Tuesday, September 16, 2014

So it is! from the Indiana State commissionaire

State Health Commissioner
The Indiana State Department of Health (ISDH) has identified four confirmed cases of respiratory enterovirus EV-D68 among Indiana residents.  Testing was performed at the Centers for Disease Control and Prevention (CDC).  Several other suspect cases are pending testing at the Indiana State Department of Health Laboratory.  Syndromic surveillance of hospital emergency department chief complaints has indicated a higher than expected level of respiratory illness statewide for this time of year.  Several other states, including Colorado, Illinois, Iowa, Kentucky, Kansas, and Missouri, have also identified confirmed EV-D68 cases. 
EV-D68 infections can be mild and self-limited, but children with asthma are at risk for severe respiratory illness and may require hospitalization to receive intensive supportive therapy.  Patients with asthma should carefully maintain their current medical management and follow their asthma action plan to monitor for early signs of exacerbation.  People who smoke are also at higher risk for severe enterovirus infections.
The CDC recommends hospitals use standard, contact, and droplet precautions when caring for patients.  Alcohol-based hand sanitizers are not effective against EV-D68.  Bleach-based disinfectants, like those used for rhinovirus and norovirus, are effective for environmental cleaning.
Clinicians are advised to suspect enterovirus infection in patients hospitalized with asthma exacerbations or severe respiratory illness.  To confirm the presence of EV-D68 in Indiana and further characterize this illness, the ISDH Laboratory is temporarily requesting that clinicians send nasopharyngeal and oropharyngeal swabs in the same transport medium or upper respiratory aspirates:
·         Patients must test positive for rhinovirus/enterovirus before submission to the ISDH Laboratory.  Indicate this positive test result and the test method on the specimen submission form.  Specimen submissions lacking this information will not be tested.
·         Specimens from patients who test positive for rhinovirus/enterovirus do not need prior authorization.
·         Specimens do not need to be tested for influenza and respiratory syncytial virus (RSV) prior to submission.
Sequencing will be conducted to identify the specific viral strain.  Instructions for specimen submissions to ISDH for testing are located on the ISDH enterovirus page at http://www.in.gov/isdh/26487.htm under the laboratory specimen information section. Specimens should arrive at the ISDH Laboratory Monday-Friday excluding state holidays within three days of the collection date.  Specimens must be submitted using LIMSNET.  To sign up for a LIMSNET account, contact the ISDH LIMS HelpDesk at 317-921-5506 or 1-888-535-0011.
Healthcare providers who identify outbreaks or unusual occurrences of respiratory illness should contact Shawn Richards, Outbreak Supervisor, at srichard@isdh.in.gov or 317.233.7125 to inquire about specimen submission and further investigation to identify the cause of these outbreaks.
Most enterovirus infections in the U.S. occur seasonally during the summer and fall, and enterovirus outbreaks tend to occur in several-year cycles.  Respiratory enteroviruses include EV-D68 and rhinovirus and are transmitted through contact with secretions from the eyes, nose, and mouth (saliva, mucus, sputum) of an infected person; having close contact with an infected person, such as touching or shaking hands; and touching objects or surfaces that have been contaminated with infectious secretions.
No vaccine is available to prevent infection with respiratory enteroviruses, and no antiviral medication is available.  Health care providers should recommend the following:
·         Clean:  wash hands often with soap and water for 20 seconds
·         Cover:  cover sneezes and coughs with your sleeve or a tissue
·         Contain:  prevent spreading illness to others by staying home if you are sick
·         Avoid close contact and sharing cups or eating utensils with those who are ill
·         Disinfect frequently touched surfaces
·         Avoid smoking or exposure to second-hand smoke
For questions regarding epidemiology/surveillance, please contact Shawn Richards at srichard@isdh.in.gov or 317.233.7740.   For questions on specimen collection or submission please contact Stephanie Dearth at stdearth@isdh.in.gov or 317.921.5843.  
For more information on enteroviruses, please visit the following websites:
Indiana State Department of Health website at http://www.in.gov/isdh/26487.htm.
Centers for Disease Control and Prevention (CDC) website at http://www.cdc.gov/non-polio-enterovirus
William C. VanNess II, MD
State Health Commissioner

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