From the Guidelines
Enterovirus D68 (EV-D68) diagnosis should be performed using reverse transcriptase PCR (RT-PCR) targeting the 5′noncoding regions (5′NCR) due to their sensitivity, specificity, and short turnaround time, as recommended by the European non-polio enterovirus network (ENPEN) 1.
Diagnosis and Characterization
The diagnosis of EV-D68 is crucial, especially in patients with suspected neurological infections, as it can cause severe respiratory and neurological symptoms.
- Respiratory and stool samples, in addition to cerebrospinal fluid (CSF) and blood samples, should be submitted for EV testing from patients with suspected neurological infections 1.
- Sequencing of the VP1 capsid protein gene is recommended for EV typing, as EV typing cannot be based on the 5′NCR sequences due to frequent recombination events 1.
Clinical Presentation
EV-D68 typically causes symptoms similar to the common cold, including runny nose, sneezing, cough, and body aches. However, in some cases, especially in children with asthma or other respiratory conditions, it can cause severe respiratory symptoms requiring hospitalization 1.
- In rare instances, EV-D68 has been associated with acute flaccid myelitis (AFM), a serious neurological condition that causes sudden weakness in the arms or legs 1.
Management and Prevention
There is no specific antiviral treatment for EV-D68 infections, and management focuses on supportive care to relieve symptoms.
- This includes over-the-counter pain relievers like acetaminophen for fever and pain, adequate hydration, and rest 1.
- For severe cases requiring hospitalization, oxygen therapy or mechanical ventilation may be necessary 1.
- Prevention measures include regular handwashing, avoiding close contact with sick individuals, disinfecting frequently touched surfaces, and staying home when ill 1.
From the Research
Enterovirus D68 Overview
- Enterovirus D68 (EV-D68) is a member of the species Enterovirus D in the genus Enterovirus of the Picornaviridae family 2
- EV-D68 was first isolated in the United States in 1962 and is primarily an agent of respiratory disease 2
- Infections with EV-D68 have been rarely reported until recently, when reports of EV-D68 associated with respiratory disease increased notably worldwide 2
Clinical Characteristics
- Respiratory illness associated with EV-D68 infection ranges from mild illness that just needs outpatient service to severe illness requiring intensive care and mechanical ventilation 2
- EV-D68 is associated with severe disease in otherwise healthy children of all ages 3
- Children with non-asthma or reactive airway disease (RAD) comorbidities are at higher risk for severe outcomes when hospitalized 3
- Having an underlying condition other than asthma or RAD is associated with increased odds of receiving supplemental oxygen or intensive care admission 3
Epidemiology
- An outbreak in 2014 in the United States involved more than 1,000 cases of severe respiratory disease that occurred across almost all states 2
- EV-D68 detections in the United States have increased in recent years, with a biennial pattern observed during 2014-2018 4
- The circulation of EV-D68 in 2020 might have been limited by widespread COVID-19 mitigation measures 4