Enterovirus 68

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Enterovirus 68
Virus classification
Group:Group IV ((+)ssRNA)
Family:Picornaviridae
Genus:Enterovirus
Species:Enterovirus D
Subtype
Enterovirus 68
Synonyms
Human rhinovirus 87[1]
Enterovirus 68 (EV68, EV-D68, HEV68) is a member of the Picornaviridae family, an enterovirus. First isolated in California in 1962 and considered rare, it has been on a worldwide upswing in the 21st century.[2][3][4]

Biology[edit]

EV68 is one of the more than one hundred types of enteroviruses, a group of ssRNA viruses containing the polioviruses, coxsackieviruses, and echoviruses. It is unenveloped. Unlike all other enteroviruses, EV68 displays acid lability and a lower optimum growth temperature, both characteristic features of the humanrhinoviruses. It was previously called human rhinovirus 87 by some researchers.[5]

Epidemiology[edit]

Since its discovery in 1962, EV68 has been described mostly sporadically, in isolated cases: six clusters (equal to or more than 10 cases) or outbreaksbetween 2005 and 2011 have been reported from the Philippines, Japan, the Netherlands, and the states of Georgia, Pennsylvania and Arizona in the United States.[6] EV68 was found in 2 of 5 children during a 2012/13 cluster of polio-like disease in California.[7]
Cases have been described to occur late in the enterovirus season,[6] which is typically during the warm months, from spring to autumn (August and September in the Northern hemisphere).

Predisposing factors[edit]

Children less than 5 years old and children with asthma appear to be most at risk for the illness,[8] although illness in adults with asthma andimmunosuppression have also been reported.[6]

2014 North American Outbreak[edit]

Main article: 2014 Enterovirus D68 outbreak
In August 2014, the virus caused clusters of respiratory disease in eleven, mostly Midwestern, states of the U.S., first confirmed in Kansas City, Missouri, and Chicago.[9] By mid-September there were 145 suspected cases in states in the US, including Colorado, Louisiana, Alabama, New York, New Jersey, North Carolina, Michigan, Missouri, Iowa, Illinois, Montana, Kentucky, Kansas, Oklahoma, Indiana, Connecticut, Massachusetts, Rhode Island, and Wisconsin (Including one involving a previously asthmatic non-immunocompromised adult).[citation needed] In Canada in September 2014, 49 cases of the virus were confirmed in Alberta,[10] three in British Columbia, and over 100 in Ontario.[11][12] Health officials reported Los Angeles County's first case of enterovirus 68 on October 1, 2014.-JT760.The first case of enterovirus D68, a potentially serious respiratory illness, has been confirmed in Riverside County on October 3, 2014. The health department said the teenager is from southwest Riverside County and was treated in San Diego County.-JT760.
According to the CDC, 538 people from 43 states have been confirmed between mid-August to October as having the virus. There have been reports specifically among younger children of muscle paralysis, and a few deaths, however the paralysis accounts and deaths have not yet had a proven link directly to the virus.[13]
The first death to be blamed on the virus is the death of a 4-year-old boy named Eli Waller. According to a New Jersey health officer, "He had no signs of any illness that night, and his passing was sudden and shocking."[14]

Signs and symptoms[edit]

EV68 almost exclusively causes respiratory illness, and varies from mild to severe. Initial symptoms are similar to those for the common cold, including a runny nose, sore throat, cough, and fever.[11] As the disease progresses, more serious symptoms may occur, including difficulty breathing as in pneumonia, reduced alertness, a reduction in urine production, and dehydration, and may lead to respiratory failure.[6][11] Like all enteroviruses, it can cause variable skin rashes, abdominal pain and soft stools. Two California children who tested posted for the virus, had muscle weakness or paralysis of one or more limbs reaching peak severity within 48 hours of onset. "Recovery of motor function was poor at 6-month follow-up."[15] As of October 2014 the CDC is investigating 10 cases of paralysis and/or cranial dysfunction in Colorado and other reports around the country, coinciding with the increase in enterovirus D68 activity.[16]

Treatment[edit]

There is no specific treatment and no vaccine, so the illness has to run its course; treatment is directed against symptoms (symptomatic treatment). Most people recover completely, and few need to be hospitalized.[6] Five EV68 paralysis cases were treated with steroids, intravenous immunoglobulin and/orplasma exchange. The treatment had no apparent benefit as no recovery of motor function was seen.[15]

Prevention[edit]

The US Centers for Disease Control and Prevention (CDC) recommend "avoiding those who are sick." Since the virus is spread through saliva and phlegm as well as stool, washing hands is most important.[11] Sick people can avoid spreading the virus by basic sanitary measures, such as covering the nose and mouth when sneezing or coughing.[8] Other measures including cleaning surfaces and toys.[11]
For hospitalized patients with EV-D68 infection, the CDC recommends transmission-based precautions, i.e. standard precautions, contact precautions, as is recommended for all enteroviruses,[17] and to consider droplet precautions [9]

Environmental cleaning[edit]

Surfaces in healthcare settings should be cleaned with a hospital-grade disinfectant with an EPA label claim for any of several non-enveloped viruses (e.g. norovirus, poliovirus, rhinovirus).[18]

See also[edit]

  • Enterovirus 71, a similar, related virus also first isolated in California in the 1960s

References[edit]

  1. Jump up^ Ishiko, H.; Miura, R.; Shimada, Y.; Hayashi, A.; Nakajima, H.; Yamazaki, S.; Takeda, N. (2002). "Human Rhinovirus 87 Identified as Human Enterovirus 68 by VP4-Based Molecular Diagnosis". Intervirology 45 (3): 136.doi:10.1159/000065866. edit
  2. Jump up^ Oberste, M. S. (2004). "Enterovirus 68 is associated with respiratory illness and shares biological features with both the enteroviruses and the rhinoviruses". Journal of General Virology 85 (9): 2577.doi:10.1099/vir.0.79925-0. edit
  3. Jump up^ Lauinger, I. L.; Bible, J. M.; Halligan, E. P.; Aarons, E. J.; MacMahon, E.; Tong, C. Y. W. (2012). "Lineages, Sub-Lineages and Variants of Enterovirus 68 in Recent Outbreaks". PLoS ONE 7 (4): e36005.doi:10.1371/journal.pone.0036005. edit
  4. Jump up^ Tokarz, R.; Firth, C.; Madhi, S. A.; Howie, S. R. C.; Wu, W.; Sall, A. A.; Haq, S.; Briese, T.; Lipkin, W. I. (2012). "Worldwide emergence of multiple clades of enterovirus 68". Journal of General Virology 93: 1952.doi:10.1099/vir.0.043935-0. edit
  5. Jump up^ Blomqvist, S.; Savolainen, C.; Raman, L.; Roivainen, M.; Hovi, T. (2002). "Human Rhinovirus 87 and Enterovirus 68 Represent a Unique Serotype with Rhinovirus and Enterovirus Features". Journal of Clinical Microbiology 40 (11): 4218. doi:10.1128/JCM.40.11.4218-4223.2002. PMID 12409401. edit
  6. ^ Jump up to:a b c d e "Clusters of Acute Respiratory Illness Associated with Human Enterovirus 68 --- Asia, Europe, and United States, 2008--2010". Morbidity and Mortality Weekly Report (MMWR). 60(38): CDC. September 30, 2011. pp. 1301–1304. Retrieved 9 September 2014.
  7. Jump up^ Brown, Eryn (23 February 2014). "Mysterious polio-like illnesses reported in some California children". LA Times. Retrieved 25 February 2014.
  8. ^ Jump up to:a b Gillian Mohney (2014-09-06). "Respiratory Virus Sickening Children in Colorado". ABC News.
  9. ^ Jump up to:a b "Severe Respiratory Illness Associated with Enterovirus D68 — Missouri and Illinois, 2014". Morbidity and Mortality Weekly Report (MMWR) (CDC). 63(Early Release): 1–2. September 8, 2014. Retrieved 9 September 2014.
  10. Jump up^ Herriman, Robert (23 September 2014). "Confirmed enterovirus D68 cases in Alberta rise to 49". Outbreak News Today. The Global Dispatch, Inc. Retrieved 27 September 2014.
  11. ^ Jump up to:a b c d e "Enterovirus D68: 3 confirmed cases in B.C.'s Lower Mainland".CBC News. 16 September 2014. Retrieved 17 September 2014.
  12. Jump up^ Carville, Olivia (24 September 2014). "100 Ontario children infected with vicious EV-D68 virus". Toronto Star. Retrieved 25 September 2014.
  13. Jump up^ http://www.cdc.gov/non-polio-enterovirus/outbreaks/EV-D68-states.html
  14. Jump up^ http://abcnews.go.com/Health/preschool-enterovirus-victim-died-sleep/story?id=25996482
  15. ^ Jump up to:a b Alexandra Roux,Sabeen Lulu, Emmanuelle Waubant,Carol Glaser,Keith Van Haren (April 29, 2014). "A Polio-Like Syndrome in California: Clinical, Radiologic, and Serologic Evaluation of Five Children Identified by a Statewide Laboratory over a Twelve-Months Period". Poster Session III: Child Neurology and Developmental Neurology III. Retrieved 9 September 2014.
  16. Jump up^ "CDC continues investigation of neurologic illness; will issue guidelines".AAP News (The American Academy of Pediatrics). 3 October 2014. Retrieved 6 October 2014.
  17. Jump up^ Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. p. 225. Retrieved 17 September 2014.
  18. Jump up^ CDC (2003). "Guidelines for Environmental Infection Control in Health-Care Facilities". Retrieved 17 September 2014.