Key points
- Consider EV-D68 infection as a possible cause of unexplained severe acute respiratory illness, especially during summer and fall.
- Report suspected clusters of unexplained severe acute respiratory illness to local and state health departments.
- Follow standard, contact, and droplet precautions to prevent the spread of EV-D68 in healthcare settings.
Introduction
Enterovirus D68 (EV-D68) is one of over 100 non-polio enterovirus types and is a member of the family Picornaviridae.
Clinical features
Consider EV-D68 infection as a possible cause of unexplained severe acute respiratory illness, especially during summer and fall.
EV-D68 infection may be a possibility:
- Even if the patient does not have fever.
- For acute respiratory illness associated with a rhinovirus-positive or enterovirus-positive molecular test.
When to consider AFM
Acute flaccid myelitis (AFM) is an uncommon but serious neurologic condition that can be caused by EV-D68. AFM mostly affects children and causes the muscles and reflexes in the body to become weak.
Consider an AFM diagnosis in patients with:
- Weakness in limbs
- Poor muscle tone
- Decreased reflexes
Consult with an AFM physician
AFM may be difficult for healthcare providers to diagnose and treat. Consider scheduling a consult with an infectious disease specialist and a neurologist.
Reducing risk
Be vigilant about preventing the spread of EV-D68 and follow infection control precautions, including standard, contact, and droplet precautions.
Non-enveloped viruses such as EV-D68 may be less susceptible to alcohol than enveloped viruses or vegetative bacteria.
However, alcohol-based hand sanitizer (ABHS), when combined with glove use, offers benefits in:
- Skin tolerance
- Compliance
- Overall effectiveness for a variety of healthcare-associated pathogens
Therefore, after removing and before donning gloves, perform hand hygiene using either ABHS or soap and water.
Testing
Contact & report to health departments
Clinicians should recommend laboratory testing to investigate clusters of unexplained severe acute respiratory illness. For enterovirus-positive and rhinovirus-positive specimens, real-time PCR and virus typing by sequencing can determine if EV-D68 is present. EV-D68 typing can be performed by some public health laboratories or by CDC.
Without specialized patient treatment options for EV-D68, testing is unlikely to directly influence clinical management of individual patients. However, it can help to raise awareness of EV-D68 circulation.
Treatment and recovery
No antiviral medications are currently available for people who become infected with EV-D68. Advise your patient about their symptoms and the best way to control them.
Patient counseling
Patients with asthma may have a higher risk for severe symptoms from EV-D68 and other respiratory illnesses.
For patients with asthma
Consider the following when talking with patients:
- Ensure that patients with asthma have an asthma action plan.
- Encourage use of this plan and adherence to prescribed controller medication.
- Recommend that people with asthma experiencing an exacerbation seek care rapidly and early.
At-a-Glance Guide
Surveillance
CDC has multiple surveillance systems that monitor enteroviruses in the United States.
- National Enterovirus Surveillance System (NESS)
- Acute Respiratory Illness (ARI) Interactive Dashboard
- National Respiratory and Enteric Virus Surveillance System (NRVESS)