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For pts w/ acute, unexplained, severe acute respiratory illness, CDC recommends that clinicians do the following: - Consider EV-D68 infxn,1 esp during the months of August and November 2022,2 as a possible cause of acute, unexplained, severe acute respiratory illness (with or without fever) in children. Most AFM cases (>90%) have been in young children.3 Although adults may also become infected w/ EV-D68, it’s thought to be more commonly detected in adults w/ underlying conditions
- Recognize that EV-D68 can cause mild to severe respiratory illness, or can be asymptomatic: mild sx, incl runny nose, sneezing, cough, body aches, & muscle aches; severe sx, incl wheezing & difficulty breathing
- Consider lab testing of respiratory specimens for RVs and EVs (typically part of multiplex respiratory assays) when the cause of resp illness in severely ill pts is unclear; for EV/RV (+) specimens, molecular typing can determine if EV-D68 is present4
- Follow standard, contact, and droplet infection control measures
- Upon removal & prior to donning gloves, perform hand hygiene using either alcohol-based hand rub or soap and water. See Hand Hygiene in Healthcare Settings
- Report all suspected clusters of unexplained severe acute respiratory illness to local & state health departments. Although EV-D68 is not nationally notifiable, state and local health departments may have additional guidance on reporting
Pts w/ possible AFM: - If pt has acute flaccid limb weakness (sudden arm or leg weakness), esp after respiratory illness or fever, and btwn months of August and November 2022: Strongly consider acute flaccid myelitis (AFM)5
- Consider neurology and ID consults to assist w/ AFM dx; AFM can be difficult to diagnose because it shares many of the same sx as other neurologic diseases such as transverse myelitis and Guillain-Barre syndrome6
- If pt presents w/ possible AFM: Collect specimens from multiple sources (CSF, serum, stool, and a nasopharyngeal or oropharyngeal swab) as early as possible, preferably on day of onset of limb weakness
- Coordinate w/ state public health lab 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
Pts w/ asthma: - If pt has asthma: Ensure they have an asthma action plan. Reinforce use of this plan, incl adherence to prescribed long-term control meds
- Encourage pts w/ asthma experiencing an exacerbation to seek care early. See Asthma Care Quick Reference
All submissions to CDC for diagnostic testing require pre-approval at this time. Before sending specimens for EV-D68 testing: Footnotes 1 Non-polio enteroviruses, like EV-D68, are thought to be very common; most infxns cause no sx or only mild sx. Beginning in 1987, small numbers of EV-D68 had been reported to CDC regularly. However, btwn August & November in 2014, EV-D68 caused a nationwide outbreak of respiratory illness in the U.S. This raised awareness of EV-D68-assoc illness and, beginning 2014, U.S. surveillance for EV-D68 expanded. EV-D68 was subsequently detected in the U.S. in the late summer and early fall of 2016, 2018 and, to a lesser degree, in 2020.
2 In the U.S., pts are more likely to get infected w/ enteroviruses in the summer and fall. However, infxn is possible year-round.
3 CDC. About Acute Flaccid Myelitis. Last updated 6/21/22. Accessed 9/16/22
4 Without specialized pt tx options for EV-D68, testing is unlikely to directly influence clinical management of individual pts.
5 Clinicians should be aware that AFM sx can initially be subtle and often mimic other neurologic diseases.
CDC. Acute Flaccid Myelitis (AFM): Clinical Guidance for the Acute Medical Treatment of AFM. Last updated 7/1/22. Accessed 9/16/22
6 CDC. Acute Flaccid Myelitis (AFM). Diagnosis & Treatment of AFM. Last updated 6/21/22. Accessed 9/16/22
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EV-D68 diagnosis confirmed
Provide supportive clinical management for RV or EV infxn, incl EV-D68. Currently there are no available vaccines or approved antiviral treatments AFM-specific clinical guidance1 - There’s no indication that any specific targeted tx should be either preferred or avoided in the acute medical tx of AFM
- Acute tx used frequently in pts w/ AFM include IVIG, corticosteroids, and/or therapeutic plasma exchange
- Prospective clinical trials on treatments for AFM are lacking; current sources are limited to case reports & case-series
- Expedite neurology and ID consults to discuss tx & mgmt
- Physical rehab might improve long-term outcomes if implemented during initial phase of illness2
Footnotes 1 CDC. Acute Flaccid Myelitis (AFM): Clinical Guidance for the Acute Medical Treatment of AFM. Last updated 7/1/22. Accessed 9/16/22
2 Clinicians who specialize in diseases like AFM may recommend certain interventions on a case-by-case basis (eg, physical/occupational tx to help w/ arm or leg weakness caused by AFM).
CDC. Acute Flaccid Myelitis (AFM). Diagnosis & Treatment of AFM. Last updated 6/21/22. Accessed 9/16/22
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