CDC cites 2 more deaths in EV-D68 cases, more polio-like illnesses

The Centers for Disease Control and Prevention (CDC) has reported two more deaths in children who were infected with enterovirus D-68 (EV-D68), and a related CDC investigation has revealed another six unexplained polio-like illnesses in children.

The number of deaths in patients who tested positive for EV-D68 has reached 11, up by 2, the CDC said in an update today. Also, the national tally of EV-D68 infections increased by 4, to 1,116. The infections involve severe respiratory illness, nearly all of them in children.

The CDC has not released any findings on the role EV-D68 played in the 11 deaths, saying state health departments are investigating those cases. But in early October, New Jersey officials said the virus caused the death of a 4-year-old boy who died in his sleep.

Today's update suggests a slight uptick in overall EV-D68 activity the week of Oct 26 to Nov 1, with cases described as low in 37 states, elevated in 7, and increasing in 3. A week earlier, EV-D68 circulation was listed as low in 39 states and elevated in 7, with 4 not reporting.

The CDC said it has tested more than 2,300 specimens from children with severe respiratory illnesses in recent months, and about 40% have been positive for EV-D68. About a third have tested positive for an enterovirus or rhinovirus other than EV-D68.

Polio-like cases reach 70

In the related investigation, the CDC reported that the number of recent unexplained neurologic illnesses involving limb weakness in children has reached 70, up by 6 since a week ago. The number of affected states is now 29, one more than last week.

The mysterious cases began with a cluster in Colorado in August. Among 10 cases there, 4 patients tested positive for EV-D68. The CDC is investigating whether the neurologic cases are linked to the EV-D68 outbreak, among other possible causes, but has not reported any conclusions yet. Today's update does not say how many of the 70 patients were infected with EV-D68.

The case definition used in the investigation involves acute onset of focal limb weakness since Aug 1 in persons under 21 years old, with magnetic resonance imaging (MRI) evidence of a lesion mainly in the gray matter of the spinal cord.

The CDC said it is still checking fewer than half a dozen additional reports of similar polio-like illnesses.

Similar neurologic case in France

In related news, French researchers today described a case of acute flaccid paralysis (AFP) in a 4-year-old boy who had pneumonia associated with EV-D68. They reported the case in today's issue of Eurosurveillance.

The patient was a 4-year-old who first got sick in September with a headache and vomiting, which progressed to acute respiratory distress, hemodynamic failure, and flaccid paralysis of all four limbs. The boy improved with intensive care, including mechanical ventilation, but as of yesterday he had recovered only partial use of his extremities, the report says.

Ev-D68 was found in the boy's respiratory and stool samples but not in his cerebrospinal fluid (CSF), which counters the supposition that the virus caused the AFP but doesn't rule it out, the authors say. They also say the case has several parallels with the cases in the United States, but also differs in certain respects, including the presence of myocarditis before the onset of AFP.

See also:

CDC information on the current EV-D68 outbreak

CDC information on unexplained neurologic illnesses

Nov 6 Eurosurveillance report

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