Non-Polio Enterovirus Infection: Enterovirus D68 for Health Care Professionals - CDC

Non-Polio Enterovirus Infection: Enterovirus D68 for Health Care Professionals - CDC

• Many children in almost every state are getting severe respiratory illnesses fromenterovirus D68 (EV-D68) this year.
• Children with asthma are especially at risk for severe symptoms, such as difficulty breathing and wheezing. See what all parents need to know about EV-D68.
• Healthcare providers should follow CDC guidance for identifying patients who may have EV-D68, testing of specimens, and reporting to health departments.

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.

Also see Enterovirus D68 in the U.S., 2014.

Clinical Evaluation, Reporting, and Treatment

During late summer and fall 2014, CDC recommends that clinicians:

• consider EV-D68 as a possible cause of acute, unexplained severe respiratory illness, even if the patient does not have fever.
• ensure that the patient has 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. SeeAsthma Care Quick Reference.  [12 pages]
• report suspected clusters of severe 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.
• consider laboratory testing of respiratory specimens for enteroviruses when the cause of respiratory illness in severely ill patients is unclear.
• consider testing to confirm the presence of EV-D68. State health departments can be approached for diagnostic and molecular typing for enteroviruses.

The antiviral drugs pleconaril, pocapavir, and vapendavir have significant activity against a wide range of enteroviruses and rhinoviruses. CDC has tested these drugs for activity against currently circulating strains of enterovirus D68 (EV-D68), and none of them has activity against EV-D68 at clinically relevant concentrations.

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 respiratory specimens) using CDC instructions 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.
  • Enterovirus D68 (EV-D68) Patient Summary Form
    • fillable form and 508-compliant  [1 page]
    • PDF print version  [1 page]
• follow infection control measures; see CDC health alert for more information.

Diagnostic Methods

The CDC Picornavirus Laboratory from mid-September to mid-October developed and evaluated the EV-D68-specific rRT-PCR assay. The assay and protocol are primarily focused on evaluating respiratory disease due to EV-D68. Some developmental and validation information can be found in Appendix B. The protocol that follows has worked reliably in our hands with little difficulty in any phase of the testing process, including interpretation of results.

For protocols about using the EV-D68 Real-Time RT-PCR assay, please see these Instructions (Version 10/14/2014)  [13 pages].

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 for the current outbreak of EV-D68.
• 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.

Related Pages

• Respiratory Illness and Enterovirus D68: Clinical Guidance, Medscape video/podcast, 5:15 minutes, September 19, 2014
• Enterovirus D68 in the United States: Epidemiology, Diagnosis & Treatment, COCA Call, September 16, 2014
• Severe Respiratory Illness Associated with Enterovirus D68 — Missouri and Illinois, 2014,MMWR, September 8, 2014
• Clusters of Acute Respiratory Illness Associated with Human Enterovirus 68 --- Asia, Europe, and United States, 2008--2010,MMWR, September 30, 2011