Highlights & Basics
- Enterovirus D-68 (EV-D68) is an important cause of viral lower respiratory tract illness in children. In 2014, the US experienced an outbreak of EV-D68, with numerous children requiring hospital admission due to severe lower respiratory illness and asthma.
- Most people infected have mild symptoms such as runny nose, cough, sneezing, or muscle aches; some patients have fever. Often patients with more severe disease have a history of asthma or chronic lung disease.
- A possible association exists between EV-D68 infection and polio-like acute flaccid myelitis.
- Diagnosis is clinical. Most clinical tests for rhinovirus do not distinguish EV-D68 in the absence of specific testing.
- Specific testing for EV-D68 should be considered in children with severe unexplained respiratory illness, even in the absence of fever. Although not routinely available, specific testing can be obtained on a case-by-case basis through state or local health departments, or the Centers for Disease Control and Prevention.
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Citations
Oermann CM, Schuster JE, Conners GP, et al. Enterovirus D68: a focused review and clinical highlights from the 2014 United States outbreak. Ann Am Thorac Soc. 2015 May;12(5):775-81.[Abstract]
Midgley CM, Jackson MA, Selvarangan R, et al. Severe respiratory illness associated with enterovirus d68 - missouri and illinois, 2014. MMWR Morb Mortal Wkly Rep. 2014 Sep 12;63(36):798-9.[Abstract][Full Text]
Pastula DM, Aliabadi N, Haynes AK, et al. Acute neurologic illness of unknown etiology in children: Colorado, August - September 2014. MMWR Morb Mortal Wkly Rep. 2014 Oct 10;63(40):901-2.[Abstract][Full Text]
Greninger AL, Naccache SN, Messacar K, et al. A novel outbreak enterovirus D68 strain associated with acute flaccid myelitis cases in the USA (2012-14): a retrospective cohort study. Lancet Infect Dis. 2015 Jun;15(6):671-82.[Abstract]
Oberste MS, Maher K, Schnurr D, et al. Enterovirus 68 is associated with respiratory illness and shares biological features with both the enteroviruses and the rhinoviruses. J Gen Virol. 2004 Sep;85(Pt 9):2577-84.[Abstract]
Centers for Disease Control and Prevention. Enterovirus D68 for health care professionals. Nov 2018 [internet publication].[Full Text]
Centers for Disease Control and Prevention. Acute flaccid myelitis (AFM): initial evaluation and diagnostic studies. Jul 2022 [internet publication].[Full Text]
Centers for Disease Control and Prevention. Acute flaccid myelitis (AFM): case definitions for AFM. Jul 2022 [internet publication].[Full Text]
Centers for Disease Control and Prevention. Acute flaccid myelitis (AFM): clinical guidance for the acute medical treatment of AFM. Jul 2022 [internet publication].[Full Text]
1. Oermann CM, Schuster JE, Conners GP, et al. Enterovirus D68: a focused review and clinical highlights from the 2014 United States outbreak. Ann Am Thorac Soc. 2015 May;12(5):775-81.[Abstract]
2. Midgley CM, Jackson MA, Selvarangan R, et al. Severe respiratory illness associated with enterovirus d68 - missouri and illinois, 2014. MMWR Morb Mortal Wkly Rep. 2014 Sep 12;63(36):798-9.[Abstract][Full Text]
3. Foster CB, Friedman N, Carl J, et al. Enterovirus D68: a clinically important respiratory enterovirus. Cleve Clin J Med. 2015 Jan;82(1):26-31.[Abstract][Full Text]
4. Pastula DM, Aliabadi N, Haynes AK, et al. Acute neurologic illness of unknown etiology in children: Colorado, August - September 2014. MMWR Morb Mortal Wkly Rep. 2014 Oct 10;63(40):901-2.[Abstract][Full Text]
5. Greninger AL, Naccache SN, Messacar K, et al. A novel outbreak enterovirus D68 strain associated with acute flaccid myelitis cases in the USA (2012-14): a retrospective cohort study. Lancet Infect Dis. 2015 Jun;15(6):671-82.[Abstract]
6. Ayscue P, Haren KV, Sheriff H, et al. Acute flaccid paralysis with anterior myelitis - California, June 2012-June 2014. MMWR Morb Mortal Wkly Rep. 2014 Oct 10;63(40):903-6.[Abstract][Full Text]
7. Messacar K, Schreiner TL, Maloney JA, et al. A cluster of acute flaccid paralysis and cranial nerve dysfunction temporally associated with an outbreak of enterovirus D68 in children in Colorado, USA. Lancet. 2015 Apr 25;385(9978):1662-71.[Abstract]
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18. Sejvar JJ, Lopez AS, Cortese MM, et al. Acute flaccid myelitis in the United States, August-December 2014: results of nationwide surveillance. Clin Infect Dis. 2016 Sep 15;63(6):737-45.[Abstract][Full Text]
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20. Centers for Disease Control and Prevention. Health Alert Network (HAN). Severe respiratory illnesses associated with rhinoviruses and/or enteroviruses Including EV-D68 - Multistate, 2022. Sep 2022 [internet publication].[Full Text]
21. Levy A, Roberts J, Lang J, et al. Enterovirus D68 disease and molecular epidemiology in Australia. J Clin Virol. 2015 Jun 17;69:117-21.[Abstract]
22. Skowronski DM, Chambers C, Sabaiduc S, et al. Systematic community- and hospital-based surveillance for enterovirus-D68 in three Canadian provinces, August to December 2014. Euro Surveill. 2015;20(43).[Abstract][Full Text]
23. Pfeiffer HC, Bragstad K, Skram MK, et al. Two cases of acute severe flaccid myelitis associated with enterovirus D68 infection in children, Norway, autumn 2014. Euro Surveill. 2015 Mar 12;20(10):21062.[Abstract]
24. Lang M, Mirand A, Savy N, et al. Acute flaccid paralysis following enterovirus D68 associated pneumonia, France, 2014. Euro Surveill. 2014 Nov 6;19(44).[Abstract][Full Text]
25. Williams CJ, Thomas RH, Pickersgill TP, et al. Cluster of atypical adult Guillain-Barré syndrome temporally associated with neurological illness due to EV-D68 in children, South Wales, United Kingdom, October 2015 to January 2016. Euro Surveill. 2016;21(4).[Abstract][Full Text]
26. Holm-Hansen CC, Midgley SE, Fischer TK. Global emergence of enterovirus D68: a systematic review. Lancet Infect Dis. 2016 Feb 24;16(5):e64-e75.[Abstract]
27. Oberste MS, Maher K, Schnurr D, et al. Enterovirus 68 is associated with respiratory illness and shares biological features with both the enteroviruses and the rhinoviruses. J Gen Virol. 2004 Sep;85(Pt 9):2577-84.[Abstract]
28. Blomqvist S, Savolainen C, Råman L, et al. Human rhinovirus 87 and enterovirus 68 represent a unique serotype with rhinovirus and enterovirus features. J Clin Microbiol. 2002 Nov;40(11):4218-23.[Abstract]
29. Imamura T, Suzuki A, Lupisan S, et al. Detection of enterovirus 68 in serum from pediatric patients with pneumonia and their clinical outcomes. Influenza Other Respir Viruses. 2014 Jan;8(1):21-4.[Abstract][Full Text]
30. Centers for Disease Control and Prevention. Enterovirus D68 for health care professionals. Nov 2018 [internet publication].[Full Text]
31. Montes M, Oñate E, Muguruza A, et al. Enterovirus D68 Causing Acute Respiratory Infection: Clinical Characteristics and Differences With Acute Respiratory Infections Associated With Enterovirus Non-D68. Pediatr Infect Dis J. 2019 Jul;38(7):687-91.[Abstract][Full Text]
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33. Kreuter JD, Barnes A, McCarthy JE, et al. A fatal central nervous system enterovirus 68 infection. Arch Pathol Lab Med. 2011 Jun;135(6):793-6.[Abstract][Full Text]
34. Centers for Disease Control and Prevention. Acute flaccid myelitis (AFM): initial evaluation and diagnostic studies. Jul 2022 [internet publication].[Full Text]
35. Centers for Disease Control and Prevention. Acute flaccid myelitis (AFM): case definitions for AFM. Jul 2022 [internet publication].[Full Text]
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37. Centers for Disease Control and Prevention (CDC). Vital signs: Acute Flaccid Myelitis (AFM). Aug 2020 [internet publication].[Full Text]
38. Murphy OC, Messacar K, Benson L, et al. Acute flaccid myelitis: cause, diagnosis, and management. Lancet. 2021 Jan 23;397(10271):334-46.[Abstract][Full Text]
39. Ma KC, Winn A, Moline HL, et al. Increase in acute respiratory illnesses among children and adolescents associated with rhinoviruses and enteroviruses, including enterovirus D68 - United States, July-September 2022. MMWR Morb Mortal Wkly Rep. 2022 Oct 7;71(40):1265-70.[Abstract][Full Text]
40. Midgley CM, Watson JT, Nix WA, et al. Severe respiratory illness associated with a nationwide outbreak of enterovirus D68 in the USA (2014): a descriptive epidemiological investigation. Lancet Respir Med. 2015 Nov;3(11):879-87.[Abstract]
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42. Centers for Disease Control and Prevention. Non-polio enterovirus. Prevention and treatment. Aug 2020 [internet publication].[Full Text]
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