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Severe respiratory illness associated with enterovirus D68 - Missouri and Illinois, 2014
Insights
Severe respiratory illness outbreaks in children were linked to Enterovirus D68 (EV-D68). This virus was identified in patients hospitalized with respiratory symptoms in Missouri and Illinois, prompting further investigation into potential widespread transmission.
Area of Science:
- Virology
- Public Health
- Epidemiology
Background:
- An unusual increase in severe pediatric respiratory illness admissions was observed in Kansas City, Missouri, and Chicago, Illinois, during August 2014.
- Simultaneously, an increase in detections of rhinovirus/enterovirus was noted in nasopharyngeal specimens.
Purpose of the Study:
- To identify the causative agent responsible for the severe respiratory illness outbreaks in pediatric patients.
- To characterize the genetic makeup of the identified pathogen.
Main Methods:
- Nasopharyngeal specimens from affected patients were collected and analyzed.
- Multiplex polymerase chain reaction (PCR) assays were used for initial pathogen detection.
- Next-generation sequencing was performed by the CDC Picornavirus Laboratory to identify the specific virus.
Main Results:
- Enterovirus D68 (EV-D68) was identified in a significant majority of specimens from both Kansas City (19/22) and Chicago (11/14).
- The identified EV-D68 strain was associated with severe respiratory illness, including cases requiring pediatric intensive care unit admission.
- Elevated hospitalization rates for severe respiratory illness persisted at both facilities following the initial identification of EV-D68.
Conclusions:
- Enterovirus D68 (EV-D68) was identified as the likely cause of the severe respiratory illness outbreaks in children in Missouri and Illinois.
- The findings highlight the potential for EV-D68 to cause significant public health challenges, necessitating ongoing surveillance and investigation.
- Further investigations into suspected EV-D68 clusters in other regions were initiated.
Abstract:
On August 19, 2014, CDC was notified by Children's Mercy Hospital in Kansas City, Missouri, of an increase (relative to the same period in previous years) in patients examined and hospitalized with severe respiratory illness, including some admitted to the pediatric intensive care unit. An increase also was noted in detections of rhinovirus/enterovirus by a multiplex polymerase chain reaction assay in nasopharyngeal specimens obtained during August 5-19. On August 23, CDC was notified by the University of Chicago Medicine Comer Children's Hospital in Illinois of an increase in patients similar to those seen in Kansas City. To further characterize these two geographically distinct observations, nasopharyngeal specimens from most of the patients with recent onset of severe symptoms from both facilities were sequenced by the CDC Picornavirus Laboratory. Enterovirus D68 (EV-D68) was identified in 19 of 22 specimens from Kansas City and in 11 of 14 specimens from Chicago. Since these initial reports, admissions for severe respiratory illness have continued at both facilities at rates higher than expected for this time of year. Investigations into suspected clusters in other jurisdictions are ongoing.
