Respiratory Illness and Enterovirus D68: Clinical Guidance

Susan I. Gerber, MD


September 19, 2014

Editorial Collaboration

Medscape &

This feature requires the newest version of Flash. You can download it here.

Hello. I'm Dr. Susan Gerber, a medical epidemiologist at the Centers for Disease Control and Prevention (CDC). I'm speaking with you as part of the CDC Expert Commentary series on Medscape. You may have recently heard about a virus called enterovirus D68 (EV-D68) that has been causing severe respiratory illness among children in some states. Today I will talk about this virus and what we know so far about the current EV-D68 situation in the United States.

In August 2014, two hospitals in Missouri and Illinois started seeing more children with severe respiratory illness. These respiratory illnesses were more than expected compared with this time period in previous years. Many of the severe cases were later identified as EV-D68. Other states are investigating similar clusters of severe respiratory illness and are determining whether there are increases among patients in their hospitals.

From mid-August to September 11, 2014, a total of 82 people in Missouri, Illinois, and four other states—Iowa, Kentucky, Colorado, and Kansas—were confirmed to have EV-D68 infections. So far, no deaths attributed to EV-D68 infection have been documented.

EV-D68 is one of more than 100 types of enteroviruses. It was first identified in California in 1962. Since then, EV-D68 infections have not been commonly reported in the United States. In fact, EV-D68 infections are thought to occur less often than infections with some other enteroviruses. In general, the circulation of specific types of enteroviruses is often quite unpredictable, and different types of enteroviruses can be common in different years with no particular pattern. However, most enterovirus infections in the United States tend to occur in the summer and fall. EV-D68, similar to other enteroviruses, is known to cause infections primarily in children but has been known to infect adults.

EV-D68 can shed from an infected person's respiratory secretions, such as saliva, nasal mucus, or sputum. The virus likely spreads from person to person when an infected person coughs, sneezes, or touches surfaces. EV-D68 can cause mild to severe respiratory illness. Most of the children who became very ill with EV-D68 infection in Missouri and Illinois had difficulty breathing, and some had wheezing. Many of these children had asthma or a history of wheezing.

Although there are no vaccines to prevent EV-D68 infections, clinicians should encourage their patients to follow these prevention steps:

Wash hands often with soap and water for 20 seconds;

Avoid touching eyes, nose, and mouth with unwashed hands;

Avoid kissing, hugging, and sharing cups or eating utensils with people who are sick; and

Disinfect frequently touched surfaces, such as toys and doorknobs, especially if someone is sick.

They should help ensure that patients with asthma regularly take prescribed medications and follow guidance to maintain control of their illness. They should also take advantage of influenza vaccine when available, because people with asthma have a difficult time with respiratory illnesses.

When seeing patients, especially children, with respiratory illness, clinicians should be aware of EV-D68 as a potential cause. They should consider laboratory testing of respiratory specimens for enteroviruses when the cause of infection in severely ill patients is unclear. Many hospitals can test suspected patients for enteroviruses, but they are probably not able to do the testing needed to determine the type of enterovirus. Clinicians can approach their state health department for such testing. Clinicians should report clusters of severe respiratory illness to state and local health departments.

Once diagnosed, there is no specific treatment for EV-D68 infection. Also, no antiviral medications are available for EV-D68. Some patients with severe respiratory illness may need to be hospitalized and receive supportive therapy.

CDC will continue to share information and guidance with clinicians as it becomes available. Please visit the CDC's non-polio enterovirus website to obtain regular updates.

Web Resource


Dr. Susan Gerber is team lead for the Respiratory Viruses and Picornavirus Team, Division of Viral Diseases, at the Centers for Disease Control and Prevention (CDC). She received her MD from Loyola University and completed a pediatric residency and pediatric infectious disease fellowship at the University of Chicago. Dr. Gerber later joined the University of Chicago faculty in the section of pediatric infectious disease. Dr. Gerber acquired 14.5 years of experience in local public health with work on communicable diseases at the Cook County Department of Public Health and the Chicago Department of Public Health.