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Enterovirus EV-D68 & pertussis

Today’s topics:

  • Enterovirus EV-D68
  • Pertussis

Enterovirus EV-D68

Action requested: Consider enterovirus EV-D68 in the differential for severe upper respiratory illness among children.

Background: The Centers for Disease Control & Prevention (CDC) has reported two clusters of severe respiratory illness in children caused by enterovirus D68 (EV-D68), an uncommon pathogen first seen in California in 1962 (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6038a1.htm). About 100 types of enteroviruses are known and an estimated 10-15 million infections occur annually in the United States.  Enterovirus infections are more likely to occur in the fall; children and teens are most likely to be infected.  Clinical manifestations vary widely and can include mild respiratory illness, febrile rash illness, and neurologic illness, such as aseptic meningitis and encephalitis.  However, EV-D68 infection has been associated almost exclusively with respiratory illness ranging from relatively mild illness not requiring hospitalization to severe illness requiring intensive care and mechanical ventilation.  The virus likely spreads person to person when an infected person coughs, sneezes, or touches surfaces.  There is no vaccine or specific therapy other than supportive care and management of complications.

Recommendations:

  • Consider EV-D68 when children present with moderate or severe respiratory illness.
  • Testing is not necessary for patients not requiring hospitalization.  For hospitalized patients, generic enterovirus testing can be requested from commercial laboratories, but specific testing to identify EV-D68 is being done at CDC laboratories (for specimens testing positive for enterovirus).
  • Call the Health District (425-339-5278) to report clusters of severe respiratory illness or for assistance with testing.
  • Prevention is through general respiratory and hand hygiene. Healthcare providers should use standard and droplet precautions.
  • Remind the public:
    • 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, especially if someone is sick.
    • Cover coughs or sneezes.
    • Stay home when ill.

For more information, see http://www.cdc.gov/non-polio-enterovirus/index.html.

 

Pertussis

Action requested: Test for pertussis and exclude from work or child care only when symptoms are present.

Background: Recent provider actions suggest confusion about testing and exclusion recommendations for pertussis.  Given that pertussis continues to circulate at low levels within our community, it is appropriate for providers to consider pertussis when patients present with   symptoms.  Pertussis typically presents as a paroxysmal coughing illness that increases in severity over a period of a few weeks and is associated with whooping and/or vomiting.  In infants, apnea may be presenting symptom.  Testing is appropriate when symptoms are present, but not for asymptomatic contacts.

Recommendations:

  • Test symptomatic patients (nasopharyngeal swab for PCR) and treat with appropriate antibiotics at time of initial visit.
  • Exclude ill persons from work or child care until they have completed 5 days of antibiotics.
  • DO NOT test or exclude asymptomatic (non-infectious) contacts who are being seen for prophylaxis.
  • Call Communicable Disease Response at 425-339-5278 if you have questions about pertussis management.
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