The Enterovirus D68 Outbreak: A Public Health Concern

Tammie Lee Demler, BS, PharmD, MBA, BCPP


US Pharmacist. 2015;40(5):22-26. 

In This Article

Respiratory Illness

The current EV-D68 outbreak started in the U.S. in August 2014, with two pediatric hospitals reporting an increased rate of admissions for severe respiratory illness and increased infections confirmed by polymerase chain reaction (PCR) assay of nasopharyngeal specimens.[7] Respiratory illness is not the only physical manifestation of illness, and other symptoms are discussed in the following section.

During late summer and fall 2014, enteroviruses and rhinoviruses likely contributed the most to the increases in respiratory illnesses. During 2014, the most common type of enterovirus detected was the EV-D68.[1] Many viruses can cause similar respiratory illnesses and can only be identified and differentiated through laboratory testing. However, many people with respiratory illness who go to the doctor are not tested, and often those with mild respiratory illness do not seek medical attention. At the end of the fall season, enterovirus infections began to decline as expected, and at the same time respiratory illnesses caused by other viruses, such as influenza, became more common. The cause of this seasonal change in viral prevalence is likely due to the temperature sensitivity of EV-D68 and results in a greater diagnostic challenge for providers.[8] Overall respiratory illnesses may appear to be the same; however, the sources of the viral infection may be entirely different.

The incubation period of EV-D68 is between 1 and 5 days, which is similar to that of other enteroviruses and rhinoviruses, and a person is considered contagious from 1 day prior to symptom onset to 5 days after symptoms appear.[3] The virus is found in nasal mucus, sputum, and saliva and is spread most likely via droplets expelled with coughs and sneezes of an infected person. The oral-fecal route is another likely means of transmission via unwashed hands and contaminated objects and surfaces. As previously noted by Dr. Gerber, there are no vaccines or antivirals to prevent infection at this time.[2]