Enterovirus 68, TB, and Ebola in the U.S. – Analysis by Dr. Donald Donahue JR

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This is the second of two articles this week from Dr. Donald Donahue JR., DHEd, MBA, FACHE. Retired Lieutenant Colonel Donahue is as an Advisory Member to the American Academy of Disaster Medicine.

The American Academy of Disaster Medicine (AADM) is a unique volunteer organization dedicated to promoting and educating physicians and healthcare professionals concerning the critical importance of disaster medicine preparedness.

Jump to EBOLA IN U.S.


On Tuberculosis:

From CNNFive babies in El Paso, Texas, have tested positive for tuberculosis after being exposed to the infectious disease at a local hospital, the city’s health department says.  Providence Memorial Hospital has identified more than 850 infants and 43 health care workers who were potentially exposed after a nurse came to work with an active case of TB sometime between September 2013 and August 2014. He or she worked with infants in the nursery and in the post-partum unit at the hospital.

On Enterovirus:

UPDATE 10/1/2014:

A child with a staph infection and enterovirus D68 has died in Rhode Island, the state’s health department said Wednesday.

The child died last week. Infection by both is a “rare combination,” health officials say, that can cause very severe illnesses in children and adults. Enterovirus D68 has been causing severe respiratory illnesses in children across the country. The Centers for Disease Control and Prevention has confirmed 472 cases in 41 states.

NEW YORK –  Health officials are investigating nine cases of muscle weakness or paralysis in Colorado children and whether the culprit might be a virus causing severe respiratory illness across the country.  The Centers for Disease Control and Prevention on Friday sent doctors an alert about the polio-like cases and said the germ — enterovirus 68 — was detected in four out of eight of the sick children who had a certain medical test. The status of the ninth case is unclear.


While Ebola has dominated the news over the past weeks, less frightening, but still serious outbreaks are being tracked by public health officials across the United States. The discovery of potential exposure to tuberculosis in a Texas hospital and identification of possible complications from enterovirus 68 in Colorado provide a sobering reminder of the persistent danger of communicable disease.


These events offer a window into the variability of outbreaks and the need for both awareness and preventive measures. Hospitals routinely test employees for the presence of tuberculosis. It is likely the nurse acquired the infection after being hired and unknowingly exposed others.

Globally, two in seven people carry the TB bacteria. It can lie dormant for years before becoming active and communicable. Only transmissible during its active stage, TB requires close contact over a period of time to infect others. Left untreated, tuberculosis can be fatal. When incompletely treated, a drug-resistant strain can develop. Under these circumstances, contact tracing is critical. While the numbers being screened are seemingly — and thankfully — far fewer than those testing positive, it is important that anyone who may have been exposed be tested.

Enterovirus 68 is a relatively rare cousin of the common cold, but which has produced serious complications, particularly among children with pulmonary conditions such as asthma. The virus is also a distant relative of polio, prompting concerns over the emergence of polio-like symptoms in a limited number of patients. In addition to the symptoms of a cold, the enterovirus 68 illness can include a fever and a rash. As we approach the start of flu season, the ability to differentiate between enterovirus 68 and influenza is important. Receiving this year’s flu shot, which offers protection from four different strains, can help. Given the concerns over serious complications, seeking medical care is highly recommended if you suspect someone under 21 has contracted enterovirus 68.



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