Enteroviruses cause a wide range of illness; most are associated with the common cold, but others are associated with lower respiratory tract, skin and mucous membrane, and central nervous system diseases.
Enterovirus- D68 (EV-D68) is a previously rare enterovirus that can cause mild to severe illness. EV-D68 is unusual in that it is more often associated with lower respiratory illness. The virus is spread person-to-person through contact with the respiratory secretions of infected persons.
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.
In August 2014, several children’s hospitals in the US reported increases in children hospitalized with severe respiratory illness. EV-D68 was identified in many of these children; notably, 70% of the children had a history of asthma or wheezing.
Since then, over 500 cases in 43 US states and the District of Columbia have been confirmed to have respiratory illness caused by EV-D68. Although not nationally notifiable, cases of EV-D68 have also been identified in 5 Canadian provinces (BC, Alberta, Saskatchewan, Manitoba, and Ontario). More case reports are anticipated as diagnostic testing for EV-D68, which requires sequencing of the virus, is completed on suspect cases.
On September 26, 2014, the US CDC issued a Health Advisory to clinicians reporting a cluster of polio-like illness in 9 children (aged 1-18 years) in Colorado. Of the 8 tested specimens, 6 were positive for entero/rhinoviruses, of which 4 were confirmed as EV-D68, with 2 typing results pending at the time of report. As part of this advisory, the US CDC requested further information on patients ≤21 years of age presenting with acute onset of focal limb weakness occurring on or after August 1, 2014, and an MRI showing spinal cord lesion largely restricted to grey matter. Since then, clusters of polio-like illness have been cited in some provinces including BC, Ontario and Alberta although information about whether these may have been associated with EV-D68 is still pending.
What do health care providers need to know?
Clinicians should consider EV-D68 infections in children presenting with severe respiratory illness and report any increase or unusual clusters/outbreaks of respiratory illness to their local public health authority.
Health care providers should implement droplet and contact precautions, in addition to routine practices for patients with suspected EV-D68. Surfaces should be cleaned with a hospital-grade disinfectant with a Drug Identification Number or DIN and a label claim for non-enveloped viruses.
What can members of the public do?
Members of the public can take action to prevent the spread of this virus. Hands should be washed frequently with soap and water, or cleaned with an alcohol-based hand rub containing at least 70 per cent alcohol. As well, coughing and sneezing into your sleeve can help minimize the risk of spread of illness. Children should be kept home from school if they have cold-like symptoms. If symptoms of a lower respiratory illness develop, the child should be assessed by a healthcare provider, especially if the child has a history of asthma or wheezing. There is no vaccine against EV-D68 like there is with polio. Sudden onset of muscle weakness or partial paralysis is very rare in children. Parents are advised to monitor their children and take them to see a doctor if a lingering cold seems to suddenly get worse or if the child suddenly develops a fever. As well, any child who suddenly develops muscle weakness or is unable to move their limbs should seek immediate medical care.