Enterovirus D-68

Last reviewed: June 2019

Last updated: March 2019

Summary

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 paralysis.

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

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, it can sometimes be obtained on a case-by-case basis through state or local health departments.

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.

Definition

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] [2] [3] 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 paralysis. [4] [5] [6] [7] 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] com.bmj.content.model.Caption@54cccd69 [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 paralysis. From the collection of Neil Friedman, MBChB, Center for Pediatric Neurology, Cleveland Clinic, Cleveland, Ohio [Citation ends].