Health care providers should consider enterovirus D68 (EV-D68) as a possible cause of acute, severe respiratory illness in children — with or without fever, according to a new advisory from the Centers for Disease Control and Prevention (CDC). They also should be aware that cases of acute flaccid myelitis (AFM) may increase in the coming weeks.
Several regions of the U.S. have seen increases recently in children hospitalized for severe respiratory illness who also tested positive for rhinovirus (RV) and enterovirus (EV). In addition, sentinel surveillance sites are reporting a higher proportion of EV-D68 positivity in children who are RV/EV positive compared with previous years.
EV-D68 primarily causes acute respiratory illness but also has been associated with AFM, a rare but serious neurologic complication involving limb weakness.
While RVs circulate year-round, with peaks in the spring and fall, the typical EV season is late summer and early fall. Similarly, EV-D68 is thought to peak in late summer and early fall.
Between April and August, EV-D68 was detected in some children and adolescents with acute respiratory illness across seven surveillance sites, with the number of detections greater than in the same period of the previous three years. While the CDC has not received increased reports of AFM cases with onset in 2022, increases in EV-D68 respiratory illnesses typically have preceded cases of AFM.
The advisory includes recommendations for health care providers, laboratories, infection preventionists, public health departments and the public.
Recommendations for health care providers
- Consider laboratory testing of respiratory specimens for RVs and EVs (typically part of multiplex respiratory assays) when the cause of respiratory infection in severely ill patients is unclear, if not already part of typical diagnostic routine.
- Provide supportive clinical management for RV or EV, including EV-D68. There are no available vaccines or approved antiviral treatments.
- Report clusters of severe respiratory illness to local and state health departments.
- Strongly consider AFM in patients with acute flaccid limb weakness, especially after respiratory illness or fever, from now until November.
- Collect specimens from multiple sources (cerebrospinal fluid, serum, stool and a nasopharyngeal or oropharyngeal swab) from patients presenting with possible AFM as early as possible and preferably on the day of limb weakness onset.
- Coordinate with the state public health laboratory to send AFM specimens to the CDC for AFM and polio testing.
- Maintain vigilance and report possible cases of AFM to the state or local health department using the patient summary form.
Recommendation for laboratories
Coordinate with the state public health laboratory to submit specimens from possible cases of AFM to the CDC for AFM and polio testing.
Recommendations for families
In addition to basic infection control to avoid illnesses (washing hands, etc.), individuals are reminded of the following:
- Contact a health care provider if a patient has trouble breathing or has sudden onset of limb weakness.
- Ensure asthma action plans are up to date.
- Stay current on all recommended vaccines.
AAP resources can be found at https://aap.org/afm.