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BACKGROUND: Enteroviruses are associated with a spectrum of symptoms including rash, respiratory illness, and neurological illness. Enterovirus D68 (EV-D68), an uncommon virus that can cause mild to severe respiratory illness, was first identified in California in 1962 and since 2008 several outbreaks have been reported worldwide. EV-D68 is closely related to human rhinovirus, a common cause of respiratory illness. Commonly available diagnostic testing cannot distinguish rhinoviruses from enteroviruses. In August 2014, two midwestern US pediatric hospitals notified the Centers for Disease Control and Prevention (CDC) of an increase in severe respiratory illness; specialized testing conducted by CDC determined that some illnesses were caused by EV-D68. Two pediatric hospitals in Colorado also reported increases in severe respiratory illness and hospitalizations in August 2014; CDC testing indicated some illnesses were caused by EV-D68. In Colorado, like other states, enterovirus surveillance data is not available as the condition is not reportable. In addition, Colorado does not yet have statewide syndromic surveillance.
METHODS: To track the EV-D68 outbreak in Colorado, the Colorado Department of Public Health and Environment (CDPHE) conducted weekly aggregate reporting of patients presenting to 12 sentinel hospitals with non-influenza viral respiratory illness [including numbers of positive enterovirus/rhinovirus tests, emergency department visits, non-intensive care unit (ICU) admissions, ICU admissions, and deaths from August through November 2014]. The existing statewide web-based electronic disease reporting system was used to collect these data. CDPHE also analyzed existing aggregate outpatient acute upper respiratory infection data from a large HMO and worked with hospitals to facilitate testing at CDC of 89 respiratory samples collected in August-September 2014 from patients with severe respiratory illness.
RESULTS: Aggregate reporting demonstrated that non-influenza viral respiratory illness in Colorado peaked the week ending September 13, 2014. Outpatient data also showed a peak in acute upper respiratory infections in the week ending September 13, 2014. Testing at CDC found that 39 of 89 (44%) submitted specimens were positive for EV-D68, with 75% of positive test results in persons reporting illness onset between the week ending August 30 and week ending September 13, 2014.
CONCLUSIONS: The data gathered through aggregate reporting was corroborated by data from an extant data source and laboratory testing for EV-D68, showing that the EV-D68 outbreak in Colorado likely peaked the week ending September 13, 2014. This rapid, innovative, and low-cost approach that adapted existing surveillance systems could be used by other state/local health departments to track emerging infections.