From: Donald T. Allegra, MD, ID Consultant Re: Severe Respiratory Disease Associated With Enterovirus D68 You are probably all aware from news reports that a respiratory illness originating in the Midwest is now spreading rapidly and causing many hospital admissions in children and teenagers. This started on August 19, 2014 when CDC was notified of an increase in respiratory illness in Children's Mercy Hospital in Kansas City, Missouri. On August 23, 2014, the University of Chicago Children's Hospital also notified CDC of a similar problem in their institution. An investigation was begun and a relatively rarely isolated organism, Enterovirus EV-D68 was identified. Subsequently, this virus has now spread to more than 12 states from Utah to Delaware. Enteroviral infections are associated with many illnesses from meningitis to rash. EV-D68 appears to cause primarily a respiratory disease. The patients admitted to hospitals have been from 6 weeks to 16 years old with a median age of 4-5 years. About 10% of patients presenting to Midwest hospitals have been admitted, so for many patients this disease appears to be just a "summer cold" with little consequences. However, the 10% who have been admitted often have a history of asthma (70%), all had difficulty breathing, and several patients required a ventilator. There have been no deaths so far. There is no available vaccine nor is there any specific treatment for this disease. It appears to spread through airborne droplets and contact with environmental objects contaminated with the virus. Given the wide geographic spread of the virus in the last month, we have to assume that cases will appear in New Jersey very soon or are already here and not detected. All parents should consider EV-D68 as a possible cause of acute unexplained severe respiratory illness in children. If their children start with cold symptoms and then develop wheezing or trouble breathing, they should bring their children to the closest emergency room as soon as possible.