real time.
    • Once we have finished testing the remaining specimens, we will then be able to test and report results for new specimens within a few days of receiving them.
    • CDC will provide protocols to state public health labs and explore options for providing test kits.

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