The CDC Health Alert Network provides recommendations for the management of severe respiratory infections in children

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The US Centers for Disease Control and Prevention’s (CDC) Health Alert Network (HAN) has provided specific recommendations for health care providers, infection control professionals, clinical laboratories, and public health departments to report a recent increase in pediatric cases of acute respiratory illness. In many states of America.

Study: Severe Respiratory Diseases Associated with Rhinoviruses and/or Enteroviruses EV-D68 – Multistate, 2022. Image Credit: Pixel-Shot/Shutterstock
Research: EV-D68 – Severe Respiratory Diseases Associated with Rhinoviruses and/or Enteroviruses, including Multistate, 2022. Image credit: Pixel-Shot/Shutterstock

Testing of patient-collected specimens confirmed that the disease was associated with rhinovirus and/or enterovirus infection. Additional genotyping detected enterovirus D68 in some samples.

Background

Rhinoviruses and enteroviruses Enterovirus Share genus and similar clinical signs. While rhinoviruses are typically associated with acute respiratory disease, enteroviruses can cause other clinical manifestations, including fever, aseptic meningitis, encephalitis, or acute flaccid myelitis.

Patients infected with rhinoviruses or enterovirus D68 share similar respiratory symptoms. Acute flaccid myelitis caused by enterovirus D68 is a rare but severe neurological disease that primarily affects children and causes sudden limb weakness.

Because of their genomic similarity, rhinoviruses and enteroviruses cannot be distinguished by routine multiple respiratory tests. Genomic sequencing or enterovirus D68-specific reverse transcription-polymerase chain reaction (RT-PCR) is required to distinguish between viruses.

The first case of enterovirus D68 infection in the US was reported in 2014. After that, the main outbreaks were recorded in the end of 2016, 2018, and in 2020, it was not seen much.

In August 2022, health care providers and hospitals notified the US CDC of recent cases of respiratory illness in children in several regions of the USA. The children tested positive for rhinovirus and/or enterovirus. Enterovirus D68 infection has also been reported in some children.

The number of enterovirus D68 infections detected in 2022 is higher than in previous years. However, the onset of enterovirus D68-related respiratory illnesses typically preceded cases of acute flaccid myelitis. This indicates a need for more intensive surveillance of acute flaccid myelitis in the coming weeks.

CDC HAN Recommendations for Health Care Providers

The CDC HAN provides several recommendations for health care providers to effectively manage rhinovirus and enterovirus outbreaks in children.

According to the recommendations, healthcare providers should consider the possibility of enterovirus D68 infection in children with acute and severe respiratory illness. Breath samples collected from critically ill patients should be tested for rhinoviruses and enteroviruses when the cause of the respiratory tract infection is unknown.

Since there are no vaccines or antiviral drugs, patients should be given supportive clinical interventions for rhinoviruses and enteroviruses, including enterovirus D68. Clusters of severe respiratory illnesses should be reported to the local or state health department.

The possibility of acute flaccid myelitis should be considered in patients with sudden limb weakness following respiratory illness. Biological samples from various sources (cerebrospinal fluid, serum, stool and respiratory tract) should be taken immediately after the onset of limb weakness and for the diagnosis of acute flaccid myelitis and polio. Cases of acute flaccid myelitis should be reported to the local or state public health department.

Recommendations of infection control experts

The CDC HAN recommends that infection control professionals isolate patients with rhinovirus or enterovirus in an individual room. Depending on the type of infection, healthcare workers should wear appropriate personal protective equipment. In healthcare settings, surfaces should be cleaned with hospital-grade disinfectants.

During acute respiratory disease activity, physical examination should be delayed for respiratory symptoms or pre-existing respiratory conditions. Other visitors must wear a properly fitted mask at all times in the facility.

Recommendations for public health departments

Public health departments are advised to use the “Patient Summary Form” to report cases of acute flaccid myelitis to the CDC. To reduce the spread of the virus, the departments should advise sick people to stay at home and maintain personal hygiene.

Health departments should raise public awareness about the importance of face coverings as a preventive measure to prevent the spread of respiratory viruses.

Tips for the public

CDC HAN recommends that the general public protect themselves from acquiring and spreading respiratory viruses, including rhinoviruses, rhinoviruses, and enterovirus D68, by implementing some control measures.

People should wash their hands with soap and water for 20 seconds and avoid touching their eyes, nose, and mouth with unwashed hands. Close contact with sick people should be avoided. Similarly, sick people should self-isolate to prevent further spread.

People should use a tissue or the sleeve of their shirt instead of their hands to cover coughs and sneezes. In households with infected members, commonly touched surfaces should be properly and frequently washed and disinfected.

People with respiratory symptoms should wear face masks in public places. If they experience difficulty breathing or organ weakness, they should contact their healthcare provider immediately. Parents of children with similar symptoms should also seek immediate medical attention.

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