Health Alert: Enterovirus Affects Children in Multiple States

iStock_000003107981SmallThe CDC has issued a Heath Alert Advisory regarding Enterovirus D68 following several cluster outbreaks of severe respiratory illness.  Although there has not been a confirmed cases in New Hampshire yet, there have been more than 100 cases of Enterovirus D68 confirmed in 12 states.  The CDC believes the real number of severe respiratory illnesses caused by this virus is probably even higher.

Enteroviruses are very common, especially in the early fall. The CDC estimates that 10 million to 15 million infections occur in the United States each year. These viruses usually present like the common cold; symptoms include sneezing, a runny nose and a cough.  Although most people recover without any treatment, Enterovirus D68 appears to be exacerbating breathing problems in children who have asthma.

Heath care workers in New Hampshire are asked to report cases of severe respiratory illness or clusters of respiratory infections with an unknown etiology to the NH DPHS at 603-271-4496. Further information and guidance (HAN) will be forthcoming from the Centers for Disease Control and Prevention.

 CDC Alert Recommendations

Clinical Care

  • Although the findings to date have been in children, EV-D68 may also affect adults.
  • Health care providers should consider EV-D68 as a possible cause of acute, unexplained severe respiratory illness, even in the absence of fever.

Infection Control

  • Routes of transmission for EV-D68 are not fully understood.
  • Infection control guidelines for hospitalized patients with EV-D68 infection should include standard precautions, and contact precautions in certain situations, as is recommended for all enteroviruses (
  • As EV-D68 is a cause of clusters of respiratory illness, similar to rhinoviruses, droplet precautions also should be considered as an interim recommendation until there is more definitive information available on appropriate infection control.
  • As EV-D68 is a non-enveloped virus, environmental disinfection of surfaces in healthcare settings should be performed using a hospital-grade disinfectant with an EPA label claim for any of several non-enveloped viruses (e.g. norovirus, poliovirus, rhinovirus). Disinfectant products should be used in accordance with the manufacturer’s instructions for the specific label claim and in a manner consistent with environmental infection control recommendations (


  • Providers should report suspected clusters of severe respiratory illness to local and state health departments, including the New Hampshire Department of Health and Human Services.
  • EV-D68 is not nationally notifiable, but state and local health departments may have additional guidance on reporting.
  • Health departments may contact CDC for epidemiologic support. Please contact Dr. Claire Midgley ( with brief descriptions of possible clusters.

“Children less than 5 years old and children with underlying asthma appear to be at greatest risk of having medical complications from EV-D68,” says Oklahoma epidemiologist Dr. Kristy Bradley. “If a child develops a cold or a cough, parents and caregivers should just watch the child a little more closely. … If wheezing or asthma-like symptoms develop, medical care should be accessed immediately.”

The virus is hard to track, as many enteroviruses cause similar symptoms and hospitals generally do not test for specific types. The CDC has asked hospitals across the country to send in samples if workers suspect that Enterovirus D68 has caused a patient’s severe respiratory illness.

The CDC is watching this situation closely and helping the states with testing of specimens. For frequently asked questions with answers about Enterovirus D68 click on this website.  Additional details about these EV-D68 clusters can be found in the September 8, 2014, MMWR Early Release.


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