Enterovirus D68 cases reach 796 as unexplained neuro illnesses rise
The count of confirmed enterovirus D68 (EV-D68) cases in the United States reached 796 today, and the number of unexplained neurologic illnesses with potential links to the virus has risen to 37, according to the Centers for Disease Control and Prevention (CDC).
The new total of 796 cases is up 16 from yesterday. On the basis of state health department assessments made last week, EV-D68 activity is low or declining in 32 states and is elevated or increasing in 12 states, the CDC reported.
States that have increasing activity, as shown on a CDC map, are Pennsylvania, Virginia, West Virginia, and North Carolina. Forty-six states have had confirmed cases, according to earlier reports.
The number of deaths in patients who were infected with the virus remained at seven, but the CDC has said the virus's role in the deaths is unclear. Almost all the EV-D68 cases have been in children.
Yesterday the CDC reported that the number of unexplained neurologic illnesses under investigation concurrently with the EV-D68 outbreak increased to 37 in 16 states, compared with 17 in 12 states last week. The CDC said it was working to verify more than a dozen additional cases.
According to the CDC case definition, the illnesses involve unexplained limb weakness in patients under age 21, with lesions in the gray matter of the spinal cord. The illnesses were first noticed in Denver, where there was a cluster of 10 cases. Four of those children tested positive for EV-D68, but investigators have not determined whether the virus was a factor in the polio-like illnesses.
CDC EV-D68 information
CDC information on probe of neurologic illnesses
Vaccination coverage in US kindergartners high, but some still vulnerable
Vaccination coverage in US children entering kindergarten last year (2013-14 school year) was at or near the 95% target of the national Healthy People 2020 initiative in most states, but geographic clusters of children with low coverage or high exemption rates remain vulnerable to vaccine-preventable diseases and should be sought out at the local level if possible, says a report in the Oct 17 issue of Morbidity Mortality Weekly Report.
The CDC analyzed vaccination data collected by federally funded state, local, and territorial immunization programs, as they do each year. The median coverage rate for two doses of MMR (measles, mumps, and rubella) vaccine, based on data from 49 states and the District of Columbia (DC), was 94.7%; 23 states reported coverage of 95% or more.
The median coverage rate for varying local requirements for DTaP (diphtheria, tetanus toxoid, and acellular pertussis) vaccine was 95%, with 25 states reporting coverage of 95% or more.
The median rate for two doses of varicella vaccine was 93.3% in the 36 states (and Washington, DC) that have a two-dose requirement; 9 of those states reported coverage of 95% or higher.
The median exemption rate, based on data from 46 states and DC, was 1.8%.
The authors discuss the challenges inherent in collecting the vaccination data, such as states that do not report and varying requirements and reporting methods in different states. "Use of appropriate sampling and survey methods can improve the usefulness of data for local use and comparability of estimates across school, local area, state, and national levels to accurately assess vaccination coverage and track progress toward Healthy People 2020 targets," they say.
Oct 17 MMWR article