What is EV-D68?
Enteroviruses are a group of viruses that can cause a range of symptoms including:
- mild cold-like symptoms,
- illnesses with fever and rashes,
- neurologic problems,
- or no symptoms at all.
Infections with enteroviruses are very common and most people have mild symptoms. There are about 100 types of enteroviruses.
EV-D68 is a specific enterovirus that causes respiratory illness ranging from mild to severe. Symptoms can include a cold-like illness with coughing and wheezing to severe infections requiring admission to a hospital or possibly to an intensive care unit because of breathing difficulties.
Children and teenagers appear to be at increased risk of infection from EV-D68 because they may lack protection from previous exposures to the virus, although the virus can infect adults as well. Children with asthma seem to have a higher risk for severe respiratory illness.
When do infections from enteroviruses usually occur?
Enteroviruses usually circulate in the late summer and fall, although this can vary depending on the type of enterovirus.
How is EV-D68 spread?
EV-D68 can be present in respiratory secretions from the nose and throat and can spread from an infected person when they cough or sneeze. Touching surfaces or objects contaminated with these secretions may also result in infection if the virus then gets into the body by touching the mouth, nose or eyes.
Is there a vaccine or specific treatment for EV-D68?
There is no vaccine or specific antiviral treatment for EV-D68. Most people don’t require any treatment and will get better on their own, but symptoms like wheezing and fever can be treated (aspirin should be avoided in children). Patients who have difficulty breathing may require hospital admission and those with severe breathing problems may require treatment in an intensive care unit which may involve being placed on a ventilator.
What is happening with EV-D68?
From mid-August 2014 to January 15, 2015 the Centers for Disease Control and Prevention (CDC) and state public health laboratories reported a total of 1,153 people with EV-D68, a virus only rarely reported before that time. EV-D68 was primarily identified in children, many of whom had asthma or a history of wheezing. CDC also stated that there were likely millions of individuals with mild EV-D68 infections who did not seek medical care thus were not tested for the virus. During the late summer and early fall of 2014, several provinces in Canada also reported laboratory confirmed cases of EV-D68.
EV-D68 did not appear to circulate to any great extent in 2015. However, since August 2016 there have been a few reports of EV-D68 from Ontario and other jurisdictions in Canada, the United States and elsewhere, with a small number of reports of acute flaccid paralysis in children with EV-D68 infection.
Recent reports may indicate that EV-D68 is beginning to circulate. As noted above, the actual number of cases of EV-D68 is not known as people with viral infections often don’t seek medical care. As well, when care is sought, swabs to test for viral infections are not routinely done and not all laboratories test for EV-D68 or other respiratory viruses. Furthermore, most respiratory infections, including EV-D68, are not reportable to public health authorities unless they are identified as part of an institutional outbreak of respiratory illness. For most viruses, knowing the specific type of virus does not change patient care.
What is the history of EV-D68?
EV-D68 was first identified in 1962. It has occurred infrequently from then until 2014, although from 2008-2010, the Centers for Disease Control and Prevention reported on six clusters of EV-D68 in the Philippines, Japan, the Netherlands, and three US states (Georgia, Pennsylvania and Arizona). The clusters appeared to be concentrated in the fall season. Four of the six outbreaks only reported infected children, one outbreak reported only infected adults and one outbreak involved both adults and children. Patients in these clusters often had new onset or worsening wheezing. Hospitalizations and admissions to intensive care units were noted and three individuals died.
What precautions can be taken regarding EV-D68?
As with many viral infections, simple precautions can reduce the chances of getting EV-D68:
- Clean your hands frequently with soap and water or an alcohol-based hand rub, including after touching commonly touched objects and surfaces, before touching your face, before preparing food and before eating;
- Avoid touching your face as much as possible;
- Stay at least two metres (six feet) away from people who are ill;
- Frequently clean surfaces and objects that are commonly touched.
To avoid spreading viral infections:
- Stay home from work, school and other activities if you are ill;
- Cough and sneeze into your elbow and not your hand;
- Clean your hands frequently with soap and water or an alcohol-based hand rub.
People with asthma should ensure that they have their puffers readily available and know how to use them properly. Seek medical attention right away if wheezing does not respond to puffers or if you are having difficulty breathing.