infections with ME and CFS as noted by the author below. Gudrun Lange,
PhD., who was a member of the distinguished external review panel that
in 2008 evaluated
the CFS program at CDC, testified in 2009 saying, "...it is rather
surprising that CDC has not shown any initiative to address obvious
research questions posed by the H1N1 epidemic. Why are we not
surveilling the population for postinfectious fatigue following H1N1?
The question again may be whether the CDC is once again choosing not
to address the obvious."
October 10, 2011
Acute respiratory illness clusters attributed to human enterovirus 68
Akira Suzuki TI. MMWR. 2011;60:1301-1304.
Six clusters of respiratory illness-associated human enterovirus 68
have been recently reported in Asia, Europe and the United States. The
illness has caused mild to severe infection and three fatalities,
according to data published in a recent Morbidity and Mortality Weekly
Report.
=93Clinicians should be aware of [human enterovirus 68 (HEV68)] as one
of many possible causes of viral respiratory disease and should report
clusters of unexplained respiratory illness to the appropriate public
health agency,=94 the researchers wrote.
Between 2008 and 2010, six clusters of respiratory illness-associated
HEV68 were reported:
21 cases that included two fatalities were reported in the Philippines.
More than 120 cases, including one fatality were reported in Japan;
clinical and demographic data were only available on a subset of 11
pediatric patients.
24 cases were identified in a prospective, hospital-based study of
respiratory infections in the Netherlands.
Six cases were reported in a hospital in Atlanta.
28 cases were reported in a pediatric hospital in Philadelphia.
A community hospital in Arizona sent seven nasopharyngeal specimens to
the CDC; five were identified as HEV68.
HEV68 cases were confirmed by reverse transcription-polymerase chain
reaction (RT-PCR) testing in each cluster, followed by partial
sequencing of the structural protein genes, VP4-VP2, VP1, the gold
standard test for HEV 68 detection, according to the researchers.
The researchers cautioned that some diagnostic tests, such as the CDC
rhinovirus real-time RT-PCR assay, may not detect HEV68 or may
misidentify the infection as human rhinovirus.
In an accompanying editorial, CDC officials wrote: =93Identification of
a large number of patients with HEV68 respiratory disease detected
during a single season, such as described in this report, is a recent
phenomenon. Whether this increase in recognized cases is attributable
to improved diagnostics or whether the clusters themselves represent
an emergence of the pathogen is unknown.=94
For the past few years, it has been realized that many enterovirus
infections can also be transmitted through the respiratory route.
Thus, the biologic and clinical borders between the enterovirus and
the rhinovirus groups are fading, at least in part. HEV68 is peculiar
in this regard. In fact, since 2002, it is known that HEV68 shares
antigenic properties with the human rhinovirus 87 (HRV87), that these
agents are almost genetically identical, that both are acid-sensitive
and grow better at temperatures lower than 37=95C (characteristics that
are proper of rhinoviruses and that probably explain their lack of
enteropathogenicity), and that both share the same cellular receptor
(DAF). Thus, HEV68 and HRV87 are now held as strains of a single virus
type that presents features of both rhinoviruses and enteroviruses. As
a consequence, HRV87 has been removed from the rhinovirus group.
The MMWR researchers suggest that it remains unclear =91whether this
increase in recognized HEV68 cases is attributable to improved
diagnostics or whether the clusters themselves represent an emergence
of the pathogen.=92 Studies conducted in Finland indicate that
neutralizing antibodies to HEV68 were widely represented in the
population in 2002. Thus, in at least some communities, this agent is
not new or rare.
The report, in any case, recalls pediatricians and clinicians of the
vast and still undefined array of diseases that are possibly
associated with the entero/rhinovirus group of agents. This is
particularly important, since many of these viruses are responsible
for relevant clinical syndromes, and are suspected to produce, in a
minority of cases, persistent and severe conditions (eg, dilated
myocardiopathy, post-polio syndrome, chronic fatigue syndrome with
fibromyalgia).
Finally, this work draws attention to the need for specific
antipicornaviral drugs.
The necessity of these agents has been recently evidenced by the WHO
as an essential component of the final steps of the polio eradication
campaign. In the mean time, the compassionate use of antivirals under
development and/or intravenous immunoglobulin may be of help in
critical cases.
Antonio Toniolo, MD
University of Insubria, Varese, Italy
Disclosure: Dr. Toniolo reports no relevant financial disclosures.
http://www.pediatricsupersite.com/view.aspx?rid=3D88324
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