Increased Respiratory Illness Circulating in Indiana: Enterovirus D68 (EV-D68) 9/8/14

September 8th, 2014

The ISDH has detected an increase of respiratory syndrome statewide in emergency room chief complaint data and has received several calls from hospitals with increased admissions for acute respiratory illness, particularly among children.  Other states, including Missouri, Illinois, Kentucky, and Ohio, have reported similar increases in respiratory illness activity and hospitalizations and are enhancing surveillance.  Several individuals in other states have tested positive for human Enterovirus D68 (EV-D68).

Typically, EV-D68 causes upper respiratory illness, such as low-grade fever, cough, runny nose, sneezing and body/muscle aches.  Infected individuals generally self-recover without incident by treating symptoms.  However, some individuals, especially those with weakened immune systems or underlying medical conditions, such as asthma, may experience severe complications and require hospitalization with supportive therapy.

Three Indiana patients have tested positive for rhinovirus/enterovirus.  Sequencing is pending to determine the specific viral strain.

Diagnosis

The ISDH encourages health care providers to submit specimens to the ISDH Laboratory from patients with acute respiratory illness in which RSV and influenza tests are negative or those who have tested positive for rhinovirus/enterovirus.

Nasopharyngeal swabs (NOT nasal swabs or nasal washes) in viral transport media are required for specimen testing. Instructions for submission of nasopharyngeal swabs to ISDH for testing are located on the ISDH influenza page at http://www.in.gov/isdh/25462.htm under the laboratory specimen information section.

Healthcare providers who identify outbreaks or unusual occurrences of respiratory illness should contact Shawn Richards, Outbreak Supervisor, at srichard@isdh.in.gov or 317.233.7740 to determine if specimens should be sent to ISDH Laboratory for testing.  Specimens that are not authorized to be sent to ISDH for testing will not be tested.  Specimens should arrive at ISDH Laboratory Monday-Friday, excluding state holidays and received within 3 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.

Transmission

Most enterovirus infections in the U.S. occur seasonally during the summer and fall, and outbreaks of tend to occur in several-year cycles.  Respiratory enteroviruses, including EV-D68 and rhinovirus, 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:
    • Wash hands often with soap and water for 20 seconds.
    • Stay home if you are ill.
    • Avoid close contact and sharing cups or eating utensils will those who are ill.
    • Clean and disinfecting frequently touched surfaces.

For questions regarding epidemiology/surveillance or specimen authorization the current respiratory illness or to participate in enterovirus sentinel surveillance, please contact Shawn Richards at srichard@isdh.in.gov or 317.233.7740.   For questions on lab collection or submission please contact Stephanie Dearth at stdearth@isdh.in.gov or 317.921.5843.

For more information on non-polio enteroviruses, please visit the Centers for Disease Control and Prevention (CDC) website at http://www.cdc.gov/non-polio-enterovir

Questions, call Deb McMahan, MD