Enterovirus D-68

Enterovirus D-68 (EV-D68) is an important cause of viral lower respiratory tract illness in children. In 2014, the US experienced an outbreak of EV-D68, with numerous children requiring hospital admission due to severe lower respiratory illness and asthma.

Most people infected have mild symptoms such as runny nose, cough, sneezing, or muscle aches; some patients have fever. Often patients with more severe disease have a history of asthma or chronic lung disease.

A possible association exists between EV-D68 infection and polio-like acute flaccid myelitis.

Diagnosis is clinical. Most clinical tests for rhinovirus do not distinguish EV-D68 in the absence of specific testing.

Specific testing for EV-D68 should be considered in children with severe unexplained respiratory illness, even in the absence of fever. Although not routinely available, specific testing can be obtained on a case-by-case basis through state or local health departments, or the Centers for Disease Control and Prevention.

In patients with mild upper respiratory symptoms, the illness is typically self-limited and no specific therapy is indicated.

Patients with asthma exacerbation or severe unexplained respiratory illness should receive supportive care. Management should occur in a setting that can provide access to appropriate pediatric subspecialty and critical care support. Currently there is no specific antiviral therapy available for the treatment of any enterovirus.

Preventive measures to avoid transmission include avoiding close contact with sick persons, washing hands with soap and water, covering coughs and sneezes, staying home when sick, and cleaning and disinfecting contaminated surfaces. In the healthcare setting, healthcare providers should use standard, contact, and droplet precautions.

Enterovirus D-68 (EV-D68) is a member of the Picornaviridae family. It has emerged as an important cause of acute respiratory illness, especially in children.[1]Oermann CM, Schuster JE, Conners GP, et al. Enterovirus D68: a focused review and clinical highlights from the 2014 United States outbreak. Ann Am Thorac Soc. 2015 May;12(5):775-81. http://www.ncbi.nlm.nih.gov/pubmed/25714788?tool=bestpractice.com [2]Midgley CM, Jackson MA, Selvarangan R, et al. Severe respiratory illness associated with enterovirus d68 - missouri and illinois, 2014. MMWR Morb Mortal Wkly Rep. 2014 Sep 12;63(36):798-9. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6336a4.htm http://www.ncbi.nlm.nih.gov/pubmed/25211545?tool=bestpractice.com [3]Foster CB, Friedman N, Carl J, et al. Enterovirus D68: a clinically important respiratory enterovirus. Cleve Clin J Med. 2015 Jan;82(1):26-31. http://www.ccjm.org/index.php?id=107953&tx_ttnews[tt_news]=319161&cHash=311070af3357f93577156ab83fd358ec http://www.ncbi.nlm.nih.gov/pubmed/25552624?tool=bestpractice.com In 2014, the US experienced an outbreak, with numerous children requiring hospital admission due to severe lower respiratory illness and asthma. Emerging data also support a role for EV-D68 in polio-like acute flaccid myelitis.[4]Pastula DM, Aliabadi N, Haynes AK, et al. Acute neurologic illness of unknown etiology in children: Colorado, August - September 2014. MMWR Morb Mortal Wkly Rep. 2014 Oct 10;63(40):901-2. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6340a5.htm http://www.ncbi.nlm.nih.gov/pubmed/25299607?tool=bestpractice.com [5]Greninger AL, Naccache SN, Messacar K, et al. A novel outbreak enterovirus D68 strain associated with acute flaccid myelitis cases in the USA (2012-14): a retrospective cohort study. Lancet Infect Dis. 2015 Jun;15(6):671-82. http://www.ncbi.nlm.nih.gov/pubmed/25837569?tool=bestpractice.com [6]Ayscue P, Haren KV, Sheriff H, et al. Acute flaccid paralysis with anterior myelitis - California, June 2012-June 2014. MMWR Morb Mortal Wkly Rep. 2014 Oct 10;63(40):903-6. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6340a6.htm http://www.ncbi.nlm.nih.gov/pubmed/25299608?tool=bestpractice.com [7]Messacar K, Schreiner TL, Maloney JA, et al. A cluster of acute flaccid paralysis and cranial nerve dysfunction temporally associated with an outbreak of enterovirus D68 in children in Colorado, USA. Lancet. 2015 Apr 25;385(9978):1662-71. http://www.ncbi.nlm.nih.gov/pubmed/25638662?tool=bestpractice.com  EV-D68 is closely related to rhinoviruses. Most clinical tests for rhinovirus do not distinguish EV-D68 in the absence of strain-specific typing.[8]McAllister SC, Schleiss MR, Arbefeville S, et al. Epidemic 2014 enterovirus D68 cross-reacts with human rhinovirus on a respiratory molecular diagnostic platform. PLoS One. 2015 Mar 23;10(3):e0118529. http://www.ncbi.nlm.nih.gov/pubmed/25799541?tool=bestpractice.com [Figure caption and citation for the preceding image starts]: MRI of the spine showing a T2/STIR hyperintensity restricted to the ventral gray matter of the cervical and thoracic spinal cord in a child with acute flaccid myelitis.From the collection of Neil Friedman, MBChB, Center for Pediatric Neurology, Cleveland Clinic, Cleveland, Ohio [Citation ends].