Eastern Equine Encephalitis in Children, Massachusetts and New Hampshire,USA, 1970–2010 - Vol. 19 No. 2 - February 2013 - Emerging Infectious Disease journal - CDC

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Eastern Equine Encephalitis in Children, Massachusetts and New Hampshire,USA, 1970–2010 - Vol. 19 No. 2 - February 2013 - Emerging Infectious Disease journal - CDC

Table of Contents
Volume 19, Number 2– February 2013

Volume 19, Number 2—February 2013

CME ACTIVITY

Eastern Equine Encephalitis in Children, Massachusetts and New Hampshire,USA, 1970–2010

Article Contents

• Medscape CME Activity
• Methods
• Results
• Discussion
• Conclusions
• Acknowledgments
• References
• Figure 1
• Figure 2
• Figure 3
• Figure 4
• Table 1
• Table 2
• Table 3
• Table 4
• Table 5
• Suggested Citation

Michael A. Silverman, John Misasi, Sandra Smole, Henry A. Feldman, Adam B. Cohen, Sandro Santagata, Michael McManus, and Asim A. Ahmed 

Author affiliations: Author affiliations: Children's Hospital Boston, Boston, Massachusetts, USA (M.A. Silverman, J. Misasi, H.A. Feldman, S. Santagata, M. McManus, A.A. Ahmed); Department of Public Health, Boston (S. Smole); Massachusetts General Hospital, Boston (A.B. Cohen); Brigham and Women’s Hospital, Boston (S. Santagata)

Suggested citation for this article

Abstract

We describe the clinical, laboratory, and radiographic characteristics of 15 cases of eastern equine encephalitis in children during 1970–2010. The most common clinical and laboratory features were fever, headache, seizures, peripheral leukocytosis, and cerebrospinal fluid neutrophilic pleocytosis. Radiographic lesions were found in the basal ganglia, thalami, and cerebral cortex. Clinical outcomes included severe neurologic deficits in 5 (33%) patients, death of 4 (27%), full recovery of 4 (27%), and mild neurologic deficits in 2 (13%). We identify an association between a short prodrome and an increased risk for death or for severe disease.

Eastern equine encephalitis (EEE) is a highly virulent reemerging arboviral encephalitis in humans; the disease is endemic to the eastern United States and the Gulf Coast (1,2). EEE is characterized by a nonspecific prodrome followed by severe headache, high fevers, lethargy, and seizures (1,3,4). The meningoencephalitis often progresses rapidly to coma and death; mortality rates are 30%–70% (4). On average, there are 6 cases per year in the United States, some occurring sporadically and others in epidemics (5). Over the past decade, EEE virus (EEEV) transmission has resurged in the northeastern region of North America. In the United States, overlapping epidemics among humans occurred in Massachusetts during 2004–2006 and in New Hampshire during 2005 and 2007 (1). During consecutive years of EEEV activity from 2009 to 2011, New York State reported its first human cases of EEE in 26 years (6). In 2012, a total of 7 human cases of EEE were diagnosed in Massachusetts (7)—this is the highest number of annual cases in the state since 1956. Moreover, the first human cases of EEE in Vermont were reported in 2012 (8), and public health surveillance indicates that the range of EEEV has extended into the state of Maine (9) and into Nova Scotia, Canada (10).
The natural history of EEEV infections in children has not been well characterized. This mosquito-borne illness in humans was first described during an outbreak in Massachusetts in 1938 (11), and Farber et al. (12) described 8 cases of EEE in children during that outbreak. Since then, case series of EEE have been published (1,3,4,13), but investigations of EEE in children are lacking. We conducted this study to determine the clinical, laboratory, radiographic, and pathologic features of EEE in children and to assess features associated with the clinical outcome of EEE in children.