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CDC Alerts Pediatricians of Rare Respiratory Disease, Provides Recommendations

Cases and hospitalizations due to EV-D68, a rare form of enterovirus associated with acute flaccid myelitis (AFM), have been increasing among children across the country.

A health alert was issued by the US Centers of Disease Control and Prevention (CDC) regarding the enterovirus D68 (EV-D68), which has been affecting children with symptoms comparable to influenza or the common cold.

An increase in pediatric hospitalizations were reported to the CDC in August, mainly consisting of children with severe respiratory illness who had been infected with rhinovirus (RV) and/or enterovirus. Further analysis revealed that EV-D68 was present in some of these cases.

Enteroviruses are not uncommon–affecting 10-15 million Americans each year. However, EV-D68 is a much rarer form of the disease.

“Concurrently, pediatric acute respiratory illness sentinel surveillance sites are reporting a higher proportion of EV-D68 positivity in children who are RV/EV positive compared to previous years,” according to the CDC statement. “Although it primarily causes acute respiratory illness, EV-D68 has been associated with acute flaccid myelitis (AFM), a rare but serious neurologic complication involving limb weakness.”

The Health Alert Network (HAN) Health Advisory was directed at pediatricians and parents with the intention of notifying healthcare providers, laboratories, infection control specialists, and public health departments of the increase in severe respiratory illness among children, and particularly the rising hospitalization rates among those with existing respiratory conditions like asthma.

Additionally, the CDC urged providers to view EV-D68 as a potential cause for pediatric patients presenting with acute, severe respiratory illness, regardless if a fever is detected. Also, heightened awareness of possible increases in acute flaccid myelitis cases must be considered.

The CDC included a set of recommendations that healthcare providers, laboratories, infection preventionists, public health departments, and the public should implement at this time. The following guidelines were published on the agency's website for healthcare providers, infection control healthcare settings, and the public.

Recommendations for Healthcare Providers:

  • Consider EV-D68 as a possible cause of acute, severe respiratory illness (with or without fever) in children. Adults may also become infected with EV-D68, but it is thought to be more commonly detected in adults with underlying conditions.
  • Consider laboratory testing of respiratory specimens for RVs and EVs (typically part of multiplex respiratory assays) when the cause of respiratory infection in severely ill patients is unclear, if not already part of typical diagnostic routine.
  • Provide supportive clinical management for RV or EV, including EV-D68. There are no available vaccines or approved antiviral treatments.
  • Report clusters of severe respiratory illness to local and state health departments.
  • Strongly consider AFM in patients with acute flaccid limb weakness, especially after respiratory illness or fever, and between the months of August and November 2022.
  • Collect specimens from multiple sources (cerebrospinal fluid [CSF], serum, stool, and a nasopharyngeal [NP] or oropharyngeal [OP] swab) from patients presenting with possible AFM as early as possible and preferably on the day of onset of limb weakness.
  • Coordinate with your state public health laboratory to send AFM specimens to CDC for AFM and polio testing.
  • Maintain vigilance and report possible cases of AFM to the state or local health department using the patient summary form.

Recommendations for Infection Control Healthcare Settings:

  • Place patients with respiratory symptoms who test positive with RV or EV in a single-person room and use recommended personal protective equipment
  • depending on the suspected pathogen. If EV-D68 is suspected, gowns, gloves, and a mask are recommended. Eye protection should be used if the risk for splashes and sprays exists (e.g., near a coughing patient).
  • Use hospital-grade disinfectant with an EPA label claim
  • against EV-D68 or any of several other non-enveloped viruses (e.g., norovirus, poliovirus, rhinovirus) to disinfect surfaces in healthcare settings. Follow the manufacturer’s instructions for non-enveloped viruses. Use disinfectant products following the manufacturer’s instructions for the specific label claim and in a manner consistent with environmental infection control recommendations
  • During periods of high respiratory illness activity, consider requiring visitors to wear well-fitting masks at all times in the facility; visitors with respiratory symptoms or underlying respiratory conditions should delay in-person visitation.

Recommendations for the Public:

  • Help protect yourself from getting and spreading respiratory viruses, like rhinoviruses or EV-D68, by following these steps:
    • Wash your hands often with soap and water for 20 seconds.
    • Avoid touching your eyes, nose, and mouth with unwashed hands.
    • Avoid close contact such as kissing, hugging, and sharing cups or eating utensils with people who are sick, and when you are sick.
    • Cover your coughs and sneezes with a tissue or your upper shirt sleeve, not your hands.
    • Clean and disinfect frequently touched surfaces, such as toys and doorknobs, especially if someone is sick.
    • Stay home when you are sick.
  • Consider wearing a mask around other people if you have respiratory symptoms.
  • Contact a healthcare provider immediately if you or your child has trouble breathing or has a sudden onset of limb weakness.
  • Ensure you or your child are following an up-to-date asthma action plan if you or your child have asthma.
  • Stay up-to-date with all recommended vaccines.