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Enterovirus D68 for Health Care Professionals

CDC Expert Commentary with Medscape

Clinical guidance offered in this Medscape video by CDC’s Dr. Susan I. Gerber.

Respiratory Illness and Enterovirus D68: Clinical Guidance
Run time: [5:15 mins]
Released 9/19/2014

Enterovirus D68 (EV-D68) is one of many non-polio enteroviruses. For general information on the infection, including symptoms, transmission, risk factors, diagnosis, and treatment, see Overview of Enterovirus D68.

EV-D68 in 2016

As of June 3, 2016, CDC has confirmed four cases of EV-D68 infection in one state. The EV-D68 viruses that caused illness in these people are similar to those detected previously in the United States. As in previous years, CDC will continue to work in 2016 with states by testing specimens to determine virus type, supporting the identification and investigation of outbreaks, and monitoring seasonal activity.

Clinical Evaluation, Reporting, and Treatment

CDC recommends that clinicians:

  • Consider EV-D68 infection, especially during summer and fall, as a possible cause of acute, unexplained severe acute respiratory illness, even if the patient does not have fever. For these patients, they should do the following:
    • Consider laboratory testing of respiratory specimens for enteroviruses.
    • Consider EV-D68 testing of specimens that test positive for enterovirus or rhinovirus. Contact your state or local health department for enterovirus diagnostic and molecular typing, and before sending specimens.
    • Ensure that patients with asthma have an asthma action plan. Reinforce use of this plan, including adherence to prescribed long-term control medication. Encourage people with asthma who are experiencing an exacerbation to seek care early. See Asthma Care Quick Reference [12 pages].
    • Follow standard, contact, and droplet infection control measures.
  • 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 reporting.

Laboratory Testing

Before sending specimens for diagnostic and molecular typing:

  • Contact your state or local health department.
  • Submit specimens (nasopharyngeal and oropharyngeal swabs are preferred, or any other type of upper respiratory specimens; or sera) and complete specimen submission form 50.34.
  • Complete a patient summary form for each patient for whom specimens are being submitted. Please send a printed copy of the form at the same time as specimen submission.
  • Follow infection control measures; see CDC health alert (HAN) dated September 12, 2014 for more information.

Infection Control Recommendations

Healthcare professionals in healthcare settings should be vigilant about preventing the spread of EV-D68:

  • Infection control precautions should include Standard, Contact, and Droplet Precautions.
  • Although non-enveloped viruses such as EV-D68 may be less susceptible to alcohol than enveloped viruses or vegetative bacteria, alcohol-based hand rub (ABHR) offers benefits in skin tolerance, compliance, and, especially when combined with glove use, overall effectiveness for a wide variety of healthcare pathogens. Therefore, upon removal and prior to donning gloves, perform hand hygiene using either ABHR or soap and water. See Hand Hygiene in Healthcare Settings for more information.
  • See CDC health alert (HAN) dated September 12, 2014 for guidance for environmental disinfection specific for EV-D68.

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