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Published on October 07, 2014

Enterovirus D68 (EV-D68) 

Frequently Asked Questions

What is enterovirus D68?

Enterovirus-D68 (EV-D68) is one of many non-polio enteroviruses. This virus was first identified in California in 1962, but it has not been commonly reported in the United States.

What are the symptoms of EV-D68 infection?

EV-D68 can cause mild to severe respiratory illness.

  • Mild symptoms may include fever, runny nose, sneezing, cough, and body and muscle aches.
  • Most of the children who became very ill with EV-D68 infection in Missouri and Illinois, the first states that noticed an increase in children with more severe respiratory infections, had difficulty breathing and some had wheezing (a whistling or rattling sound when someone breathes). Many of these children had asthma or a history of wheezing.

How does the virus spread?

Since EV-D68 causes respiratory illness, the virus can be found in an infected person’s respiratory secretions, such as saliva, nasal mucus or sputum from coughing. EV-D68 likely spreads from person to person when an infected person coughs or sneezes, or through contaminated surfaces and hands

How widespread is this outbreak?

Most states in the United States are likely affected by respiratory illnesses caused by EV-D68.

However, it is too soon to know exactly how widespread it is in the U.S. Over 40 states have confirmed EV-D68 infections, indicating that at least one case has been detected in each state listed, but it is unclear how widespread infections are in each state. Other states may also have the virus circulating, but they may not have detected it yet since there can be a delay between when a patient presents to the doctor and when test results return. As investigations progress, New Hampshire Department of Health and Human Services (DHHS) will have a better understanding of whether the trends for EV-D68 infections are going up or down.

How common are EV-D68 infections in the United States?

EV-D68 infections are thought to occur less commonly than other enterovirus infections; however, it is unknown how many infections and deaths from EV-D68 occur each year in the United States. Healthcare professionals are not required to routinely report this information to DHHS or health departments in other states. Also routine testing is not available to detect EV-D68, which limits identification and reporting of this virus.

What time of the year are people most likely to get infected with enteroviruses?

In general, the spread of enteroviruses is often quite unpredictable, and different types of enteroviruses can be common in different years with no particular pattern. In the United States, people are more likely to get infected with enteroviruses in the summer and fall. New Hampshire is currently in the middle of the enterovirus season, and EV-D68 infections are likely to decline later in the fall.

Who is at risk?

In general, infants, children and teenagers are most likely to get infected with enteroviruses and become ill because they do not yet have immunity (protection) from previous exposures to these viruses. DHHS believes this is also true for EV-D68 as the majority of patients presenting to hospitals with EV-D68 infections are children and adolescents. Children with asthma or a history of wheezing appear to also be at higher risk for severe respiratory illness.

How is EV-D68 diagnosed?

For patients presenting with a respiratory infections, EV-D68 can be diagnosed by doing specific lab tests on specimens from a person’s nose and throat. Many hospitals and some doctors’ offices can test ill patients to see if they have enterovirus infection. However, most cannot do specific testing to determine the type of enterovirus, such as EV-D68. It can take a while to test specimens and obtain lab results since determining the virus type can only be done by Centers for Disease Control and Prevention and a small number of state public health laboratories. DHHS Public Health Laboratory does not currently do this specific testing.

Who should be tested?

Patients who are exhibiting symptoms of a severe respiratory illness and difficulty breathing without another clear cause can be tested for EV-D68. Anyone with a respiratory illness should contact their healthcare provider if they are having difficulty breathing or if their symptoms are getting worse. 

What is the treatment for EV-D68?

There is no specific treatment for people with respiratory illness caused by EV-D68. For mild respiratory illness, one can help relieve symptoms by taking over-the-counter medications for pain and fever. Aspirin should NOT be given to children. Some people with severe respiratory illness may need to be hospitalized. There are no antiviral medications currently available for people who become infected with EV-D68.

How can I protect myself and my family?

You can help protect yourself from respiratory illness by following these steps and encouraging others to do the same:

  • Wash hands often with soap and water for 20 seconds, especially after changing diapers.
  • Avoid touching eyes, nose and mouth with unwashed hands.
  • Avoid kissing, hugging and sharing cups or eating utensils with people who are sick.
  • Disinfect frequently touched surfaces, such as toys and doorknobs, especially if someone is sick.

Since people with asthma are at a higher risk for respiratory illness, they should take their medicines as prescribed and maintain control of their illness during this time. They should also receive the flu vaccine at their earliest convenience since they are at a higher risk for severe complications from the flu virus. There is no vaccine available for EV-D68. 

What should people with asthma and children suffering from conditions such as reactive airway disease (a history of coughing, wheezing or shortness of breath that may or may not be caused by asthma) do?

CDC and DHHS recommend that people with asthma and children suffering from conditions such as reactive airway disease:

  • Discuss and update asthma action plan with their primary care providers;
  • Take prescribed asthma medications as directed, especially long-term control medication(s);
  • Be sure to keep reliever medications with them;
  • Follow the steps of their asthma action plan if they develop new or worsening asthma symptoms. If symptoms do not go away, they should call their healthcare provider right away;
  • Have parents notify the child’s caregiver and/or teacher of their condition and confirm that they know how to help if the child experiences any symptoms related to asthma.

Is there a vaccine against EV-D68?

No. There are no vaccines for preventing EV-D68 infections.

Is EV‐D68 fatal?

No confirmed deaths associated with EV‐D68 have been reported during this recent increase in respiratory infections. 

What should schools, childcare centers and offices do to help prevent EV-D68 infections?

Schools are encouraged to be vigilant for any unexpected increase in illness among their students and report any suspected outbreak of any illness, including EV‐D68, to New Hampshire Department of Health and Human Services, Division of Public Health Services at 603-271-4496.

If a child is diagnosed with enterovirus or EV‐D68, should they be excluded from school/daycare?

Children without a fever should be excluded until they are symptom free. Children with a fever (oral temperature of >100°F) should stay home until they are fever free for 24 hours without fever‐reducing medication and are symptom free.

Is there a risk of my child getting EV‐D68 if my child goes to school?

As with other respiratory infections, including the flu and common cold, there is some increase in risk of contracting EV‐D68 in places with large numbers of people, such as schools and daycare settings. Children can protect themselves by washing their hands often, not touching their eyes and noses, and coughing or sneezing into a tissue or their arm/elbow and properly disposing of the tissue. Parents should never send a sick child to school. Any child with a fever of 100°F or more should stay home until they are fever free for 24 hours.

What is New Hampshire Department of Health and Human Services doing to respond to EV‐D68?

DHHS continues to monitor the situation and is in communication with hospitals, local health departments, healthcare providers, schools and daycare providers about testing and clinical guidance. In conjunction with CDC and other partners, DHHS is having samples tested to determine how widespread infection with EV-D68 is in New Hampshire.

Has EV-D68 been confirmed in New Hampshire?

Yes. Several cases have been confirmed in New Hampshire so far. There are also several cases that are pending final test results. The identification of this virus in the State was expected and the presence does not change recommendations about prevention and control.

I heard that EV-D68 is causing neurologic symptoms including limb weakness in children, is that true?

Centers for Disease Control and Prevention is currently investigating a cluster of nine cases of children in Colorado with a neurologic syndrome, including limb weakness, that were reported since August. The cause of this syndrome is presently unknown and may or may not be related to the current widespread increase in EV-D68 infections; the investigation is ongoing. 

For more information about Enterovirus D68, visit New Hampshire Department of Health and Human Service Web site or Centers for Disease Control and Prevention Web site.

 Source: New Hampshire Department of Health and Human Services