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General · 5th October 2014
Posted by GB editors
Enterovirus D-68 seems to be making the news these days, so we've posted an article from the web to help shed light on the issue.

What is EV-D68?
Enteroviruses are a group of viruses that can cause a range of symptoms - from no symptoms at all, to mild cold-like symptoms, to illnesses with fever and rashes, to neurologic problems. Infections with enteroviruses are very common and most people have mild symptoms. There are about 100 types of enteroviruses.
EV-D68 is a specific enterovirus that causes respiratory illness ranging from mild to severe. Symptoms can include a cold-like illness with coughing and wheezing to severe infections requiring admission to a hospital or possibly to an intensive care unit because of breathing difficulties.
Children and teenagers appear to be at increased risk of infection from EV-D68 because they may lack protection from previous exposures to the virus, although the virus can infect adults as well. Children with asthma seem to have a higher risk for severe respiratory illness.

When do infections from enteroviruses usually occur?
Enteroviruses usually circulate in the summer and fall, although this can vary depending on the type of enterovirus. Past outbreaks of EV-D68 have occurred mainly in the fall.
How is EV-D68 spread?
EV-D68 can be present in respiratory secretions from the nose and throat and can spread from an infected person when they cough or sneeze. Touching surfaces or objects contaminated with these secretions may also result in infection if the virus then gets into the body by touching the mouth, nose or eyes.

Is there a vaccine or specific treatment for EV-D68?
There is no vaccine or specific antiviral treatment for EV-D68. Most people don’t require any treatment and will get better on their own, but symptoms like wheezing and fever can be treated (aspirin should be avoided in children). Patients who have difficulty breathing may require hospital admission and those with severe breathing problems may require treatment in an intensive care unit including being placed on a ventilator.

What is currently happening with EV-D68?
In mid-August 2014, the US Centers for Disease Control and Prevention (CDC) began investigating clusters of children with severe respiratory illness in Missouri and Illinois. Laboratory testing indicated that EV-D68 was the cause of these illnesses. The CDC has since reported an increasing number of laboratory-confirmed cases of EV-D68 from an increasing number of states. As of September 15, 2014, laboratory-confirmed cases have been reported in Canada. While increases in hospitalizations for respiratory illness have been reported in affected areas, no deaths have been attributed to the recent increase in EV-D68 in North America.
The actual number of cases of EV-D68 is not known as people with viral infections often don’t seek medical care and swabs to test for viral infections are not routinely done. As well, not all laboratories test for EV-D68 or other respiratory viruses, and most respiratory infections are not reportable to public health. For most viruses, knowing the specific type of virus does not change patient care.
References: Centers for Disease Control and Prevention, Enterovirus D68 (Accessed September 16, 2014)
Centers for Disease Control and Prevention. Severe Respiratory Illness Associated with Enterovirus D68 — Missouri and Illinois, 2014 Morbidity and Mortality Weekly Report, September 12, 2014 / 63(36);798-799

What is the history of EV-D68?
EV-D68 was first identified in 1962. It has occurred infrequently since that time, although from 2008-2010, the Centers for Disease Control and Prevention reported on six clusters of EV-D68 in the Philippines, Japan, the Netherlands, and three US states (Georgia, Pennsylvania and Arizona). The clusters appeared to be concentrated in the fall. Four of the six outbreaks only reported infected children, one outbreak reported only infected adults and one outbreak involved both adults and children. Patients in these clusters often had new onset or worsening wheezing. Hospitalizations and admissions to intensive care units were noted and three individuals died.
Reference: Centers for Disease Control and Prevention (CDC). Clusters of Acute Respiratory Illness Associated with Human Enterovirus 68 -Asia, Europe, and United States, 2008—2010 Morbidity and Mortality Weekly Report, September 30, 2011 / 60(38);1301-1304

What precautions can be taken regarding EV-D68?
As with many viral infections, simple precautions can reduce the chances of getting EV-D68:
• Clean your hands frequently with soap and water or an alcohol-based hand rub, including after touching commonly touched objects and surfaces, before touching your face, before preparing food and before eating;
• Avoid touching your face as much as possible;
• Stay at least two metres (six feet) away from people who are ill;
• Frequently clean surfaces and objects that are commonly touched.
To avoid spreading viral infections:
• Stay home from work, school and other activities if you are ill;
• Cough and sneeze into your elbow and not your hand;
• Wash your hands frequently with soap and water or an alcohol-based hand rub.
People with asthma should ensure that they have their puffers readily available and know how to use them properly. Seek medical attention right away if wheezing does not respond to puffers or if you are having difficulty breathing.

Does EV-D68 cause neurologic problems?
The family of enteroviruses include types of viruses known to cause neurologic problems such as muscle weakness and paralysis. Rarely, EV-D68 has been identified in people who develop muscle weakness or paralysis. The Centers for Disease Control and Prevention (CDC) is currently investigating a small cluster of nine children hospitalized in Colorado who were identified from August 9 to September 17, 2014 with acute neurologic illness. EV-D68 has been identified in four of the nine children and some tests are still pending. Most of the children had a respiratory illness with fever in the two weeks before the onset of their neurologic symptoms.
Additional clinical information is available in the CDC Health Advisory issued on September 26, 2014.