Medical toll from the 2014 Enterovirus D68 outbreak

Although it is not quite over yet, the Enterovirus D68 outbreak of 2014 has taken a tragic medical toll. The CDC has released the following numbers (from USA Today):

• 1,116 cases (likely an underestimate because of the absence of a widely-available accurate diagnostic)
• Almost all in children
• Cases in nearly all (47) states
• 75 children have been afflicted with polio-like paralysis symptoms
• 12 children have died

It is not known whether all of the paralysis cases are due to the D68 virus because some of the kids did not have the enterovirus in their nasal mucus. One possibility is that the D68 diagnostic is not sensitive enough (i.e. many false negatives); the other possibility is that some other virus caused the paralysis.

Although these numbers are quite large, it is important to place them in context. By comparison in 1952 (Wikipedia), a few years before the polio vaccine was introduced, there were in the U.S. 57,628 cases of polio, 3,145 patients died, and 21,269 were left with mild to disabling paralysis. Polio (like Enterovirus E68) mainly affects children, although some adults were affected (Figure 1).

The mass administration of the vaccine led to an immediate and drastic reduction in polio cases. By 1961, there were only 161 total cases in the U.S. The last case of paralytic poliomyelitis caused by endemic transmission of poliovirus in the United States was in 1979 which occurred among the Amish in several Midwestern states (Wikipedia).

By comparison the Enterovirus D68 outbreak in 2014 was much smaller. However, one big concern is whether the incidence of D68 is rising. Next summer we will see whether the number of cases grows significantly. If this happens, developing a vaccine to Enterovirus D68 may become a priority. Hopefully it will not be necessary.

Figure 1. President Franklin D. Roosevelt suffered from polio.