Thread: CDC official: Virus hitting Midwest could be 'tip of iceberg'

CDC official: Virus hitting Midwest could be 'tip of iceberg'

By Michael Martinez, John Newsome and Elizabeth Cohen, CNN
updated 1:52 PM EDT, Sun September 7, 2014
Source: KMGH

STORY HIGHLIGHTS

• NEW: CDC official says reported cases may be tip of iceberg in terms of severe cases
• Missouri doctor calls situation "unprecedented" in terms of kids in intensive care
• "This is the worst I've seen in my time," a Colorado doctor says
• Enterovirus EV-D68 causes respiratory illnesses like a cold, only worse

(CNN) -- A respiratory virus is sending hundreds of children to hospitals in Missouri and possibly throughout the Midwest and beyond, officials say.

The unusually high number of hospitalizations reported now could be "just the tip of the iceberg in terms of severe cases," said Mark Pallansch, a virologist and director of the Centers for Disease Control and Prevention's Division of Viral Diseases.

"We're in the middle of looking into this," he told CNN on Sunday.

"We don't have all the answers yet."

Ten states have contacted the CDC for assistance in investigating clusters of enterovirus -- Colorado, North Carolina, Georgia, Ohio, Iowa, Illinois, Missouri, Kansas, Oklahoma, and Kentucky.

Enteroviruses, which bring on symptoms like a very intense cold, aren't unusual. They're actually common. When you have a bad summer cold, often what you have is an enterovirus, he said. The season often hits its peak in September.

Top 8 germiest places in school

The unusual situation now is that there have been so many hospitalizations.

The virus is sending 30 children a day to a Kansas City, Missouri, hospital, where about 15% of the youngsters were placed in intensive care, officials said.

In a sign of a possible regional outbreak, Colorado, Illinois and Ohio are reporting cases with similar symptoms and are awaiting testing results, according to officials and CNN affiliates in those states.

In Kansas City, about 450 children were recently treated at Children's Mercy Hospital, and at least 60 of them received intensive hospitalization, spokesman Jake Jacobson said.

"It's worse in terms of scope of critically ill children who require intensive care. I would call it unprecedented. I've practiced for 30 years in pediatrics, and I've never seen anything quite like this," said Dr. Mary Anne Jackson, the hospital's division director for infectious diseases.

"We've had to mobilize other providers, doctors, nurses. It's big," she said.

The Kansas City hospital treats 90% of that area's ill children. Staff members noticed an initial spike on August 15, Jackson said.

"It could have taken off right after school started. Our students start back around August 17, and I think it blew up at that point," Jackson said. "Our peak appears to be between the 21st and the 30th of August. We've seen some leveling of cases at this point."

No vaccine for virus

This particular type of enterovirus -- EV-D68 -- is uncommon, but not new. It was first identified in the 1960s and there have been fewer than 100 reported cases since that time. But it's possible, Pallansch said, that the relatively low number of reports might be because EV-D68 is hard to identify.

EV-D68 was seen last year in the United States and this year in various parts of the world. Over the years, clusters have been reported in Georgia, Pennsylvania, Arizona and various countries including the Philippines, Japan and the Netherlands.

An analysis by the CDC showed at least 19 of the Kansas City children tested positive for EV-D68, according to the Missouri Department of Health and Senior Services.

Vaccines for EV-D68 aren't currently available, and there is no specific treatment for infections, the Missouri agency said.

"Many infections will be mild and self-limited, requiring only symptomatic treatment," it said. "Some people with several respiratory illness caused by EV-D68 may need to be hospitalized and receive intensive supportive therapy."

Some cases of the virus might contribute to death, but none of the Missouri cases resulted in death and no data are available for overall morbidity and mortality from the virus in the United States, the agency said.

Symptoms include fever, body and muscles aches, sneezing, coughing and rash, one hospital said.

Jackson said physicians in other Midwest states reported cases with similar symptoms.

"The full scope is yet to be known, but it would appear it's in the Midwest. In our community, meticulous hand-washing is not happening. It's just the nature of kids," Jackson said.
"Worst I've seen"

Denver also is seeing a spike in respiratory illnesses resembling the virus, and hospitals have sent specimens for testing to confirm whether it's the same virus, CNN affiliate KUSA said.

More than 900 children have gone to Children's Hospital Colorado emergency and urgent care locations since August 18 for treatment of severe respiratory illnesses, including enterovirus and viral infections, hospital spokeswoman Melissa Vizcarra told CNN. Of those, 86 have been sick enough to be admitted to the Aurora facility.

And Rocky Mountain Hospital for Children had five children in intensive care and 20 more in the pediatric unit, KUSA said last week.

"This is the worst I've seen in my time here at Rocky Mountain Hospital for Children," Dr. Raju Meyeppan told the outlet. "We're going to have a pretty busy winter at this institution and throughout the hospitals of Denver."

Will Cornejo, 13, was among the children in intensive care at Rocky Mountain Hospital for Children after he came down with a cold last weekend and then woke up Tuesday night with an asthma attack that couldn't be controlled with his medicine albuterol. His mother, Jennifer, called 911 when her son's breathing became shallow, and her son was airlifted to the Denver hospital, she told KUSA.

Her son was put on a breathing tube for 24 hours.

"It was like nothing we've ever seen," Jennifer Cornejo told KUSA. "He was unresponsive. He was laying on the couch. He couldn't speak to me. He was turning white and his lips turned blue.

"We're having a hard time believing that it really happened," she added. "We're much better now because he is breathing on his own. We're on the mend."

Restricting kids' visits with patients

In East Columbus, Ohio, Nationwide Children's Hospital saw a 20% increase in patients with respiratory illnesses last weekend, and Dr. Dennis Cunningham said patient samples are being tested to determine whether EV-D68 is behind the spike, CNN affiliate WTTE reported.

Elsewhere, Hannibal Regional Hospital in Hannibal, Missouri, reported "recent outbreaks of enterovirus infections in Missouri and Illinois," the facility said this week on its Facebook page.

Blessing Hospital in Quincy, Illinois, saw more than 70 children with respiratory issues last weekend, and seven of them were admitted,CNN affiliate WGEM reported. The hospital's Dr. Robert Merrick believes that the same virus that hit Kansas City is causing the rash of illnesses seen at the Quincy and Hannibal hospitals, which both imposed restrictions this week on children visiting patients, the affiliate said.

"Mostly we're concerned about them bringing it in to a vulnerable patient. We don't feel that the hospital is more dangerous to any other person at this time," Merrick told WGEM.

Blessing Hospital is working with Illinois health officials to identify the virus, the hospital said in a statement.

While there are more than 100 types of enteroviruses causing up to 15 million U.S. infections annually, EV-D68 infections occur less commonly, the Missouri health agency said. Like other enteroviruses, the respiratory illness appears to spread through close contact with infected people, the agency said.

"Unlike the majority of enteroviruses that cause a clinical disease manifesting as a mild upper respiratory illness, febrile rash illness, or neurologic illness (such as aseptic meningitis and encephalitis), EV-D68 has been associated almost exclusively with respiratory disease," the agency said.

Clusters of the virus have struck Asia, Europe and the United States from 2008 to 2010, and the infection caused relatively mild to severe illness, with some intensive care and mechanical ventilation, the health agency said.

To reduce the risk of infection, individuals should wash hands often with soap and water for 20 seconds, especially after changing diapers; avoid touching eyes, nose and mouth with unwashed hands; avoid kissing, hugging and sharing cups or eating utensils with people who are sick; disinfect frequently-touched surfaces such as toys and doorknobs; and stay home when feeling sick, the Missouri agency said.

Rare outbreak in Tokyo as WHO warns of spread of dengue fever

Sierra Leone plans nationwide lockdown to stop spread of Ebola

http://www.cnn.com/2014/09/07/health...html?hpt=hp_c2

http://www.alipac.us/f9/illegal-immi...states-310462/

http://www.alipac.us/f12/town-halls-...grants-310114/

http://www.alipac.us/f19/cdc-caught-...deaths-298303/

http://www.alipac.us/f19/mystery-dis...mbodia-260592/

No question about where this came from? Big expense for the parents of these children.....
Respiratory virus sends hundreds of children in Colorado, Missouri to the hospital

Hundreds of children in several states, including Ohio and Illinois, have been hospitalized with similar cold-like symptoms in the last few weeks, and officials suspect the outbreaks are linked to human enterovirus 68.

BY VICTORIA TAYLOR
NEW YORK DAILY NEWS
Sunday, September 7, 2014, 3:27 PM

MIROSLAVMISIURA/GETTY IMAGES/ISTOCKPHOTO

The suspected outbreak of human enterovirus 68 has affected at least 10 states.

A respiratory virus may be to blame for the hospitalization of hundreds of children across the Midwest, officials said.
The illness has not been officially identified, but it is believed to be human enterovirus 68, according to ABC News.
The virus has symptoms similar to those experienced during a bad cold and may hit children with asthma particularly hard.

At least 10 states have contacted the Centers for Disease Control and Prevention about similar respiratory illness-related outbreaks — Colorado, Missouri, Ohio, Kansas, Oklahoma, North Carolina, Illinois, Kentucky, Georgia and Iowa.

The Missouri Department of Health & Senior Services said at the end of Augustthat more than 300 children were treated at a Kansas City hospital for respiratory illnesses and 15% of them needed to be put in the ICU. The total number of cases has risen to 450 by Sept. 2.

Children’s Hospital Colorado locations reported treating more than 900 children for severe respiratory illnesses since Aug. 18 and 86 of them needed to be admitted to the hospital, according to 7News.

Nationwide Children’s Hospital in Columbus, Ohio, also saw an increased volume in people complaining of respiratory illnesses at the end of August and beginning of September, The Columbus Dispatch reported.

The outbreaks have caused some facilities to make temporary changes to their visitor policies.

The Blessing Hospital in Quincy, Ill., has barred children under 12 from visiting “until further notice” because of a not-yet-identified virus that resembles human enterovirus 68 and has affected more than 70 youths in the area.

Children in Colorado suffering from dangerous new virus








Children’s Mercy in Kansas City, Mo., has also banned children under 12 from visiting inpatients.

Officials told CNN that enteroviruses are not uncommon, but it is unusual that so many children have been hospitalized.

There is no vaccine for human enterovirus 68. According to Missouri health officials, there is also no specific treatment for the virus.

“Many infections will be mild and self-limited, requiring only symptomatic treatment,” the health alert reads. “Some people with severe respiratory illness caused by EV-D68 may need to be hospitalized and receive intensive supportive therapy.”

Officials recommend washing your hands frequently, disinfecting touched surfaces and avoiding close contact with sick people to reduce your risk of becoming ill.

http://www.nydailynews.com/life-style/health/respiratory-virus-strikes-children-midwest-article-1.1931265

At least 10 states have contacted the Centers for Disease Control and Prevention about similar respiratory illness-related outbreaks — Colorado, Missouri, Ohio, Kansas, Oklahoma, North Carolina, Illinois, Kentucky, Georgia and Iowa.

Were these kids walking petri dishes?

Counties Worry About Cost of Immigrant-Minor Influx

Mecklenberg, Durham, Wake facing $7 million price tag

By Dan Way
Sep. 4th, 2014
Share on facebookShare on twitterShare on emailShare on favoritesShare on printMore Sharing ServicesMore|





RALEIGH — Most of the 1,429 unaccompanied minors relocated to North Carolina after they entered the United States illegally were released to host families in Mecklenburg, Durham, and Wake counties, raising health and safety concerns, as well as concerns about increased education costs to local governments.

Estimated additional costs to absorb the influx of unaccompanied minors, based on 2012-13 state, federal, and local per-pupil education and capital-expense records, would be more than $7 million for the three counties alone: $4.07 million in Mecklenburg County, $1.79 million in Durham County, and $1.51 million in Wake County.

Those numbers are based on average per-pupil costs, and do not include additional state and federal funding required for students from low-income families, students who are English language learners, and students who have disabilities. And with waves of unaccompanied minors still streaming into the country, it is uncertain how many more will be relocated to North Carolina.

A just-released report from the Federation for American Immigration Reform says North Carolina statewide will pay $20,861,808 in additional education costs this school year, ranking it No. 11 among the states, due to the influx of the unaccompanied minors. FAIR says the national cost will be $761 million.

“We have had concern about the lack of a transparent plan from the Obama Administration to deal with this situation in a humanitarian and practical way,” said Alexandra Lefebvre, spokeswoman at the N.C. Department of Health and Human Services, the state agency at the forefront of the situation.

“In the last few weeks, the federal government has provided some aggregate county level data, more specifics about the background checks, and indicated where sponsors could retrieve medical records for unaccompanied alien children,” Lefebvre said.

“This information, while piecemeal, has provided some additional assurances. We are still hoping to get additional information, such as how children are receiving appropriate follow-up care, or what is the Obama Administration’s plan to ensure the sponsors maintain appropriate contacts with our legal system,” she said.

Federal Office of Refugee Resettlement data from Jan. 1 to July 31 shows 488 unaccompanied minors were transferred to Mecklenburg County, 170 to Wake County, and 157 to Durham County.

The federal government did not say where the other 614 minors were sent. It only releases county locations when 50 or more children are sent there.

State Department of Public Instruction spokeswoman Vanessa Jeter said the state is not tracking where unaccompanied minors are being sent to school. She said she is not aware of any coordination between the federal government and DPI, but did provide a U.S. Department of Education civil rights fact sheet [ http://www2.ed.gov/policy/rights/gui...-children.html ] for educating unaccompanied minors.

Ensuring children are being enrolled, that they have up-to-date immunizations, and that there are enough classroom and English-as-Second-Language teachers to handle the surge are local school district matters, she said.

School districts can request additional money from a contingency fund only if enrollment rises by 100 students or 2 percent of their population after the first month of school, Jeter said.

Durham Public Schools and Charlotte-Mecklenburg Schools officials did not respond to repeated requests for information about the unaccompanied minor program.

“We do everything we can to provide the appropriate number of teachers. We increased our enrollment by about 3,000 this year,” including the unaccompanied minors, said Michael Yarbrough, Wake Public Schools spokesman.

The school district did not receive a master list of unaccompanied minors to ensure those of school age actually are enrolled, Yarbrough said. Nor is it keeping a tally of how many have enrolled.

That gap in information is among concerns raised by some congressmen and Numbers USA, a pro-immigration organization that seeks to minimize illegal immigration.

“There’s no one checking. Once the child meets up with the parents or a guardian, there’s no inquiry into the background or inquiry into the safety of the child,” said Numbers USA spokesman Van Esser. “What Congress is worried about is what’s happening to the children. Are they safe under these circumstances?”

“We’re not involved in background checks or anything like that at this point,” said Pam Walker, spokeswoman at the North Carolina Department of Public Safety. However, she acknowledged, “You don’t want them to be vulnerable to any kind of crime such as … human trafficking, or gang affiliation.”

Wake Public Schools spokeswoman Lisa Luten bristled when asked if Wake shared concerns voiced in other parts of the country about unaccompanied minors’ potential for communicable diseases or parasitic infections. “That’s a lot of assumptions about children from other countries,” she said.

Jeter and Luten said unaccompanied minors must present a doctor’s immunization records or shot records from immigration officials before being enrolled in school.

“I don’t think there’s been good documentation of what sort of inoculations they’ve gotten since they’ve come across,” Esser said. “I think it’s a fair question to wonder just what is being done.”

The Centers for Disease Control “believes that the children arriving at U.S. borders pose little risk of spreading infectious diseases to the general public,” said CDC spokeswoman Christine Pearson.

The majority of health issues reported by the Department of Homeland Security at the border stations are associated with the difficult journey, and include scabies, lice, rash illness, respiratory infections, and diarrhea, Pearson said.

Children from Central America often participate in childhood vaccination programs, similar to those in the United States, and many will have received vaccines, Pearson said.

“However, a few vaccines are not offered, have not been available for very long, or are not widely used, such as chicken pox, influenza, and pneumococcal vaccines,” Pearson said. As a precaution the Office of Refugee Resettlement recommends children without vaccine documents receive necessary vaccinations, Pearson said.

Children are vaccinated with multiple vaccines before they are released into a community. Typically, they include Tdap (tetanus, diphtheria, pertussis); MCV4 (meningococcal disease); MMR or MMRV (measles, mumps, rubella); Varicella (chickenpox); influenza; PCV13 (pneumococcal conjugate vaccine); IPV (inactivated polio vaccine); Hepatitis A and Hepatitis B.

“I can’t think of too many infectious diseases that would cause alarm bells to ring” among unaccompanied minors, said Fred Fuller, an infectious disease specialist at N.C. State.

Head lice and intestinal parasites might be a concern. “The stuff can spread like wildfire,” Fuller said.

Transmission of measles, mumps, and rubella by unaccompanied minors might be of concern for North Carolina families who chose not to have their children immunized, he said.

Dengue fever and malaria could be present in some children, but both require mosquito transmission from the infected person and usually repeat bites, he said. While that risk is small, Fuller said, there is precedent. Some states experienced “massive malaria outbreaks” in local populations where large numbers of infected soldiers returned from World War II.

Aside from those concerns, reports from Border Patrol agents that some of the minors are gang members, and unfunded costs being passed down to local governments, Esser believes President Obama actually is violating the 2008 human trafficking law by applying it to the unaccompanied minors influx.

“If the children have a parent or a guardian in the United States, that 2008 law doesn’t apply,” Esser said. Many of the minors are not unaccompanied, but are illegally entering with parents or relatives, he said.

“So what the president is doing in essence is hiding behind that 2008 law and not allowing them to be deported as they should be under United States law,” Esser said.

Further, he said, there is reason to question whether there is a marked rise in violence in El Salvador, Guatemala, and Honduras prompting the exodus. Some of the unaccompanied minors “have origins in parts of the country that aren’t part of that kind of violence, so I’m not sure that claim is necessarily applicable to all of them,” Esser said.

Rachel Hicks, press secretary for U.S. Sen. Richard Burr, said the North Carolina Republican believes the current situation underscores his longstanding criticism that the border is not secure, and it is imperative to address the issue.

“With regards to the immediate crisis, the Obama Administration must make it clear to individuals and governments in Central and South American countries that the United States is not relaxing immigration standards for those who illegally cross, including children, and that most of these individuals are required under law to be deported,” Hicks said.

“We are the most compassionate nation in the world, but moving these minors from detention center to detention center is inhumane,” Hicks said. “Sen. Burr supports common-sense changes in existing law that would expedite the removal of unaccompanied minors to their homes, and to keep them from spending weeks or months in federal custody.”

http://www.carolinajournal.com/exclu....html?id=11347

http://www.alipac.us/f9/where-did-en...s-come-310612/