Enterovirus EV-D68 Update 9/19/14

September 19th, 2014

The Indiana State Department of Health (ISDH) has identified ten confirmed cases of respiratory Enterovirus EV-D68 among Indiana residents. Sequencing was performed at the Indiana State Department of Health Laboratory and the U.S. Centers for Disease Control and Prevention (CDC).  The counties and submitting laboratories with confirmed cases have been contacted.   Several other suspect cases are pending testing at the Indiana State Department of Health Laboratory, and many more cases of this illness that were not tested have likely occurred. The ISDH will post EV-D68 weekly updates on the ISDH website located at http://www.in.gov/isdh/26487.htm.

Syndromic surveillance of hospital emergency department chief complaints indicates that respiratory activity has returned within normal limits and is no longer showing statewide

alerts.

Background

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.

Infection Control

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 has received an adequate number of specimens for public health surveillance purposes.

Laboratories and health care facilities should not send any additional specimens to the ISDH Laboratory for testing at this time.

Transmission

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.

Treatment

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

For questions regarding epidemiology/surveillance of EV-D68 or to report a possible respiratory disease outbreak or unusual respiratory disease activity, please contact Shawn Richards at srichard@isdh.in.gov or 317-233-7740.

Questions call Deb McMahan, MD