Enterovirus D68 in California: 14 Cases Confirmed; Riverside County Reports 1st Case

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Respiratory illnesses caused by an enterovirus are sending children to hospitals as the disease spreads across the country, health officials say. (Credit: CDC)

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California public health officials said Friday that 14 patients in the state had been diagnosed with enterovirus D68, a respiratory virus that’s been spreading in children across the country and may be linked to limb paralysis.

The disease seems to be spreading more slowly in California than elsewhere in the country, doctors from the California Department of Public Health said during an early afternoon call with reporters.

This week, Children’s Hospital Los Angeles doctors said they had treated a child who woke up after several days of normal cold-like symptoms and was unable to move a limb. Alongside a case confirmed in Long Beach, the paralysis case marked first reported diagnoses of enterovirus D68 in Los Angeles County.

The number of cases provided Friday by state officials were broken down as follows:

  • Alameda County, 2
  • City of Long Beach, 1
  • Los Angeles County, 1
  • Riverside County, 1
  • San Francisco, 1
  • Santa Cruz County, 1
  • Solano County, 1
  • Ventura County, 1
  • San Diego County, 5

The patients ranged in age from 11 months to 15 years, State Epidemiologist Dr. Gil Chavez said.

One of the 14 patients had suffered paralysis, Chavez confirmed. The paralysis case was the one announced Wednesday in Los Angeles, officials said.

On Friday, prior to the call, Riverside County public health officials had confirmed the first case of the virus there had sickened a teenager who was as home after being treated in San Diego County.

The virus can cause severe respiratory illness in young children and has sent hundreds to the hospital across the country in recent weeks. Many more children have likely been infected but have fought off the virus without getting tested, experts say.

In California, for every patient hospitalized, “there are hundreds, maybe more, that experience a milder disease and get along without medical intervention,” Chavez said.

Enterovirus D68 was first identified in California in 1962, but had since been uncommon in the U.S., according to the Centers for Disease Control and Prevention.

Earlier this year, researchers reported that two of five children in California who came down with mysterious polio-like paralysis of their limbs had tested positive for enterovirus-68 in samples given between August 2012 and July 2013. The CDC was investigating a link between the virus and paralysis in children diagnosed in Colorado.

State doctors said Friday that of 35 patients — who ranged in age from 5 months to 73 years — that has been tested for acute flaccid paralysis since 2012, only three tested positive for EV-D68. One of those three included the Los Angeles County case revealed this week; the other two were in 2012.

“This is an extremely rare syndrome,” said Dr. Carol Glaser of the paralysis cases.

More should be known about the association between paralysis and EV-D68 in coming weeks and months, said Glaser, who is interim chief of the immunization branch of the state’s Center for Infectious Diseases at the state’s public health department.

Across the U.S., from mid-August through Friday, 538 patients have been confirmed to have the disease, according to the CDC. Forty-three states and the District of Columbia have been affected.

Almost all of the confirmed cases of enterovirus D68 have been among children, the CDC stated. Four patients have died, but it’s not yet clear what role the virus played in their deaths.

The first enterovirus D68 cases in California this year were initially reported by the state Department of Public Health on Sept. 18.

Enteroviruses, the group of viruses in which EV-D68 is categorized, commonly circulate in summer and fall, according to the CDC. This particular strain is the predominant one in 2014 and “may be contributing to the increases in severe respiratory illnesses,” the CDC stated.

Symptoms include fever, runny nose, sneezing, cough and body and muscle aches. The virus can also cause more severe symptoms such as wheezing and breathing difficulty.

“These children start with what seems like a normal cold on the first day — runny nose, a little bit of cough – but by the second day, they can’t breathe at all. They come in and they need a tube to help them breathe,” said Dr. Pia Pannaraj, an infectious diseases specialist at Children’s Hospital Los Angeles.

The state health department has advised parents to seek medical attention for their children immediately if they begin to have difficulty breathing, particularly if the child has asthma.

Signs that a child is having difficulty breathing include wheezing, difficulty speaking or eating, the belly pulling in with breaths, and blueness around the lips.

There is no specific treatment for the disease, nor is there a vaccine to prevent its spread.

The virus likely spreads between people when an infected person coughs, sneezes, or touches contaminated surfaces, according to CDC.

To prevent children from becoming sickened by a respiratory illness, the CDC advised the following steps:

  • Wash hands often with soap and water for 20 seconds;
  • avoid touching your face with unwashed hands;
  • avoid close contact with people who are sick;
  • clean and disinfect frequently touched surfaces, especially when someone is sick;
  • stay home when you’re sick;
  • cover your coughs and sneezes.

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