ABOUT
Non-polio enteroviruses cause about 10 to 15 million infections and tens of thousands of hospitalizations each year in the United States. Infections with non-polio enteroviruses are common during summer and fall. Most people who get infected do not get sick or they only have mild illness, like the common cold. Some people can have serious complications, especially infants and people with weakened immune systems. A mix of enteroviruses circulates every year, and different types can be common in different years. Three better-known non-polio enteroviruses are enterovirus D68 (EV-D68), enterovirus A71 (EV-A71), and coxsackie virus A6 (CV-A6). EV-D68 usually causes respiratory illness. EV-A71 and CV-A6 are known to cause hand, foot, and mouth disease (HFMD).
Signs and symptoms
Infants, children, and teenagers are more likely than adults to get infected and become sick. Adults can also become infected but are less likely to have symptoms, or symptoms may be milder. Infants and people with weakened immune systems have a greater chance of having complications. Most people do not get sick, or they only have mild symptoms similar to the common cold.
Symptoms of mild illness may include:
- Fever
- Runny nose, sneezing, cough
- Skin rash
- Mouth blisters
- Body and muscle aches
Complications of non-polio enterovirus infections can cause:
- Viral conjunctivitis
- Hand, foot, and mouth disease
- Viral meningitis (infection of the covering of the spinal cord and/or brain)
- Viral encephalitis (infection of the brain)
- Myocarditis (infection of the heart)
- Pericarditis (infection of the sac around the heart)
- Acute flaccid paralysis (a sudden onset of weakness in one or more arms or legs)
- Inflammatory muscle disease (slow, progressive muscle weakness)
COMMUNITY
HEALTHCARE PROFESSIONALS
No antiviral medications are currently available for people who become infected with EV-D68. Advise your patients about their symptoms and the best way to manage them. Patients with asthma may have a higher risk for severe symptoms from EV-D68 and other respiratory illnesses. For patients with asthma ensure that patients with asthma have an asthma action plan, encourage use of this plan and adherence to prescribed controller medication, recommend that people with asthma experiencing an exacerbation seek care quickly and early. There is no vaccine available in the United States to prevent EV-A71.
TESTING
Clinicians should recommend laboratory testing to investigate clusters of unexplained severe acute respiratory illness. For enterovirus/rhinovirus-positive specimens, EV-D68-specific real-time PCR and/or enterovirus typing by sequencing can determine if EV-D68 is present. Confirmation tests for EV-D68 can be performed by some public health laboratories or by CDC.
Without specialized patient treatment options for EV-D68, testing is unlikely to directly influence clinical management of individual patients. However, it can help to raise awareness of EV-D68 circulation.
PREVENTION
Practice infection control in healthcare settings
Be vigilant about preventing the spread of EV-D68 and follow infection control precautions, including standard, contact, and droplet precautions.
Practice hand hygiene
Non-enveloped viruses such as EV-D68 may be less susceptible to alcohol than enveloped viruses or vegetative bacteria.
However, alcohol-based hand sanitizer (ABHS), when combined with glove use, offers benefits in:
- Skin tolerance
- Compliance
- Overall effectiveness for a variety of healthcare-associated pathogens
Therefore, after removing and before donning gloves, perform hand hygiene using either ABHS or soap and water.
LOCAL HEALTH DEPARTMENTS
- Testing Protocol
- Patient Summary Form: EVD68 | Acute Neurological Illness
SURVEILLANCE
CDC has multiple surveillance systems that monitor enteroviruses in the United States.
- Acute Respiratory Illness (ARI) Interactive Dashboard
- National Enterovirus Surveillance System (NESS)
- National Respiratory and Enteric Virus Surveillance System (NRVESS)
