The Centers for Disease Control and Prevention are reporting today on the Enterovirus D68 outbreak in the Missouri and Illinois. It appears that the outbreak was detected by astute clinicians who noticed that there was something going on:
“On August 19, 2014, CDC was notified by Children’s Mercy Hospital in Kansas City, Missouri, of an increase (relative to the same period in previous years) in patients examined and hospitalized with severe respiratory illness, including some admitted to the pediatric intensive care unit. An increase also was noted in detections of rhinovirus/enterovirus by a multiplex polymerase chain reaction assay in nasopharyngeal specimens obtained during August 5–19. On August 23, CDC was notified by the University of Chicago Medicine Comer Children’s Hospital in Illinois of an increase in patients similar to those seen in Kansas City.”
This highlights the need for infection prevention specialists at hospitals to be in constant communication with their laboratory colleagues and with the healthcare providers in their organization. Communicating on what is going on, what each provider is seeing, allows for the early detection of outbreaks. When these lines of communication are not adequate, it may be later rather than sooner before these types of things are detected.
So CDC was notified and an investigation was launched:
“To further characterize these two geographically distinct observations, nasopharyngeal specimens from most of the patients with recent onset of severe symptoms from both facilities were sequenced by the CDC Picornavirus Laboratory. Enterovirus D68* (EV-D68) was identified in 19 of 22 specimens from Kansas City and in 11 of 14 specimens from Chicago. Since these initial reports, admissions for severe respiratory illness have continued at both facilities at rates higher than expected for this time of year. Investigations into suspected clusters in other jurisdictions are ongoing.”
I can tell you from my experience at the state health department that most of the work is being done by local epidemiologists and public health nurses. A case definition has probably been determined and cases falling within the “confirmed, probable, or suspect” case definitions are being interviewed by the local health department staff. Specimens are being collected and probably processed initially at local laboratories and then sent off to CDC for further characterization.
Here is the interesting part:
“Enterovirus infections, including EV-D68, are not reportable, but laboratory detections of enterovirus and parechovirus types are reported voluntarily to the National Enterovirus Surveillance System, which is managed by CDC. Participating laboratories are encouraged to report monthly summaries of virus type, specimen type, and collection date.”
By “not reportable,” CDC is telling us that there is no requirement for these infections to be reported to public health by healthcare providers. However, as you can see, reporting clusters and increased rates of cases is not a bad idea, especially in light of the sheer numbers of sick kids and the strain that this situation is likely to put on the pediatric healthcare system. Opening those lines of communication with the local and federal public health agencies allows for shared information and for the best situational awareness.
We’ll see how this progresses.