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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

EV68 is one of the more than hundred types of enteroviruses, a group of ssRNA viruses containing the polioviruses, coxsackieviruses, and echoviruses. Unlike all other enteroviruses, EV68 displays acid lability and a lower optimum growth temperature, both characteristic features of the human rhinoviruses. Enterovirus 68 is the same as Human rhinovirus 87.[5]

Epidemiology

Since its discovery in 1962, EV68 was described mostly sporadically, in isolated cases: six clusters (equal to or more than 10 cases) or outbreaks between 2005 and 2011 have been reported from the Philippines, Japan, the Netherlands, and three states in the United States (Georgia, Pennsylvania and Arizona).[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 fall, so in August/September on the Northern hemisphere.

Predisposing factors

Children under the age of 5 years and children with asthma appear to be most at risk for the illness,[8] although adults with asthma and immunosuppression have also been reported.[6]

2014 Outbreak in the U.S

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 97 confirmed cases, in six states—Colorado, Nebraska, Missouri, Iowa, Illinios, and Indiana.[10]

Signs and symptoms

EV68 almost exclusively causes respiratory illness, and varies from mild to severe; symptoms thus include throat ache, runny nose, cough, difficulty breathing as in pneumonia up to respiratory failure.[6] Like all enteroviruses, it can cause variable skin rashes, abdominal pain and soft stools. In two California children, it was associated with 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. Two children tested positive for enterovirus-68, a rare virus previously associated with polio-like symptoms."[11]

Prevention

The Centers for Disease Control and Prevention recommend "avoiding those who are sick". Since the virus is spread through saliva and phlegm as well as stool, washing hands is most important. Sick people can avoid spreading the virus, by basic sanitary measures covering the nose and mouth during sneezes or coughs.[8]

“Enteroviruses can be spread by close contact with an infected person who may cough or sneeze on you and by touching objects or surfaces that have the virus on them and then touching your eyes, nose or mouth,” said Patsy Stinchfield, pediatric nurse practitioner and Children’s Hospitals and Clinics of Minnesota director of infectious disease prevention and control. [12]

Treatment

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/or plasma exchange. The treatment had no apparent benefit as no recovery of motor function was seen.[11]

References

  1. ^ Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi:10.1159/000065866 , please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi=10.1159/000065866 instead.
  2. ^ Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi:10.1099/vir.0.79925-0, please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi=10.1099/vir.0.79925-0 instead.
  3. ^ Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi:10.1371/journal.pone.0036005, please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi=10.1371/journal.pone.0036005 instead.
  4. ^ Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi:10.1099/vir.0.043935-0, please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi=10.1099/vir.0.043935-0 instead.
  5. ^ Attention: This template ({{cite doi}}) is deprecated. To cite the publication identified by doi:10.1128/JCM.40.11.4218-4223.2002 , please use {{cite journal}} (if it was published in a bona fide academic journal, otherwise {{cite report}} with |doi=10.1128/JCM.40.11.4218-4223.2002 instead.
  6. ^ 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.{{cite web}}: CS1 maint: location (link)
  7. ^ Brown, Eryn (23 February 2014). "Mysterious polio-like illnesses reported in some California children". LA Times. Retrieved 25 February 2014.
  8. ^ a b Gillian Mohney (2014-09-06). "Respiratory Virus Sickening Children in Colorado". ABC News.
  9. ^ "Severe Respiratory Illness Associated with Enterovirus D68 — Missouri and Illinois, 2014". Morbidity and Mortality Weekly Report (MMWR). 63(Early Release). CDC: 1–2. September 8, 2014. Retrieved 9 September 2014.
  10. ^ http://www.cdc.gov/non-polio-enterovirus/about/ev-d68.html
  11. ^ 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.{{cite web}}: CS1 maint: multiple names: authors list (link)
  12. ^ "The facts about enterovirus D68". http://www.childrensmn.org/. Children's Hospitals and Clinics of Minnesota. {{cite web}}: External link in |website= (help)
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