The Facts

Enterovirus D68, also known as EV-D68, belongs to a larger group of viruses known as enteroviruses. This group includes more than 100 different types of enteroviruses, which together affect millions of people around the world. Enteroviruses commonly affect the gastrointestinal tract and cause stomach flu and diarrhea. However, EV-D68 is mainly associated with respiratory disease and therefore is more similar to the human rhinovirus (a type of virus that affects the respiratory tract).

EV-D68 was first identified in California in 1962 in 4 children with pneumonia and bronchiolitis (a type of infection of the airways). Until recently, only a few isolated cases had been identified since that time, but in the past 5 years outbreaks have occurred in Japan, the Philippines, the Netherlands, the United States and Canada.

Enterovirus D68 infections occur most frequently in summer and fall. Children under the age of 5 and children with asthma appear to be the most at risk of infection, but it can also affect adults with asthma and those that have weakened immune systems.

Causes

Because EV-D68 causes respiratory illness, the virus is found in the respiratory secretions of an infected person. This means that the virus can be transmitted from person to person through saliva or mucus. If an infected person touches a surface, or coughs or sneezes on it, it can become contaminated, meaning that others who touch this surface may become infected.

Symptoms and Complications

Enterovirus D68 can cause mild-to-severe symptoms depending on the risk factors of the infected person, such as having a weakened immune system. Mild symptoms include:

• body and muscle aches
• cough
• difficulty breathing
• fever
• runny nose
• sneezing
• wheezing

These respiratory symptoms can lead to further complications such as pneumonia and even respiratory failure.

EV-D68 can also cause symptoms that are common with other enteroviruses, such as:

• abdominal pain
• diarrhea
• skin rashes

A rare complication that was seen in 2 children in California involved paralysis of one or more limbs.

Making the Diagnosis

Because many of the symptoms of EV-D68 infection are similar to those seen in other respiratory conditions, EV-D68 should only be investigated after these conditions have been ruled out or if symptoms are getting worse.

Currently, EV-D68 can only be diagnosed by doing specific lab tests on samples obtained from a person’s nose and throat. Once a sample is obtained, it will be sent to a lab for diagnosis. It will take the lab approximately one week to get the results back to your doctor.

Treatment and Prevention

There is currently no specific treatment for people who have respiratory virus caused by EV-D68. There are also no antiviral medications for those infected with the EV-D68 virus and no immunizations to prevent you from getting the virus.

Treatment is directed against the symptoms of the infection. People with mild symptoms can take over-the-counter medications such as acetaminophen to help relieve possible fever or pain. If you are experiencing wheezing or respiratory issues, see your doctor. Oxygen therapy or medications can be used to help with these symptoms. Most people infected with EV-D68 recover completely; rarely, some people may need to be hospitalized.

As with any respiratory illness, the best way to avoid infection is prevention. Follow these steps to help prevent infection:

• Avoid kissing, hugging, and sharing cups or eating utensils with those who are sick.
• Avoid touching your eyes, nose, and mouth with unwashed hands.
• Disinfect frequently touched surfaces if someone in your home is sick.
• Use proper hand-washing techniques.
• Use a hand sanitizer if washing your hands with soap and water is not possible.
• Wash your hands often, with soap and water, for 20 seconds, especially after changing a baby’s diaper.
• Wash your hands before you eat or prepare food.
• Wash your hands thoroughly after being in public areas.

If you are sick, or have been recently diagnosed as having an EV-D68 infection, it is important to stay at home in order to prevent transmitting the virus to others.