SFDPH Health Advisory: Enterovirus-D68 and Acute Flaccid Paralysis September 24, 2014 Public Health, SF Dept of Public Health San Francisco Department of Public Health, Acute Flaccid Paralysis, enterovirus, EV-D68, health alert 0 Updated October 6, 2014. The San Francisco Department of Public Health was notified today that a child less than 18 years of age with severe respiratory illness was confirmed to have Enterovirus-D68 (EV-D68). The patient was discharged in good condition. EV-D68 continues to be identified nationwide in cases with severe respiratory illness. Enterovirus-D68 has been confirmed in several children with acute flaccid paralysis in Colorado. Enteroviruses can cause respiratory and gastrointestinal illness, rash and neurologic illnesses. While most infections cause mild or no symptoms, some can be severe. There are more than 100 types that cause approximately 10-15 million infections in the United States each year. Enteroviruses typically occur in the summer and fall. Since August 2014, patients with severe respiratory illness due to EV-D68 have been hospitalized in most states, including California. Most have been afebrile, and many have had wheezing. Although the findings to date have been in children, EV-D68 may also affect adults. There are no available vaccines or specific treatments for EV-D68, and clinical care is supportive. Action Requested of Clinicians Consider EV-D68 as a possible cause of (a) acute, unexplained severe respiratory illness, or (b) acute flaccid paralysis, especially in children. Report (a) patients with acute neurologic illness meeting the criteria below or (b) clusters of several respiratory illness, in persons of any age. Report 24/7 to SFDPH Communicable Disease Control Unit (CDCU) at (415) 554-2830. Test respiratory specimens for enterovirus and other respiratory viruses such as influenza at your hospital or commercial laboratory, in hospitalized patients 18 years and under with several respiratory illness. Confirmatory testing and subtyping to identify EV-D68 must be coordinated through SFDPH CDCU. Contact CDCU at (415) 554-2830 before submitting specimens for EV-D68 testing. CDCU will coordinate submission of specimens for testing. See guidelines below for testing eligibility and instructions for specimen processing. Implement standard, contact, and droplet precautions when caring for known or suspected EV-D68 patients. Click here to view the SFDPH health advisory on Enterovirus-D68. Eligibility for Testing Testing for EV-D68 takes a minimum 14 days at the California Department of Public Health (CDPH) Viral and Rickettsial Disease Laboratory (VRDL) and includes real-time reverse transcription polymerase chain reaction (rRT-PCR) testing for enterovirus, followed by sequence analysis to identify EV-D68. SFDPH CDCU will help determine appropriateness of testing in individual cases, in consultation with CDPH. Patients with Respiratory Illness: Health care providers should consider EV-D68 as a possible cause of acute, unexplained severe respiratory illness, even in the absence of fever. Priority for EV-D68 testing: Children age < 18 years with severe respiratory illness who are hospitalized AND who have tested positive for rhinovirus and/or enterovirus by PCR at a commercial or hospital laboratory. Since many commercially available PCR tests cannot distinguish enteroviruses from rhinoviruses, patients with enterovirus- or rhinovirus-positive specimens should be considered for EV-D68 testing. Patients should also be tested for influenza and respiratory syncytial virus (RSV), since both can cause severe respiratory illness in young children, and early treatment of influenza with antivirals can reduce morbidity and mortality. Patients with Neurologic Symptoms: Health care providers should consider EV-D68 as a possible cause of acute flaccid paralysis, particularly in patients aged < 21 years. Criteria for testing include patients who: Have acute flaccid paralysis, including absent or significantly diminished reflexes in one or more limbs, without a confirmed traumatic, neoplastic, arboviral or vascular etiology AND MRI shows gray matter involvement of the spinal cord or EMG shows anterior horn disease Prior enterovirus/rhinovirus positive result is not required for testing for patients meeting these clinical criteria. The San Francisco Department of Public Health (SFDPH) provides this guidance based on current information. For the most up-to-date information, visit www.sfcdcp.org. Recommendations may change, and SF recommendations may differ from those issued by Centers for Disease Control & Prevention (CDC) or California Department of Public Health (CDPH). Comments are closed.
