September 12th, 2014
The Indiana State Department of Health (ISDH) has identified four confirmed cases of respiratory Enterovirus EV-D68 among Indiana residents. Testing was performed at the U.S. Centers for Disease Control and Prevention (CDC). Several other suspect cases are pending testing at the Indiana State Department of Health Laboratory. Syndromic surveillance of hospital emergency department chief complaints has indicated a higher than expected level of respiratory illness statewide for this time of year. Several other states, including Colorado, Illinois, Iowa, Kentucky, Kansas, and Missouri, have also identified confirmed EV-D68 cases.
Most enterovirus infections in the U.S. occur seasonally during the summer and fall, and enterovirus outbreaks tend to occur in several-year cycles. Respiratory enteroviruses include EV-D68 and rhinovirus and are transmitted through contact with secretions from the eyes, nose, and mouth (saliva, mucus, sputum) of an infected person; having close contact with an infected person, such as touching or shaking hands; and touching objects or surfaces that have been contaminated with infectious secretions.
EV-D68 infections can be mild and self-limited, but children with asthma are at risk for severe respiratory illness and may require hospitalization to receive intensive supportive therapy. Patients with asthma should carefully maintain their current medical management and follow their asthma action plan to monitor for early signs of exacerbation. People who smoke are also at higher risk for severe infection due to enterovirus.
The CDC recommends hospitals use standard, contact, and droplet precautions when caring for patients. Alcohol-based hand sanitizers are not effective against EV-D68. Bleach-based disinfectants, like those used for rhinovirus and norovirus, are effective for environmental cleaning.
Clinicians are advised to suspect enterovirus infection in patients hospitalized with asthma exacerbations or severe respiratory illness. The ISDH Laboratory is temporarily requesting that clinicians send nasopharyngeal and oropharyngeal swabs in the same transport medium from patients who test positive for rhino/enterovirus to the ISDH Laboratory for epidemiologist confirmation of disease in Indiana.
Sequencing will be conducted to identify the specific viral strain. Nasal swabs and nasal washes are not acceptable. Instructions for submission of NP and OP swabs to ISDH for testing are located on the ISDH enterovirus page at http://www.in.gov/isdh/26487.htm under the laboratory specimen information section.
No vaccine is available to prevent infection with respiratory enteroviruses, and no antiviral medication is available. Health care providers should recommend the following:
- Clean: wash hands often with soap and water for 20 seconds
- Cover: cover sneezes and coughs with your sleeve or a tissue
- Contain: prevent spreading illness to others by staying home if you are sick
- Avoid close contact and sharing cups or eating utensils with those who are ill
- Disinfect frequently touched surfaces
- Avoid smoking or exposure to second-hand smoke
Healthcare providers who identify outbreaks or unusual occurrences of respiratory illness should contact Shawn Richards, Outbreak Supervisor, at email@example.com or 317.233.7125.
Specimens should arrive at the ISDH Laboratory Monday-Friday excluding state holidays within three days of the collection date. Specimens must be submitted using LIMSNET. To sign up for a LIMSNET account, contact the ISDH LIMS HelpDesk at 317-921-5506 or 1-888-535-0011.
For questions regarding epidemiology/surveillance, please contact Shawn Richards at firstname.lastname@example.org or 317.233.7740.
For questions on specimen collection or submission please contact Stephanie Dearth at email@example.com or 317.921.5843.
Indiana State Department of Health website at http://www.in.gov/isdh/26487.htm.
Centers for Disease Control and Prevention (CDC) website at http://www.cdc.gov/non-polio-enterovirus.
Questions call Deb McMahan, MD