Laboratory Testing for Non-Polio Enterovirus

Key points

  • CDC laboratories routinely conduct testing for non-polio enteroviruses and parechoviruses.
  • CDC and some health departments test with molecular sequencing methods, or a real-time reverse transcription polymerase chain reaction (rRT-PCR) lab test.
  • Submissions to CDC for diagnostic testing require pre-approval.
Surface view of EV-D68 looking down an icosahedrtal 2-fold axis.

Overview

Clinicians consider EV-D68 as a possible cause of acute, serious respiratory illness. If not already part of a typical diagnostic routine, lab tests should be done when the cause of respiratory infection in seriously ill patients is unclear.

Services and outreach

CDC laboratories routinely conduct testing for non-polio enteroviruses and parechoviruses, such as:

  • Qualitative molecular testing; pan-enterovirus and pan-parechovirus.
  • Molecular testing, followed by sequencing to identify enterovirus and parechovirus types (formerly serotypes).
  • Testing for less common picornaviruses (excluding Hepatitis A).

The CDC helps state laboratories with testing by:

  • Sharing new diagnostic technologies and providing training on how to perform these techniques.
  • Helping them identify enteroviruses and par echoviruses they have been unable to test.
  • Guiding how to properly collect and ship clinical specimens to the CDC for confirming and typing picornaviruses.

Contact CDC ‎

Health departments may contact the CDC for further enterovirus typing or other lab testing procedures.
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Types of tests

Infection with non-polio enteroviruses or parechoviruses can be confirmed by:

  • Polymerase chain reaction (PCR) assays and sequencing.
  • Isolating the virus in cell culture, followed by PCR assays for virus identification.

Specimen collection overview

Non-polio enteroviruses and parechoviruses can be detected in stool or rectal swabs and respiratory specimens (including from the throat).

Depending on the symptoms, other specimen types such as cerebrospinal fluid, blister fluid, and blood can be collected for testing.

Keep Reading: Collecting Specimens for Non-Polio Enterovirus Testing

Submitting specimens

For EV-D68 testing, contact health department first‎

Please contact your health department for enterovirus diagnostic testing and molecular typing before sending specimens. Some state laboratories may have EV-D68 RT-PCR or EV molecular typing capacity. Others may suggest submission to CDC.
Find contact info
  1. Before submitting to CDC: Request pre-approval for all submission to CDC for diagnostic testing. This is because specimen submission requirements for CLIA diagnostic testing are currently being updated.
    1. Please contact PicornaLab@cdc.gov for testing non-AFM specimens.
    2. Please contact AFMLab@cdc.gov before submitting any AFM specimens.
  2. Preferred specimens: Submit nasopharyngeal and oropharyngeal swabs, or any other type of upper respiratory specimens.
  3. Specimen submission form: Complete CDC specimen submission form (CDC Form 50.34).
  4. Shipping and handling: Follow collection, storage, and shipment guidelines.

Interpreting results

A positive laboratory test for non-polio enteroviruses and parechoviruses from certain specimens, such as rectal or respiratory swab, does not necessarily mean the virus is the cause of infection. Non-polio enteroviruses and parechoviruses can be shed for several weeks after the symptoms have resolved.

Reporting results

Report suspected clusters of unexplained severe acute respiratory illness to local and state health departments. EV-D68 is not nationally notifiable, but state and local health departments may have additional guidance on molecular typing and reporting.

Resources

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Content Source:
National Center for Immunization and Respiratory Diseases; Division of Viral Diseases