Enterovirus D68 for Health Care Professionals

CDC Expert Commentary with Medscape

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.

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:
  • Laboratory testing is recommended for the investigation of clusters of acute, unexplained severe respiratory illness. For enterovirus/rhinovirus positive specimens, molecular typing 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. 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 EV-D68 testing:

• Contact your state or local health department. Some state laboratories may have EV-D68 RT-PCR or molecular typing capacity, while others may suggest submission to CDC.
• Before submitting to CDC, please contact PicornaLab@cdc.gov.
  • Submit specimens (nasopharyngeal and oropharyngeal swabs are preferred, or any other type of upper respiratory specimens) and complete specimen submission form 50.34.
  • See 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.
• 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.