The American Academy of Pediatrics (AAP) continues to monitoring the nationwide outbreak of enterovirus D68 (EV-D68) associated with severe respiratory illness in children. The Centers for Disease Control and Prevention (CDC) offers up-to-date information, identifies states with laboratory-confirmed cases, and shares Health Alert Network (HAN) messages. In 2014, the AAP began to monitor a situation being investigated by the CDC in regards to acute flaccid myelitis in children. For more information, see the AAP Acute Flaccid Myelitis in Children Web page.
Health care providers should consider EV-D68 as a possible cause of severe respiratory illness, particularly in children, and are encouraged to report any unusual or unexplained illnesses to local and state health departments. Many other viruses that cause respiratory illness are circulating in the United States during this time of year. Not all clusters or outbreaks of respiratory illness occurring now are due to this virus.
Enterovirus D68 is one of many non-polio enteroviruses that can cause mild to severe respiratory illness. Symptoms may include fever, runny nose, sneezing, cough, body and muscle aches, and in more severe cases, wheezing and difficulty breathing. Infants, children, and teenagers are more likely to get infected with enteroviruses and become ill, yet adults can be affected as well. The onset of symptoms can be quick. Within hours, typical cold systems have turned into breathing difficulties, sometimes accompanied by wheezing, cough, rash or fever. Health care providers should consider enterovirus D68 as a possible cause of acute, unexplained severe respiratory illness, even in the absence of fever.
Enterovirus D68 is not frequently identified, so it is less studied, and the ways it spreads are not well-understood. Since EV-D68 causes respiratory illness, the virus can be found in respiratory secretions, such as saliva, nasal mucus, or sputum. The virus likely spreads from person to person when an infected person coughs, sneezes, or touches contaminated surfaces.
In October 2014, the CDC developed a faster lab test for detecting EV-D68. Because of these efforts, the number of confirmed cases was expected to increase substantially. The increases will not reflect changes in real-time or mean that the situation is getting worse, rather, the faster testing will show outbreak trends and help to monitor changes that are occurring now. Many state health departments are currently investigating increases in cases of severe respiratory illness in children. This increase could be caused by many different viruses that are common during this time of year. EV-D68 appears to be the predominant type of enterovirus this year and is likely contributing to the increases in severe respiratory illnesses. Almost all of the CDC-confirmed cases this year of EV-D68 infection have been among children.
There is no vaccine, nor antiviral treatment for this virus. Any child or individual experiencing more severe symptoms, such as any difficulty breathing, should be examined by a health care provider right away. Some people with severe respiratory illness caused by EV-D68 may need to be hospitalized and receive intensive supportive therapy.
US Health Care Providers should continue to:
- Be aware of EV-D68 as a potential cause of clusters of severe respiratory illness in children.
- Consider laboratory testing of respiratory specimens for enteroviruses when the cause of infection in severely ill patients is unclear.
- Before sending specimens to CDC, health care providers should:
- Contact their state or local health department, and
- Consult with the CDC by sending an email to email@example.com.
- Report cases and clusters of severe respiratory illnesses to state and local health departments.
- Be strategic in meeting the needs of children at increased risk for respiratory illnesses. Discuss with parents that there should be a plan in place to treat these children early if they develop symptoms. Parents concerned about wheezing or breathing difficulties in their child should be advised to contact their pediatrician or health care professional as soon as possible. Also see the Healthy Children Web page and strategies for child care programs and schools.
People can help protect themselves from respiratory illnesses by following these steps:
- 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 higher risk for respiratory illnesses, they should regularly take medicines and follow guidance to maintain control of their illness. All people with asthma should have an asthma action plan. They should also be immunized as soon as seasonal influenza vaccine is available, since people with asthma have a difficult time with respiratory illnesses.
AAP News updates to members include:
AAP Redbook Chapter on Enteroviruses
CDC enterovirus D68
CDC enterovirus D68 Resources
CDC What Parents Need to Know about Enterovirus D68
CDC Archived Webinar (September 16, 2014) Enterovirus D68 in the United States: Epidemiology, Diagnosis & Treatment 9/16/14
CDC Health Advisory Notice: Severe Respiratory Illness Associated with Enterovirus D68 – Multiple States, 2014 9/12/14
CDC MMWR – "Severe Respiratory Illness Associated with Enterovirus D68 — Missouri and Illinois, 2014" 9/12/2014
AAP Healthy Children Web page
For additional information, e-mail DisasterReady@aap.org.