Enterovirus D68 (EV-D68): Symptoms and Treatment

Enterovirus D68 (EV-D68) is one of the more than 100 types of enteroviruses which can cause 10 – 15 million infections in the US each year. EV-D68 was first identified in California 1962 and until recently has caused very few infections in the United States. However, this strain of virus began an outbreak in the Midwest and has now reached coast-to-coast causing children’s respiratory problems.

Most children that get enterovirus D68 infections have mild to moderate symptoms that include a runny nose, coughing and sneezing, fever (mild) and body aches. For some children, especially those with a history of any respiratory problem such as asthma, the viral infection can be more severe and cause wheezing and difficulty breathing.

EV-D68 can be very dangerous to some individuals. However, for most individuals it is usually not serious. Young children with asthma or other breathing problems can have serious breathing problems develop when infected with this enterovirus. Some of these children will need to be hospitalized and given supportive care.

Although the more serious disease usually occurs in children with breathing problems, children without these problems may also develop serious breathing problems.

EV-D68 may, in a few children, cause death. In addition, in a few others, muscle weakness and paralysis has been noted. This may occur rarely with enteroviral infections. However, the infrequent role non-polio enterovirus play in the development of these paralysis symptoms is not well understood. Although enteroviruses infrequently may cause weakness in the muscles and even paralysis, enterovirus D68 and many other enteroviruses are still considered as “non-polio” enteroviruses.

As stated previously, enterovirus D68 was first identified in California in 1962; it is not a new virus and previous outbreaks of EV-D68 were small and not characterized by serious complications. Even with this outbreak, most children that become infected with EV-D68 have symptoms they considered to be only a common cold.

Unfortunately, the symptoms of the flu (influenza) and EV-D68 are initially similar and in mild cases of both infections, clinically indistinguishable. Specific lab tests can distinguish these two viruses. Such tests are usually not done unless the person develops more severe symptoms. There is no vaccine to protect against EV-D68 but there are vaccines available to protect against flu. Since the flu every year usually causes many more complications and deaths than EV-D68 or other non-polio enteroviruses, everyone is encouraged to get their yearly flu vaccine.

EV-D68 spreads easily from person to person through the air with coughs, sneezes, or other secretions like saliva, nasal mucus or sputum. If these particles that contain live viruses touch surfaces that are then handled by uninfected individuals, the viruses can be transferred and infect the individual.

Most people (children) will have mild to moderate enterovirus D68 symptoms for about a week. Those with severe symptoms may have infection last longer (about 10 – 14 days). Unfortunately, the virus may be shed from the body for several weeks so that an infected child, even though they clinically recover in a week, may still shed viruses that can infect others for several weeks.

There are no specific enterovirus D68 treatments for children with respiratory illness caused by EV-D68; in general, treatment is supportive to help relieve symptoms such as fever, discomfort, and cough. Aspirin should not be given to children under age 18. There are no vaccines or antiviral medications currently available for EV-D68 treatment. Infrequently, children with severe symptoms may require hospitalization and more intensive supportive help such as assistance in breathing.

Severe symptoms of EV-D68 often need more immediate medical care or they need to be taken to an emergency department. Severe symptoms include wheezing, shortness of breath and a bluish coloration of the lips.

Avoiding contact with a person that has an infection with enterovirus D68 is one of the good ways to protect you from infection. Avoiding close contact with bodily fluids, including nasal secretions, mucous secretions, spit, and staying about 6 feet away from someone who is coughing are precautions that reduce the chance of infection. In addition to good hand washing techniques, avoiding touching your eyes or mucous membranes with your hands and avoiding physical contact such as kissing or hugging individuals that might be infected can reduce your risk. There is no enterovirus D68 vaccine or antiviral available to prevent EV-D68 infections.

Children with asthma are the most likely individuals to develop more severe enterovirus D68 symptoms. If your child has asthma, one of the best things to do is to make sure that asthma symptoms are well controlled with the child’s medication. This can help reduce the severity of symptoms if the child develops infection. If a child with a history of asthma develops any respiratory decline with the early symptoms of EV-D68, they should seek medical evaluation immediately.