EV-D68

7 10 2014

We were writing an update on EV-D68 when this email arrived from CDC. We think the points are important for parents to know, so we’re going to share this with you and will provide future updates as warranted.

As parents, we’re all concerned about this virus which isn’t really new, but has captured the nation’s attention. If you have questions, please ask them in the comments and we’ll get answers for you.

[This information is current as of 17 October, 2014 and has been slightly edited for length (believe it or not). The bold text includes the latest updates]:

The United States is currently experiencing a nationwide outbreak of enterovirus D68 (EV-D68) associated with severe respiratory illness.

From mid-August to October 17, 2014, CDC or state public health laboratories have confirmed a total of 825* people in 46 states and the District of Columbia with respiratory illness caused by EV-D68.** This indicates that at least one case has been detected in each of those states but does not indicate how widespread infections are in each state.

In the United States, people are more likely to get infected with enteroviruses in the summer and fall. We are currently in the middle of the enterovirus season. EV-D68 infections are likely to decline later in fall.

CDC has received informal reports from some hospitals and states that there are signs of decreasing EV-D68 infections. CDC is gathering more info to see if this is a national trend.

Many state health departments are currently investigating reported increases in cases of severe respiratory illness in children. This increase could be caused by many different viruses that are common during this time of year. EV-D68 appears to be the predominant type of enterovirus this year and is likely contributing to the increases in severe respiratory illnesses.

Due to increasing knowledge about the nationwide EV-D68 outbreak, there has been a very large increase in the number of specimens tested from patients with severe respiratory illness. Awareness of these initial results is also contributing to increased recognition of new cases.

CDC is prioritizing testing of specimens from children with severe respiratory illness. There are likely many children affected with milder forms of illness.

Of the more than 1,400 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 of the CDC-confirmed cases this year of EV-D68 infection have been among children. Many of the children had asthma or a history of wheezing.

CDC has developed, and started using on October 14, a new, faster lab test for detecting EV-D68, allowing CDC to rapidly process in about seven to 10 days the more than 1,000 remaining specimens received since mid-September. As a result, the number of confirmed EV-D68 cases will likely increase substantially in the coming days. These increases will not reflect changes in real time or mean the situation is getting worse.

As a result, confirmed cases increased today and will likely continue to increase in coming days. This does not mean the situation is getting worse.

Faster testing will help to better show the trends of this outbreak since August and to monitor changes occurring in real time.

EV-D68 has been detected in specimens from seven*** patients who died and had samples submitted for testing.

CDC is reporting the test results to state health departments as we obtain them. State and local officials have the authority to determine the cause of death, the appropriate information to release, and the time to release it. CDC will defer to states to provide this information.

So far, state and local officials have reported that two of these deaths were caused by EV-D68.

CDC will post updated data to the website every Thursday.

CDC understands that Americans may be concerned about these severe respiratory illnesses and the new reports of neurological illness. Severe illness is always a concern to us, especially when infants and children are affected. We will share information as soon as we have it, and post updates on our website (http://www.cdc.gov/non-polio-enterovirus/outbreaks/EV-D68-outbreaks.html).

Clinicians should consider EV-D68 as a possible cause of severe respiratory illness, particularly in children, and report unusual increases in the number of patients with severe respiratory illness to their health department.

The general public can help protect themselves from respiratory illnesses by washing hands with soap and water, avoiding close contact with sick people, and disinfecting frequently touched surfaces. Anyone with respiratory illness should contact their doctor if they are having difficulty breathing, or if their symptoms are getting worse.

*Total confirmed case count includes results from State Public Health Laboratories that can do testing to determine type of enterovirus.
**The primary reason for current increases in cases is that a backlog of specimens is being processed from several states that are investigating clusters of people with severe respiratory illness. It can take a while to test specimens and obtain lab results because the testing is complex and slow, and can only be done by CDC and a small number of state public health laboratories. These increases will not necessarily reflect changes in real time, or mean that the situation is getting worse.
***Investigations are ongoing; CDC will review and update available data every Wednesday.

 

BACKGROUND

Enteroviruses are very common viruses; there are more than 100 types.

It is estimated that 10 to 15 million enterovirus infections occur in the United States each year. Tens of thousands of people are hospitalized each year for illnesses caused by enteroviruses.

Different enteroviruses can cause different illnesses, such as respiratory, febrile rash, and neurologic [e.g., aseptic meningitis (swelling of the tissue covering the brain and spinal cord) and encephalitis (swelling of the brain)].

In general, the spread of enteroviruses is often quite unpredictable. A mix of enteroviruses circulates every year, and different types of enteroviruses can be common in different years.

In the United States, people are more likely to get infected with enteroviruses in the summer and fall.

 

Enterovirus D68

EV-D68 was first recognized in California in 1962. Small numbers of EV-D68 have been reported regularly to CDC since 1987. However, this year the number of people with confirmed EV-D68 infections is much greater than that reported in previous years.

The strains of EV-D68 circulating this year are not new.

CDC, working with state health departments, has identified at least three separate strains of EV-D68 that are causing infections in the United States this year; the most prominent strain is related to the strains of EV-D68 that were detected in the United States in 2012 and 2013.

There is no evidence that unaccompanied children brought EV-D68 to the United States; we are not aware of any of these children testing positive for the virus.

It is common for multiple strains of the same enterovirus type to be co-circulating in the same year.

Respiratory illnesses can be caused by many different viruses and have similar symptoms. Not all respiratory illnesses occurring now are due to EV-D68.

EV-D68 has been previously referred to as human enterovirus 68 (or HEV-68) and human rhinovirus 87 (or HRV-87). They are all the same virus. The D stands for enterovirus species D.

 

SYMPTOMS

EV-D68 infections can cause mild to severe respiratory illness, or no symptoms at all.

Mild symptoms may include fever, runny nose, sneezing, cough, and body and muscle aches.

Severe symptoms may include wheezing and difficulty breathing.
Anyone with respiratory illness should contact their doctor if they are having difficulty breathing, or if their symptoms are getting worse.

Enteroviruses are known to be one of the causes of acute neurologic disease in children. They most commonly cause aseptic meningitis, less commonly encephalitis, and rarely, acute myelitis and paralysis.

CDC is aware of two published reports of children with neurologic illnesses confirmed as EV-D68 infection from cerebrospinal fluid (CSF) testing.

 

PEOPLE AT RISK

In general, infants, children, and teenagers are most likely to get infected with enteroviruses and become sick. That’s because they do not yet have immunity (protection) from previous exposures to these viruses. We believe this is also true for EV-D68. Adults can get infected with enteroviruses, but they are more likely to have no symptoms or mild symptoms.

Children with asthma may have a higher risk for severe respiratory illness caused by EV-D68 infection.

 

TRANSMISSION

Since EV-D68 causes respiratory illness, the virus can be found in an infected person’s respiratory secretions, such as saliva, nasal mucus, or sputum.

The virus likely spreads from person to person when an infected person coughs, sneezes, or touches a surface that is then touched by others.

Diagnosis

EV-D68 can only be diagnosed by doing specific lab tests on specimens from a person’s nose and throat.

Many hospitals and some doctor’s offices can test sick patients to see if they have enterovirus infection. However, most cannot do specific testing to determine the type of enterovirus, like EV-D68. CDC and some state health departments can do this sort of testing.

CDC recommends that clinicians only consider EV-D68 testing for patients with severe respiratory illness and when the cause is unclear.

 

TREATMENT

There is no specific treatment for people with respiratory illness caused by EV-D68 infection.

For mild respiratory illness, you can 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 caused by EV-D68 may need to be hospitalized and receive intensive supportive therapy.

There are no antiviral medications are currently available for people who become infected with EV-D68.

 

PREVENTION

You can help protect yourself from getting and spreading EV-D68 by following these steps:

  • Wash hands often with soap and water for 20 seconds
  • Avoid touching eyes, nose and mouth with unwashed hands
  • Avoid close contact such as kissing, hugging, and sharing cups or eating utensils with people who are sick, or when you are sick
  • Cover your coughs and sneezes with a tissue or shirt sleeve, not your hands
  • Clean and disinfect frequently touched surfaces, such as toys and doorknobs, especially if someone is sick
  • Stay home when you are sick
  • There are no vaccines for preventing EV-D68 infections.

Children with asthma are at risk for severe symptoms from EV-D68 and other respiratory illnesses. They should follow CDC’s guidance to maintain control of their illness during this time:

  • Discuss and update your asthma action plan with your primary care provider.
  • Take your prescribed asthma medications as directed, especially long term control medication(s).
  • Be sure to keep your reliever medication with you.
  • Get a flu vaccine when available.
  • If you develop new or worsening asthma symptoms, follow the steps of your asthma action plan. If your symptoms do not go away, call your doctor right away.
  • Parents should make sure the child’s caregiver and/or teacher is aware of his/her condition, and that they know how to help if the child experiences any symptoms related to asthma.

 

WHAT IS CDC DOING

CDC continues 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 states and the populations affected.

CDC is helping states with diagnostic and molecular typing for EV-D68.

We are 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.

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. CDC will provide protocols to state public health labs and explore options for providing test kits.

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. The new test has fewer and shorter steps than the test that CDC and some states were using previously during this EV-D68 outbreak. This will allow CDC to test and report results for new specimens within a few days of receiving them.

The previous test, which CDC used for about nine years,  is very sensitive and can be used to detect and identify almost all enteroviruses; however, it requires multiple, labor-intensive processing steps and cannot be easily scaled up to support testing of large numbers of specimens in real time that is needed for the current EV-D68 outbreak.

We are 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 partial 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.

 

GUIDANCE FOR CLINICIANS

Clinicians should:

  • consider EV-D68 as a possible cause of acute, unexplained severe respiratory illness, even if the patient does not have fever.
  • report suspected clusters of severe respiratory illness to local and state health departments. EV-D68 is not nationally notifiable, but state and local health departments may have additional guidance on reporting.
  • consider laboratory testing of respiratory specimens for enteroviruses when the cause of respiratory illness in severely ill patients is unclear.
  • consider testing to confirm the presence of EV-D68. State health departments can be approached for diagnostic and molecular typing for enteroviruses.
  • contact your state or local health department before sending specimens for diagnostic and molecular typing.
  • follow standard, contact, and droplet infection control measures

The antiviral drugs pleconaril, pocapavir, and vapendavir, have significant activity against a wide range of enteroviruses and rhinoviruses. CDC has tested these drugs for activity against currently circulating strains of enterovirus D68 (EV-D68), and none of them has activity against EV-D68 at clinically relevant concentrations.

 

SURVEILLANCE

U.S. healthcare professionals are not required to report known or suspected cases of EV-D68 infection to health departments because it is not a nationally notifiable disease in the United States. Also, CDC does not have a surveillance system that specifically collects information on EV-D68 infections.

No data is currently available regarding the overall burden of morbidity or mortality from EV-D68 in the United States. Any data CDC receives about EV-D68 infections or outbreaks are voluntarily provided by labs to CDC’s National Enterovirus Surveillance System (NESS). NESS collects limited data, focusing on circulating types of enteroviruses and parechoviruses.

 

MORE INFORMATION

CDC Enterovirus D68 in the United States, 2014 website: http://www.cdc.gov/non-polio-enterovirus/outbreaks/EV-D68-outbreaks.html

CDC Enterovirus D68 general website: http://www.cdc.gov/non-polio-enterovirus/about/EV-D68.html

CDC Enterovirus D68 for Health Care Professionals website: http://www.cdc.gov/non-polio-enterovirus/hcp/EV-D68-hcp.html

CDC What Parents Need to Know about Enterovirus D68 webpage: http://www.cdc.gov/features/evd68/

Enterovirus D68 in the United States: Epidemiology, Diagnosis & Treatment, COCA Call, September 16, 2014 (http://www.bt.cdc.gov/coca/calls/2014/callinfo_091614.asp)

Severe Respiratory Illness Associated with Enterovirus D68 – Multiple States, 2014, Health Alert Network, September 12, 2014 (http://emergency.cdc.gov/han/han00369.asp)

Severe Respiratory Illness Associated with Enterovirus D68 – Missouri and Illinois, 2014, MMWR, September 8, 2014 (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6336a4.htm?s_cid=mm6336a4_w)

Clusters of Acute Respiratory Illness Associated with Human Enterovirus 68 — Asia, Europe, and United States, 2008–2010, MMWR, September 30, 2011 (http://www.cdc.gov/mmwR/preview/mmwrhtml/mm6038a1.htm)





Ebola

2 10 2014

Ebola is in the US, but we have many reasons not to panic. A short infographic to share, if you think it helpful.

 

Ebola





EV-D68 Infographic

10 09 2014

We put this together with the hope that it will simplify communications about this virus. Use it, share it, as you like.

 

EV-D68





EV-D68

8 09 2014

There’s a virus in the US that’s sending kids to the hospital. Symptoms are similar to a severe cold. The virus is called human enterovirus 68 (EV-D68).

This virus affects the respiratory system, which is made up of the organs and tissues that let us breathe, including our airways (nose, mouth, windpipe), our lungs, and many other bits that work to keep us breathing.

EV-D68 was not a common culprit of respiratory disease until about 2009. That’s when the virus started to be identified with outbreaks in different parts of the world.

There are many strains or types of enteroviruses, and they are frequently the cause of our colds. This particular strain, EV-D68, is causing colds, but there are an unusual number of hospitalizations with this infection. Symptoms include coughing and difficulty breathing, which is what’s sending some people to the hospital. In addition, some people may have wheezing, a fever, or rash.

Those with existing respiratory issues, such as asthma, may find their symptoms more severe, as they do with any respiratory infection.

IMPORTANT POINT: This virus isn’t typically life-threatening, and although some who are infected will find themselves battling severe symptoms, most will experience only a mild cold.

There’s no vaccine available. We need to do what we always do to prevent colds—clean our hands throughout the day and keep our hands off of our face, as germs enter through our nose, mouth, and eyes. If someone offers you a bite of their spaghetti or a drink of their soda, politely refuse. Get your own spaghetti and drink.

And CDC reminds us that it’s important to disinfect surfaces (doorknobs, keyboards) to zap those germs where they sit.

It’s scary for parents to hear about kids being hospitalized, but if we practice basic disease prevention methods, we’ll help our families avoid this and other viruses that cause colds.





New Movement Spotlights The Value Of Vaccination

3 09 2014

Encouraging conversation through valueofvaccination.org

An ever-growing body of individuals and organizations has come together for the purpose of highlighting that which is well-known but seldom stated: vaccination adds value to our lives.

Building upon a groundswell of public support for vaccination, the Value of Vaccination movement is garnering attention to the benefits that vaccines bring to every community. The initiative features the sharing of personal stories, videos demonstrating the positive impacts of vaccination, and easy-to-understand guides to the science behind vaccines and the immune system.TVOV-1500

The movement is expanding beyond the website to include social media platforms, including Facebook, Twitter, and Pinterest. The goal is to encourage conversation at home, at work, and at school about the value of vaccination.

“The importance of dialogue around vaccines has become recognized globally,” said Heidi Larson, who leads the Vaccine Confidence Project at the London School of Hygiene & Tropical Medicine. “Conversations between health providers and the public, among individuals, families and communities, and between the public and policy-makers are key to building trust. This important value-centered movement appreciates the science, but puts people at the center. ”

A call has been put out to the public to provide ideas on how best to illustrate the value of vaccination to others. It’s hoped that through crowdsourcing, new and unexpected methods of communicating this critical dimension of public health will be discovered.

Value of Vaccination is a body of individuals and organizations working together to promote the fact that vaccines bring value to our lives, and the many ways in which that value is actualized. This program is supported by a host of volunteers, along with financial support from PKIDs, a nonprofit based in the US. For more information, visit www.valueofvaccination.org.





And The National Immunization Survey Says . . .

28 08 2014

In 1994, the CDC began collecting information about the vaccination of children ages 19—35 months. They did this through a survey called the National Immunization Survey (NIS), and they’re still doing it.

The information they collect gives us a good picture of how well-covered our little ones are by the vaccines recommended by the Advisory Committee on Immunization Practices (ACIP).

CDC does similar surveys on teens, adults, and also specifically, flu.

The results from the latest survey on children ages 19—35 months are:

  • Most parents are getting their kids vaccinated against preventable diseases.
  • We need to be more vigilant about protecting our two-year-olds through vaccination. They aren’t getting all the recommended doses.
  • Seventeen states had less than 90% coverage with the measles, mumps, and rubella (MMR) vaccine. Communities need 95% coverage to keep measles under control. Even then, when there are groups of people not protected by the MMR vaccine, they’re at risk for measles.

Dr. Alan Hinman does a nice job of getting into the measles outbreak we’ve had this past year in his blog post on the Value of Vaccination website. Recommended reading!

To dive into all the details of the 2013 NIS, CDC’s MMWR provides the facts and figures.





NOVA: Vaccines – Calling The Shots

28 08 2014

Premieres Wednesday, September 10, 2014 at 9PM/8c on PBS!

 

Press release from NOVA about this fascinating documentary:

Measles. Mumps. Whooping cough. Diseases that were largely eradicated in the United States a generation ago are returning.

Across America and around the globe, children are getting sick and dying from preventable diseases—in part, because some parents are choosing to skip their children’s shots. How and why do vaccines work? What are the biggest concerns and misconceptions, and what are the risks to the child and society when people decide to forego immunization? The award-winning science series NOVA helps viewers find the answers they need.

Misinformation about vaccines can spread quickly, creating confusion about the relative risks of vaccinating vs. not vaccinating. VACCINES–CALLING THE SHOTS is an important new film that encourages parents to ask questions and use the best available evidence to make decisions about how to protect their children.

This documentary travels the globe to provide the latest evidence and answers.  Featuring scientists, pediatricians, psychologists, anthropologists, and parents wrestling with vaccine-related questions, the hour-long film explores the history and science behind vaccinations, tracks outbreaks, and sheds light on the risks of opting out.  The film, produced for NOVA by Tangled Bank Studios in association with Genepool Productions, premieres Wednesday, September 10 at 9PM/8c on PBS (check local listings).

“Immunization plays a crucial role in our public health, yet there is a tremendous amount of apprehension and confusion around the topic,” said Paula S. Apsell, Senior Executive Producer for NOVA. “In VACCINES—CALLING THE SHOTS, NOVA dispels the myths and examines the latest science, engaging parents and viewers in a conversation with real answers about the best way to protect their families.”

“With the return of measles, whooping cough and other highly infectious diseases, we saw an opportunity to team up with NOVA to provide clarity for viewers about vaccination and what’s really at stake here for all of us,” said Michael Rosenfeld, Executive Producer for Tangled Bank Studios.

The vast majority of Americans—more than 90 percent—vaccinate their children, and most do it on the recommended schedule. Yet many people have questions about the safety of vaccines, and at least 10 percent of parents choose to delay or skip their children’s shots. The film illustrates how vaccines not only protect individuals, but also safeguard entire communities. The higher the overall vaccination rate is, the more protection for everyone.  For highly infectious diseases like measles, 95% of the community must be vaccinated to shield the larger population, a concept known as “herd immunity.” If the rate drops below that 95% threshold, even by just a few percentage points, this layer of protection can collapse, sometimes leading to the kinds of outbreaks reported in recent news headlines. Measles was declared eliminated in the U.S. in 2000; however, the Centers for Disease Control and Prevention report 566 confirmed cases in 2014, as of July 11. In 2012, there were nearly 50,000 cases of pertussis, also known as whooping cough, and 20 deaths, in the U.S.

Highlighting real cases and placing them in historical context, VACCINES—CALLING THE SHOTS demonstrates just how fast diseases can spread—and how many people can fall sick—when a community’s immunity barrier breaks down. The film chronicles a 2013 measles outbreak in Brooklyn, New York, in which 58 people fell ill, including two pregnant women. Dr. Paul Offit, a pediatrician and infectious disease expert at The Children’s Hospital of Philadelphia, offers the physician’s perspective on the vulnerable immune systems of young children, the history of vaccines, and how diseases re-emerge when immunization rates decrease.

Some parents—including a number of new mothers interviewed in San Francisco—are concerned about the risk of adverse reactions from vaccination. The film acknowledges that there are very rare risks, but Dr. Brian Zikmund-Fisher, a psychologist and risk specialist at the University of Michigan School of Public Health, puts those risks in perspective: You’d need about ten football stadiums, each with 100,000 people, to find a single serious allergic reaction to a vaccine.

NOVA viewers meet Alison Singer, President of the Autism Science Foundation, and her daughter Jodie, who has autism. Singer cites the overwhelming scientific evidence refuting a link between vaccines and autism and discusses the lingering effects of a long-discredited study on public perception. The film further explores autism with new science from Dr. Dan Geschwind that reveals its genetic causes. His team and others have pinpointed mutations that affect the wiring of the developing brain—compelling evidence that autism begins in the womb.

VACCINES—CALLING THE SHOTS also follows Dr. Amy Middleman, Adolescent Medicine Specialist at the University of Oklahoma’s Health Sciences Center as she consults with patients and their parents on the safety and effectiveness of the controversial HPV vaccine, which protects against the cancer-causing human papillomavirus.

We’ll be watching on 10 September!








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