CDC: EV-D68 found in four patients who died

Federal health officials announced today that four patients who recently died were infected with enterovirus D68 (EV-D68), though it's not clear what role the virus played, while Rhode Island reported that a child died last week of a bacterial infection associated with the virus.

In addition, the count of confirmed infections with the respiratory virus climbed by 28, to 500, and Maine is the latest state to have confirmed cases, the Centers for Disease Control and Prevention (CDC) said in today's update. Cases have been reported in 42 states and Washington, D.C.; almost all the illnesses have been in children.

"EV-D68 has been detected in specimens from four patients who died and had samples submitted for testing," the CDC said. "The role that EV-D68 infection played in these deaths is unclear at this time; state and local health departments are continuing to investigate."

EV-D68, uncommon in the United States until recently, typically causes cold-like symptoms but can lead to serious breathing trouble, especially in children who have asthma, the CDC says.

Death in Rhode Island

CDC officials declined to give any more details on the deaths today. But the Rhode Island Department of Health said in a statement that a Rhode Island child "died last week as a result of Staphylococcus aureus sepsis associated with enteroviral infection (EV-D68)." It added that the combination of S aureus sepsis and EV-D68 infection is very rare and can cause very severe illness in children and adults.

An Associated Press (AP) story today said the child who died was a 10-year-old girl from Cumberland, R.I., who was hospitalized in Providence after she started having trouble breathing.

"We are all heartbroken to hear about the death of one of Rhode Island's children," Michael Fine, MD, director of the Rhode Island Department of Health, said in the statement. "Many of us will have EV-D68. Most of us will have very mild symptoms and all but very few will recover quickly and completely. The vast majority of children exposed to EV-D68 recover completely."

In most cases the symptoms are limited to a runny nose and a low-grade fever, the statement said.

Reports of neurologic symptoms

Meanwhile, there were more reports today of children who experienced polio-like neurologic problems that may be associated with EV-D68. Ten such cases are under investigation in Colorado, and the latest reports cited similar cases in Boston, Michigan, and British Columbia, among other places.

Television station WCVB, Boston's ABC affiliate, reported that four children at a Boston hospital who had polio-like symptoms after a respiratory illness are being tested for EV-D68. It said one of the children tested negative and that results in the other four were still awaited. A doctor said the children had "significant weakness."

Michigan reported an EV-D68 case in a child under 1 year old in Washtenaw County who has been treated and released from the hospital but is now partially paralyzed, The Detroit News reported yesterday.

"We believe this is the first case in Michigan where we've seen some of the neurological involvement, some of the limb weakness or paralysis that's been reported in Colorado," said Susan Ringler-Cerniglia, a spokeswoman for Washtenaw County Public Health.

In Canada, officials with the British Columbia Centre for Disease Control yesterday reported that two of eight patients with confirmed EV-D68 infections developed paralytic symptoms that have persisted for nearly a month. The officials, led by Danuta Skowronski, MD, reported the cases via ProMED-mail, the reporting service of the International Society for Infectious Diseases.

One of the patients, between the ages of 15 and 20, required mechanical ventilation early in the neurologic illness and still needs help breathing, the report said. The other patient, who is younger, has left-arm flaccid paralysis and loss of reflexes, which did not improve during 9 days of hospitalization.

Meanwhile, Colorado officials told CIDRAP News today that there were no new developments today in the investigation of the 10 polio-like cases there.

The CDC announced today that it will present a COCA (Clinician Outreach and Communication) conference call Oct 3 at 2 p.m. EDT to brief clinicians about the "acute neurologic illness of unknown etiology occurring in children." It said the illness features focal limb weakness and abnormalities of the spinal cord gray matter on magnetic resonance imaging (MRI).

See also:

Oct 1 CDC list of affected states

CDC EV-D68 page

Oct 1 Rhode Island Department of Health statement

Oct 1 AP story on Rhode Island case

Oct 1 WCVB TV story

Sep 30 Detroit News story

Sep 30 ProMED post from British Columbia officials

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