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 thePicornaviridae 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[edit]

EV68 is one of the more than hundred types of enteroviruses, a group of ssRNA viruses containing thepolioviruses, coxsackieviruses, and echoviruses. It is unenveloped. Unlike all other enteroviruses, EV68 displays acid lability and a lower optimum growth temperature, both characteristic features of the human rhinoviruses.

Epidemiology[edit]

Since its discovery in 1962, EV68 has been 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 the states of Georgia, Pennsylvania and Arizona in the United States.[5] EV68 was found in 2 of 5 children during a 2012/13 cluster of polio-like disease in California.[6]

Cases have been described to occur late in the enterovirus season,[5] which is typically during the warm months, from spring to autumn (August and September in the Northern hemisphere).

Predisposing factors[edit]

Children less than 5 years old and children with asthma appear to be most at risk for the illness,[7]although adults with asthma and immunosuppression have also been reported.[5]

2014 North American Outbreak[edit]

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.[8] By mid-September there were 130 suspected cases in states in the US, including Colorado, Louisiana, Alabama, New York, New Jersey, Missouri, Iowa, Illinois, Montana, Kentucky, Kansas, Oklahoma, Indiana, Connecticut, and Massachusetts.[citation needed] In Canada in September 2014, 18 cases of the virus were confirmed inAlberta and three in British Columbia .[9]

Signs and symptoms[edit]

EV68 almost exclusively causes respiratory illness, and varies from mild to severe. Initial symptoms are similar to those for the common cold, including a runny nose, sore throat, cough, and fever.[9] As the disease progresses, more serious symptoms may occur, including difficulty breathing as inpneumonia, reduced alertness, a reduction in urine production, and dehydration, and may lead torespiratory failure.[9][5] 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."[10]

Treatment[edit]

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.[5] Five EV68 paralysis cases were treated with steroids, intravenous immunoglobulinand/or plasma exchange. The treatment had no apparent benefit as no recovery of motor function was seen.[10]

Prevention[edit]

The US Centers for Disease Control and Prevention (CDC) recommend "avoiding those who are sick". Since the virus is spread through saliva and phlegm as well as stool, washing hands is most important.[9] Sick people can avoid spreading the virus by basic sanitary measures, such as covering the nose and mouth when sneezing or coughing.[7] Other measures including cleaning surfaces and toys.[9]

For hospitalized patients with EV-D68 infection the CDC recommends transmission-based precautions, i.e. standard precautions, contact precautions, as is recommended for all enteroviruses[11] and to consider droplet precautions [8]

http://en.wikipedia.org/wiki/Enterovirus_68