Regional Outbreak of Rare Respiratory Virus Hospitalizes Hundreds

Outbreak of enterovirus D68 spreads to several states across the Midwest.

Hundreds of children across several states in the Midwest have been hospitalized due to an outbreak of a potentially serious respiratory infection.

Although incidents of the virus, called enterovirus D68 (EV-D68), typically spike during the months of August and September in limited numbers, the current outbreak has driven an unusually large number of patients to hospitals in several states.

To date, the US Centers for Disease Control and Prevention (CDC) has reported suspected cases in Colorado, Georgia, Illinois, Iowa, Kansas, Kentucky, Missouri, North Carolina, Ohio, and Oklahoma, with approximately 1000 children hospitalized throughout those regions.

In a statement, the CDC said it is monitoring the situation closely.

“Health care providers should consider EV-D68 as a possible cause of acute, unexplained severe respiratory illness; suspected clusters or outbreaks should be reported to local or state health departments,” the CDC said.

According to the CDC, the respiratory virus causes symptoms similar to those of a severe cold, including respiratory illness, febrile rash illness, and neurologic illness, such as aseptic meningitis and encephalitis. While EV-D68 primarily causes respiratory illness, the CDC noted the full spectrum of the disease remains unclear, and there are currently no vaccines or specific treatments available to combat it.

The current outbreak appeared on the CDC’s radar on August 19, 2014, when the agency was notified by the Children’s Mercy Hospital in Kansas City, Missouri, concerning an increase in young patients with severe respiratory illness, some of whom were admitted to the pediatric intensive care unit. There was also a bump in detections of rhinovirus/enterovirus in specimens obtained from August 5, 2014, to August 19, 2014, the CDC stated.

The Missouri Department of Health and Senior Services reported more than 300 cases of respiratory illnesses at the facility, with approximately 15% of those cases resulting in children being placed under intensive care. Subsequent testing of the specimens at a specialized CDC laboratory found 19 of 22 tested specimens were positive for EV-D68.

On August 23, 2014, the University of Chicago Medicine Comer Children’s Hospital in Illinois reported to the CDC a similar increase in patients with respiratory illness.

The Children's Hospital Colorado in Denver reported seeing more than 900 children with EV-D68 symptoms in the emergency room since August 2014, with 86 patients admitted with severe symptoms, according to ABC News.

Since EV-D68 was originally isolated in California in 1962, incidents of the virus have been sporadically reported in the United States. The National Enterovirus Surveillance System received reports of 79 cases of the illness from 2009 to 2013, while small clusters of EV-D68 associated with respiratory illness were reported in 2009 and 2010.

Given the atypical number of cases in the current outbreak, the CDC has warned the public that the EV-D68 epidemic could get much worse before it gets better.

"It is only 10 states now, but it's going to be across the country,” said Richard Besser, MD, a medical correspondent for ABC News. “So, if your state doesn't have it now, watch for it. It's coming.”