12 states and Canada report enterovirus D68 cases
The number of states reporting confirmed cases of enterovirus D68 (EV-D68) has doubled, to 12, the Centers for Disease Control and Prevention (CDC) reported today, and cases have been confirmed in Alberta as well.
EV-D68, a respiratory virus that was relatively rare until recently, has been sending children to hospital emergency departments with wheezing and breathing difficulty.
In today's update, the CDC said 130 cases have been confirmed in its own labs or in state health department labs, compared with 97 cases reported on Sep 12. The 12 states affected are Alabama, Colorado, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Missouri, New York, Oklahoma, and Pennsylvania. No deaths have been reported.
The CDC predicted that more states will report confirmed EV-D68 cases in coming weeks. Several states are investigating cluster of severe respiratory illnesses, and the testing is complex and slow, the agency said.
"As the backlog of specimens is processed, the number of states and confirmed cases will likely increase," the CDC said. "These increases will not necessarily reflect changes in real time, or mean that the situation is getting worse," though some of the increase will represent new cases.
Also, at least 18 EV-D68 cases have been confirmed in Alberta, including 10 in Calgary and 5 in Edmonton, according to a CBC News report yesterday. Alberta officials were unsure if it was the same strain as in the United States and were working with Canada's national lab to find out, the story said.
In a ProMED-mail post yesterday, Alberta health officials reported the confirmation of nine cases in children at Alberta Children's Hospital in Calgary. The cases involved children who were hospitalized for treatment of asthma or bronchiolitis between Sep 1 and 11, the report says. Their ages ranged from 22 months to 12 years. Two required intensive care, and four needed supplemental oxygen.
CDC information about states reporting cases
CDC EV-D68 page
Sep 15 CBC News story
Sep 16 ProMED post on Alberta cases
Saudi Arabia reports another MERS case
Saudi Arabia's Ministry of Health (MOH) today confirmed another serious MERS-CoV case, the fifth in that country in just over a week.
The case involves a 39-year-old non-Saudi man who lives in Riyadh and is in an intensive care unit (ICU), the agency said. He is not a healthcare worker but had pre-existing disease, the MOH said in its typically terse update. He reported no recent contact with animals.
Since Sep 8 the health ministry has confirmed five cases of MERS-CoV (Middle East respiratory syndrome coronavirus) scattered around the country. The other four cases also involved ICU hospitalizations.
The new case brings Saudi Arabia's MERS total to 731 cases, including 302 fatalities.
Sep 16 MOH update
Review: Half of drugs for kids' bacterial respiratory infections not needed
Acute respiratory tract infections (ARTIs) are caused by bacteria in 27.4% of cases yet are treated with antimicrobials in outpatient visits almost twice as often as expected, translating into an estimated 11.4 million prescriptions that may be unnecessary, according to a study yesterday in Pediatrics.
The authors conducted a meta-analysis of studies published between 2000 and 2011 of children under 18 years of age with acute otitis media (AOM), sinusitis, bronchitis, upper respiratory tract infection (URI), and pharyngitis to determine bacterial prevalence rates, as well as a retrospective cohort analysis of data from the 2000-2010 National Ambulatory Medical Care Survey (NAMCS) to study antimicrobial-prescribing rates for ARTI.
Bacterial prevalence in AOM cases, based on 12 studies that met inclusion criteria, was 64.7% (95% confidence interval [CI], 50.5% to 77.7%); in cases of Streptococcus pyogenes during pharyngitis, the rate was 20.2% (95% CI, 15.9% to 25.2%) based on 11 studies. No URI studies met inclusion criteria, and only one sinusitis study met critieria; bacterial prevalence in the latter study was 78%.
On the basis of the studies analyzed, the authors say the expected rate of antimicrobial prescriptions for ARTI overall would be 27.4% (95% CI, 26.5% to 28.3%). The actual prescribing rate in ARTI encounters during the NAMCS was 56.9% (95% CI, 50.8% to 63.1%), about twice the expected rate.
This translates to an estimated excess of 11.4 million prescriptions per year, say the authors. They point out that an estimated 31.7 million visits for ARTI in children result in prescriptions of antimicrobial agents.
Sep 15 Pediatrics abstract