The federal Centers for Disease Control and Prevention has confirmed four cases of the respiratory virus enterovirus D-68 in Oregon, including at least one child from Central Oregon treated at St. Charles in September. The virus has been causing severe illness mostly in children since the summer and has been identified in 46 states and the District of Columbia.
Oregon public health officials said three cases were identified in children from Multnomah County and one from Deschutes County. All four were in children younger than 17.
“We were fully expecting that we had this infection here in Oregon,” said Dr. Richard Leman, a public health physician with the Oregon Health Authority. “We were awaiting results on a total of 19. We’ve gotten results on four, and we’ll have to check back on these other 15.”
Although most enterovirus infections are mild, this strain has landed a higher proportion of children in the hospital, including many in intensive care units.
Officials from St. Charles Bend reported Sept. 19 the hospital had treated two children with suspected EV-D68 infections. Preliminary tests showed the children had an infection from the family of viruses that includes enteroviruses, but only specialized labs such as the one at CDC could confirm the exact strain. The tests took longer than usual to complete as the CDC lab was deluged by samples from across the country.
After those initial two cases, St. Charles has treated several more children with symptoms consistent with EV-D68 but has not confirmed those infections.
At least one of the patients at St. Charles had been flown to Doernbecher Children’s Hospital at Oregon Health & Science University in Portland, and a spokeswoman there indicated the hospital had a confirmed case. But privacy rules prevented the hospital from disclosing whether the confirmed case was a Central Oregon patient.
Randall Children’s Hospital at Legacy Emanuel in Portland has the other three confirmed cases. Both hospitals had multiple suspected cases in September.
CDC began investigating several clusters of cases in August, mostly in the Midwest and generally affecting children who had a history of asthma or other respiratory problems. Three weeks ago, the agency had confirmed 160 cases from 22 states.
It has now confirmed a total of 678 people, with cases from all states but Alaska, Arizona, Hawaii and Nevada.
The agency is prioritizing testing of specimens from children with severe respiratory illness and said there are probably many children affected with milder forms of the illness.
Of the specimens tested by the CDC lab, about half have tested positive for EV-D68 and about a third have tested positive for an enterovirus or rhinovirus other than EV-D68.
The CDC lab has detected EV-D68 in samples from five patients who have died, although the agency is leaving it up to state and local health departments to determine the cause of death in those cases.
Symptoms of EV-D68 infection include fever, runny nose, sneezing, coughing, body and muscle aches, skin rash and conjunctivitis. Cases often start out looking like a cold.
“For most people it is going to be a mild illness. And there’s hundreds of enteroviruses out there, so we’re not surprised that it’s here,” said Heather Kaisner, communicable diseases manager with Deschutes County Health Services. “But that said, parents who have children with asthma or respiratory issues should be watching closely for any difficulty breathing and wheezing, and then they need to be seeking medical attention.”
There is no vaccine or specific treatment to combat the virus. Affected children are generally treated for asthma exacerbation with bronchodilators and steroids and provided with supplemental oxygen to help them breathe. Almost all children treated for the virus have recovered.
Public health officials emphasize that the addition of new states to the map of affected areas represents better surveillance and more testing for the virus rather than the spread of the virus across state lines. Some hospitals in the Midwest are reporting bed-capacity issues because of a spike in respiratory illnesses.
“That’s not something, happily, that we have seen here,” Oregon Health Authority’s Leman said. “That’s somewhat reassuring, but bear in mind, flu season is coming, and during influenza season we do see spikes and that will probably be due to influenza.”
Health officials stressed that enterovirus infection can be prevented with the same measures as for the flu — covering a cough, hand washing and staying home when sick — and urged everyone to get a flu shot both for flu protection and to avoid worry about a possible EV-D68 infection. The typical season for enteroviruses runs through the summer and fall.
“We would fully expect we would be seeing, based on past performance, that numbers would be tapering off from enterovirus,” Leman said.
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