Consider enterovirus EV-D68 in the differential for severe upper respiratory
illness among children.
Background: The Centers for
Disease Control & Prevention (CDC) has reported two clusters of severe
respiratory illness in children caused by enterovirus D68 (EV-D68), an uncommon
pathogen first seen in California in 1962 (http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6038a1.htm).
About 100 types of enteroviruses are known and an estimated 10-15 million
infections occur annually in the United States. Enterovirus infections
are more likely to occur in the fall; children and teens are most likely to be
infected. Clinical manifestations vary widely and can include mild
respiratory illness, febrile rash illness, and neurologic illness, such as
aseptic meningitis and encephalitis. However, EV-D68 infection has been
associated almost exclusively with respiratory illness ranging from relatively
mild illness not requiring hospitalization to severe illness requiring
intensive care and mechanical ventilation. The virus likely spreads person
to person when an infected person coughs, sneezes, or touches surfaces.
There is no vaccine or specific therapy other than supportive care and
management of complications.
EV-D68 when children present with moderate or severe respiratory illness.
is not necessary for patients not requiring hospitalization. For
hospitalized patients, generic enterovirus testing can be requested from
commercial laboratories, but specific testing to identify EV-D68 is being
done at CDC laboratories (for specimens testing positive for enterovirus).
the Health District (425-339-5278) to report clusters of severe
respiratory illness or for assistance with testing.
is through general respiratory and hand hygiene. Healthcare providers
should use standard and droplet precautions.
- 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.
- Cover coughs or sneezes.
- Stay home when ill.
information, see http://www.cdc.gov/non-polio-enterovirus/index.html.
Test for pertussis and exclude from work or child care only when
symptoms are present.
provider actions suggest confusion about testing and exclusion recommendations
for pertussis. Given that pertussis continues to circulate at low levels
within our community, it is appropriate for providers to consider pertussis
when patients present with symptoms. Pertussis typically
presents as a paroxysmal coughing illness that increases in severity over a
period of a few weeks and is associated with whooping and/or vomiting. In
infants, apnea may be presenting symptom. Testing is appropriate when
symptoms are present, but not for asymptomatic contacts.
symptomatic patients (nasopharyngeal swab for PCR) and treat with
appropriate antibiotics at time of initial visit.
ill persons from work or child care until they have completed 5 days of
NOT test or exclude asymptomatic (non-infectious) contacts who are being
seen for prophylaxis.
Communicable Disease Response at 425-339-5278 if you have questions about