Enterovirus D68 (EV-D68) Frequently Asked Questions

What is an enterovirus?

Enteroviruses (EV) are common viruses and there are over 100 types. It is estimated that 10‐15 million EV infections occur in the U.S. each year. The spread of EV is unpredictable and different types of EV can be common in different years. People are more likely to get infected with EV infections in the summer and fall.

What is enterovirus D68 (EV‐D68)?

  • Although enterovirus D68 (EV-D68) is not a new virus, it is less common than other enteroviruses. Compared with other enteroviruses, EV-D68 has been rarely reported in the United States for the last 40 years.
  • EV-D68 can cause serious respiratory symptoms. It can be particularly serious for children with asthma or other respiratory conditions that make breathing difficult. For these children, EV-D68 infections can result in hospitalization.

What are symptoms of EV‐D68 infection?
Symptoms may range from mild to severe.

  • Mild symptoms may include runny nose, sneezing, cough, body and muscle aches and sometimes fever.
  • Severe symptoms include difficulty breathing, wheezing and worsening of asthma. Hospitalization in an intensive care unit may be required.

Is EV-D68 linked to a neurologic illness that is characterized by limb weakness?

The United States is currently experiencing a nationwide outbreak of EV-D68 associated with severe respiratory disease. The federal Centers for Disease Control and Prevention (CDC), Colorado Department of Public Health and Environment, and the Children’s Hospital Colorado are investigating some cases of acute neurologic illness among pediatric patients, who are mostly from the Denver metropolitan area. The possible linkage of this cluster of neurologic disease to the EV-D68 outbreak is part of the current investigation. The CDC is working with state and local health departments, health care providers, hospital emergency departments and laboratories to get information about other similar neurologic illnesses in all states, especially cases clustered in time and place.

How is EV‐D68 infection spread?
EV‐D68 is spread through close contact with infected people.

  • The virus likely spreads from person to person when an infected person coughs or sneezes.
  • You can also become infected by touching objects or surfaces that have the virus on them and then touching your mouth, nose or eyes.
  • Enteroviruses are also present in stool and can be passed on to others when people do not wash their hands after touching stool.

Who is at risk for EV‐D68?

  • Infants, children and teenagers are most likely to get infected with EV and become sick. This is most likely because they do not have protection (immunity) because of no previous exposure to this virus.
  • Children with asthma seem to have a higher risk for severe respiratory illness. Infants and people with weakened immune systems have a greater chance of complications. Adults can get infected with EV and are more likely to have no symptoms or mild symptoms.

What does the CDC recommend for people with asthma and children suffering from reactive airway disease?

Since people with asthma are at higher risk for respiratory illnesses, they should regularly take medicines and maintain control of their illness during this time. They should also take advantage of seasonal flu shots since people with asthma have a difficult time with respiratory illnesses.

The CDC recommends:

  • Discuss and update your asthma action plan with your primary care provider.
  • Take your prescribed asthma medications as directed, especially long term control medications.
  • Be sure to keep your reliever medication with you.
  • If you develop new or worsening asthma symptoms, follow the steps of your asthma action plan. If your symptoms do not go away, call your doctor right away.
  • Parents should make sure the child’s caregiver, teacher and school nurse are aware of his/her condition. They can know how to help if the child experiences any symptoms related to asthma.

How is EV‐D68 treated?

There is no specific medication for EV‐D68 infections. Antibiotics do not treat enteroviruses and will have no effect on EV‐D68. Supportive treatment may be needed in some cases to control symptoms. Aspirin should not be given to children. Those with severe respiratory illness may need to be hospitalized and receive intensive care. Testing for EV‐D68 does not change the treatment an ill child will receive.

Is there a test for EV‐D68?

There is a general enterovirus test that is performed on specimens taken from the nose or mouth. This general test is usually done when a person is hospitalized and the diagnosis is not clear. While there is a specialized lab test for EV-D68, it is not routinely available through most labs and is not indicated for the vast majority of infected people. Testing for EV-D68 does not change the treatment an ill child will receive.

How can I protect my child from becoming infected with EV‐D68?

There is no vaccine to prevent EV‐D68 infections. However, you can protect yourself from EV‐D68 and other EV infections if you:

  • Wash your hands frequently with soap and water for 20 seconds, especially after sneezing, coughing and toileting.
  • Avoid touching your 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.
  • If you or your child is ill, do not go to work and keep children home from daycare or school.

How concerned should parents be about the EV‐D68?

Parents who have children with asthma should make certain that their child’s condition is well managed. All parents should encourage disease prevention through good hand washing and respiratory hygiene, which includes coughing and sneezing into a tissue or arm/elbow. If a child becomes ill or has difficulty breathing, parents should consult with their health care provider or go to the emergency room.

If a child is diagnosed with EV or EV‐D68, should they be excluded from school/daycare?

Children without a fever should be excluded until symptom free. Children with a fever (oral temperature of >100°F) must stay home until they are fever-free for 24 hours without fever‐reducing medication.

Is there a risk of my child getting EV‐D68 if my child goes to school?

As with other respiratory infections, including the flu and the common cold, there is some increase in risk of catching EV‐D68 in places with large numbers of people, such as schools and daycare settings. Children can protect themselves by washing their hands often; not touching their eyes and noses; and coughing or sneezing into a tissue or their arm/elbow and properly disposing of the tissue.

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