Enterovirus D68 for Health Care Professionals
Enterovirus D68 (EV-D68) is one of over 100 non-polio enterovirus types and is a member of the family Picornaviridae. For general information on EV-D68 infection, including symptoms, transmission, risk factors, diagnosis, and treatment, see Overview of Enterovirus D68.
Clinical Evaluation, Reporting, and Treatment
CDC recommends that healthcare providers:
- Consider EV-D68 infection, especially during summer and fall, as a possible cause of unexplained severe acute respiratory illness, even if the patient does not have fever, or for acute respiratory illness associated with a rhinovirus- or enterovirus-positive molecular test. For these patients, healthcare providers should do the following:
- Recommend laboratory testing to investigate clusters of unexplained severe acute respiratory illness. For enterovirus- and/or rhinovirus- positive specimens, real time PCR and virus typing by sequencing can determine if EV-D68 is present. Without specialized patient treatment options for EV-D68, testing is unlikely to directly influence clinical management of individual patients, but it can help to raise awareness of EV-D68 circulation. Contact your state or local health department for enterovirus diagnostic testing and/or molecular typing before sending specimens.
- Ensure that patients with asthma have an asthma action plan. Encourage use of this plan, including adherence to prescribed long-term control medication. Encourage people with asthma who are experiencing an exacerbation to seek care rapidly and early. See 2020 Focused Updates to the Asthma Management Guidelines: At-a-Glance Guide [6 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 molecular typing and reporting.
- Consider an acute flaccid myelitis (AFM) diagnosis in patients with:
- Weakness in limbs
- Poor muscle tone
- Decreased reflexes
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. AFM may be difficult for healthcare providers to diagnose and treat and they should consider consulting with an infectious disease specialist and a neurologist.
Because specimen submission requirements for CLIA diagnostic testing are currently being updated, ALL submissions to CDC for diagnostic testing require pre-approval at this time. Contact PicornaLab@cdc.gov before submitting non-AFM specimens for enterovirus testing to CDC. Please contact AFMLab@cdc.gov before submitting any AFM specimens.
Before sending specimens for EV-D68 testing:
- Contact your state or local health department. Some state laboratories may have EV-D68 RT-PCR or EV molecular typing capacity, while others may suggest submission to CDC.
- Before submitting to CDC, please contact PicornaLab@cdc.gov
- Submit specimens (preferably nasopharyngeal and oropharyngeal swabs, or any other type of upper respiratory specimens). Also, complete specimen submission form 50.34.
- Review additional collection, storage, and shipment details.
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.
- 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) offers benefits in skin tolerance, compliance, and, especially when combined with glove use, overall effectiveness for a wide variety of healthcare-associated pathogens. Therefore, upon removal and prior to donning gloves, perform hand hygiene using either ABHS or soap and water. See Hand Hygiene in Healthcare Settings for more information.
- Respiratory Illness and Enterovirus D68: Clinical Guidance, Medscape video/podcast, 5:15 minutes, September 19, 2014
- Increase in Acute Respiratory Illnesses Among Children and Adolescents Associated with Rhinoviruses and Enteroviruses, Including Enterovirus D68 — United States, July–September 2022, MMWR, October 7, 2022
- Enterovirus D68-Associated Acute Respiratory Illness ─ New Vaccine Surveillance Network, United States, July–November 2018–2020, MMWR, November 26, 2021
- Enterovirus D68–Associated Acute Respiratory Illness — New Vaccine Surveillance Network, United States, July–October 2017 and 2018, MMWR, March 29, 2019
- Enterovirus D68 (EV-D68) Resources