Enterovirus D68 Testing, Surveillance and Prevention: What We’re Telling Our Friends

By Laura Iwig, MPH, Senior Specialist, Infectious Disease Program, Stephanie Chester, MS, Influenza Program and Kelly Wroblewski, MPH, MT (ASCP), Infectious Disease Program, APHL

Fall brings the start of many things every year – school, of course, but also respiratory virus season. And this year as both kick-off we’re faced with an outbreak of a virus that is new to many, enterovirus D68 (EV-D68). Terrifying headlines have loaded up our Facebook newsfeeds, so we’re here to straighten things out a bit. When our friends and family ask us about EV-D68, this is what we tell them.

First of all, there are many enteroviruses and D68 is just one type. What makes EV-D68 unique is that it is causing severe illness in some people, particularly children which is always cause for concern. Keep in mind that while there are severe cases being reported, there very likely are also less severe cases of EV-D68 with typical cold-like symptoms going unreported. The number of severe cases is not necessarily the full picture. Despite there being no vaccine or specific treatment for EV-D68, it typically resolves itself without any complications.

We know this all sounds kind of scary especially when news reports are focusing on the most severe cases. But it is important to understand that the clinical and public health communities are well-equipped to deal with enterovirus outbreaks and actually respond to similar outbreaks on a routine basis. We and our partners are prepared.

Clinical, commercial and public health laboratories are conducting testing to determine if severe cases and/or outbreaks are being caused by an enterovirus or closely related rhinovirus. (Not specifically D68 – we’ll get to that below.) Many of these labs utilize rapid molecular methods to detect a wide array of respiratory pathogens, including enteroviruses.

If testing confirms that you do have an enterovirus and if you have severe symptoms, CDC is conducting additional testing to determine which type of enterovirus you may have. For the public, the value in differentiating EV-D68 from other related viruses is to provide real-time information to your doctor to help recognize symptoms associated with severe cases, identify them and get them early supportive treatment. For example, if your child has an underlying condition such as asthma and comes down with a cold that starts to become severe, his doctor might want to be more proactive in supportive care if they have learned from public health officials that EV-D68 was detected in your community. Knowing that it is EV-D68 is in the community or even a specific school can impact public health infection control measures and raise awareness for patients and parents to be more proactive about intervention if their child does get sick.

There is also significant value to the scientific and public health communities in determining if enterovirus cases and outbreaks are caused by EV-D68. Historically, this particular type of enterovirus has been rarely reported so we are still learning how easily it transmits, who is at risk for severe illness and how widespread the virus may be. In fact, some scientists are wondering if EV-D68 is truly as rare as many think or if our testing capabilities have improved allowing us to detect more cases. Science is a never ending process of information gathering. While most actions won’t be any different from other respiratory outbreaks if even if epidemiological and laboratory surveillance activities detect EV-D68, these investigations may change how we deal with outbreaks like these in the future making us more prepared.

What can you do to protect yourself and your family?

• Wash your hands frequently with soap and water! Alcohol based hand sanitizers do not work against enteroviruses.
• Avoid close contact with those who are sick.
• Clean and disinfect surfaces, especially those touched by those who are ill. The virus can be easily killed on surfaces.

For now, we are reassuring our friends and family that the clinical and public health communities are prepared and are responding to this outbreak. That gives us peace of mind and hopefully it will do the same for you.