Enterovirus D68 (EV-D68)
On September 9, 2022 the Centers for Disease Control and Prevention released a health advisory informing healthcare providers of an increase in pediatric hospitalization in patients with severe respiratory illness who also tested positive for rhinovirus (RV) and/or enterovirus (EV); increase occurred during August. Upon molecular serotyping, some specimens were positive for enterovirus D68 (EV-D68).
Concurrently, ongoing U.S. surveillance noted a higher proportion of EV-D68 positivity in children who were RV/EV positive compared to previous years. EV-D68 primarily causes acute respiratory illness, however it has also been associated with acute flaccid myelitis (AFM), a rare but serious neurologic complication causing limb weakness.
Purpose of Medical Advisory
- Increase healthcare providers awareness of the current situation in the U.S. Currently, this situation hasn’t been noted in Ontario, however this could be an early indicator of cases in Ontario.
- Prompt healthcare providers to consider EV-D68 as a possible differential diagnosis of acute, severe respiratory illness (with or without fever) in children.
- Remind healthcare providers that AFM is a type of acute flaccid paralysis (AFP). AFP is a reportable disease of public health significance in Ontario for children less than 15 years of age. See “Reporting to Public Health Services” below.
- Encourage healthcare providers to immediately refer pediatric patients presenting with possible AFP, to McMaster Children’s Hospital for prompt assessment
Enterovirus lab testing can be found at the following Public Health Ontario Laboratory link https://www.publichealthontario.ca/en/Laboratory-Services/Test-InformationIndex/Enterovirus
Recommendations for Infection Prevention and Control in Healthcare Settings
- Patients with respiratory symptoms should be placed in a single-person room
- Use appropriate PPE. If EV-D68 is suspected, gowns, gloves, and a mask are recommended. Eye protection should be used if there is a risk of sprays or splashes (e.g., within 2 meters of a coughing patient).
- Practice appropriate hand hygiene.
- Use a hospital-grade disinfectant with a label claim against enterovirus or any other non-enveloped viruses (e.g., norovirus, poliovirus, rhinovirus). Refer to the manufacturer’s instructions for use, safety and contact time.
Case Definition for AFP:
- Acute onset of focal weakness or paralysis characterized as flaccid (reduced tone) without other obvious cause (e.g., trauma) in children less than 15 years old.
- Cases of Guillain-Barré Syndrome (GBS) should be included as cases of AFP.
- Transient weakness (e.g., postictal weakness) should not be reported.
Reporting to Public Health Services
To report suspect and confirmed cases of AFP, call Hamilton Public Health Services Monday to Friday 8:30 a.m. to 4:30 p.m. at 905-546-2063 or fax reports to 905-546- 4078. After hours and on weekends, call 905-546-2063 and ask to speak with the Public Health Nurse on-call.