A Back to School Victim-Finding Spree for Enterovirus 68

There are multiple reports today of a large outbreak of respiratory illness in the Midwest and, no, it's not Ebola or MERS.

It's Enterovirus D68. You might recall a few months earlier a big scare with this virus causing a polio-like paralytic disease in California, but this virus (which bears Jaromir Jagr's number, for Pittsburghers) is well known as a cause of respiratory illness.

A few points about this outbreak:

  • Seems very large: 300 kids in Kansas City, MO (other states are reporting too) but this is likely not the full extent of infection as most cases are likely asymptomatic
  • High degree of ICU admission: 15%
  • Hospitals are limiting visitation of the hospitalized children

Enteroviruses, in general, are a ubiquitous group of viruses that number over 100 and cause a wide variety of illnesses from meningitis to upper respiratory tract infection. Each year over 10 million cases of infection with this group of viruses occur. However, the vast majority of these infections are without symptoms (but are still contagious). 

This new outbreak could reflect a number of things.

1. Better diagnostics: Many hospitals are moving to PCR-based testing of respiratory illness and what may have been an undifferentiated cluster of illness is now able to be named.

2. The start of school: It is widely known that schools function as viral exchange centers and this virus is likely benefiting from the school year (a sort of back to school victim finding spree for the virus).

The next steps will be to determine the true burden of this virus, understand it's full spectrum of illness, given its now proven ability to cause severe infection, and assess whether a vaccine against it (like is being developed against Enterovirus 71) is warranted.