The California Department of Public Health (CDPH) has confirmed four cases of enterovirus D68 (EV-D68) in patients in San Diego (3) and Ventura (1) counties.  From mid-August to September 22, 2014, a total of 175 people in 27 states have been confirmed to have respiratory illness caused by EV-D68. More cases are anticipated in the coming weeks.

Physicians are urged to consider EV-D68 as a possible cause of acute, unexplained severe respiratory illness, even if the patient does not have fever; and consider laboratory testing of respiratory specimens for enteroviruses when the cause of respiratory illness in severely ill patients is unclear. Physicians should report any unusual or unexplained respiratory illnesses to their local health departments.

Confirmation of the presence of the specific EV-D68 virus requires typing by molecular sequencing. Local health departments have been instructed to submit samples from all rhinovirus/enterovirus positive specimens from hospitalized children less than 18 years of age or from clusters of cases of any age to CDPH for further typing.

Although the routes of transmission for EV-D68 are not fully understood, the virus likely spreads from person to person when an infected person coughs, sneezes or touches contaminated surfaces. The Centers for Disease Control and Prevention (CDC) recommends standard infection control precautions, with contact precautions in certain situations, as is recommended for all enteroviruses. Droplet precautions also should be considered as an interim recommendation until there is more definitive information available on appropriate infection control.

Symptoms of EV-D68 include fever (although fever may not be present), runny nose, sneezing, cough, and body and muscle aches.  Some children have more serious illness with breathing difficulty and wheezing, particularly children with a history of asthma.

The American Academy of Pediatrics also recommends that physicians be strategic in meeting the needs of children at increased risk for respiratory illnesses. Physicians are urged to work with parents to have a plan in place to treat these children early if they develop symptoms.

Parents should seek medical attention immediately for children who are having any breathing difficulty (wheezing, difficulty speaking or eating, belly pulling in with breaths, blueness around the lips), particularly if the child suffers from asthma.

There is no specific treatment for people with respiratory illness caused by EV-D68, nor is there a vaccine to prevent it.  Some people with severe respiratory illness may need to be hospitalized .

The best way to prevent transmission of enteroviruses is to:

• Wash hands often with soap and water for 20 seconds, especially after changing diapers.


• Avoid touching eyes, nose and mouth with unwashed hands.


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


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

For more information about EV-D68 please read the CDC Special Advisory.