Concern Over Enterovirus D68 Amidst Death of Asymptomatic Child
Oct 07, 2014

EV68-map-thmbThe United States is currently experiencing a nationwide outbreak of enterovirus D68 (EV-D68) associated with severe respiratory illness. From mid-August to October 6, 2014, there have been a confirmed total of 594 people in 43 states and the District of Columbia diagnosed with the infection and five of those patients have since died.  While the role that EV-D68 infection played in four of these deaths is still being investigated at this time, the latest fatality of a four-year old boy from New Jersey is confirmed to have been associated with EV-D68.  As more cases appear across the country, and more questions arise about the symptoms – or lack of symptoms in the latest fatal case – parents are understandably growing concerned. What is this unfamiliar virus that is threatening the health of their otherwise healthy children?

The truth is that there are more than 100 types of enteroviruses which are fairly common through the summer and fall in the United States. In general, a mix of enteroviruses circulates every year, and different types can be common in different years. It’s estimated that 10 to 15 million enterovirus infections occur in the United States each year resulting in tens of thousands of hospitalizations.

But what has drawn the public’s attention is that EV-D68 is extremely prevalent of all the types and is causing severe respiratory illness.  While the three strains of EV-D68 circulating this year are not new, and small numbers of EV-D68 have been reported regularly to the CDC since 1987, the number of confirmed EV-D68 infections this year is much greater than what has been reported in previous years.

It’s also important to realize that different enteroviruses can cause different illnesses, such as respiratory illness, febrile rash, and acute neurological diseases such as aseptic meningitis which results in swelling of the tissue covering the brain and spinal cord, encephalitis which results in swelling of the brain, and acute myelitis and paralysis. While severe respiratory illness has been the most common result of EV-D68 infection, the CDC is aware of two published reports of children with neurologic illnesses in confirmed patients with EV-D68 infection. This, of course, is concerning and has resulted in frequent alerts and updates from the CDC in regard to the spread and symptoms of EV-D68.

Symptoms of Infection and Who Is At RiskEV68-infographic

EV-D68 infections can cause mild symptoms such as fever, runny nose, sneezing, cough, and body and muscle aches, to severe symptoms which may include wheezing and difficulty breathing. And yet, in the case of Eli, can even cause no apparent symptoms at all.  It should be noted that almost all of the CDC-confirmed cases of EV-D68 infection this year have been among children, many of which suffer with asthma or a history of wheezing. In general, infants, children, and teenagers are more likely to become sick as a result of an enterovirus infection because they don’t yet have immunity from previous exposures to these viruses. On the other hand, while adults can get infected, they’re more likely to have little or no symptoms.

Transmission and Prevention

Since the virus can be found in an infected person’s respiratory secretions, and is likely spread from person to person when an infected person coughs, sneezes, or touches a surface that is then touched by others, the best way to help prevent EV-D68 is by following these steps:

  • Wash hands often with soap and water for 20 seconds
  • Avoid touching 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, or when you are sick
  • Cover your coughs and sneezes with a tissue or 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

For children with asthma, who are at risk for severe symptoms from EV-D68 and other respiratory illnesses, they should be sure to:

  • Discuss and update their asthma action plan with their primary care provider.
  • Take prescribed asthma medications.
  • Keep reliever medication on hand.
  • Get a seasonal flu vaccine.
  • Ensure child’s caregiver and/or teachers are aware of how to help if a child experiences any symptoms related to asthma.

Anyone suffering with respiratory illness or who develops new or worsening asthma symptoms should contact their doctor right away if they are having difficulty breathing.


EV-D68 can only be diagnosed by doing specific lab tests on specimens from a person’s nose and throat.  While many hospitals and some doctor’s offices can test sick patients to see if they have enterovirus infection, they can’t necessarily test to determine the type of enterovirus, like EV-D68. The CDC and some state health departments can do this sort of testing, but it is currently only recommended that clinicians consider this for patients when the cause of severe respiratory illness is unclear.


Unfortunately, there are no specific treatments, antiviral drugs or vaccines to protect against EV-D68. For mild respiratory illness, it’s best to treat symptoms with over-the-counter medications.  For those who suffer with severe respiratory illness, hospitalization may be required for intensive supportive therapy.

What the CDC Has Been Doing

Dr. Anne Schuchat of the Centers for Disease Control and Prevention and Dr. Gregory Conners of Children’s Mercy Hospital in Missouri spoke with PBS last month to provide more details on how they have identified this growing concern with EV-D68.


The CDC will continue to collect information to better understand how widespread EV-D68 infections may be within states and how populations may be affected. By working with state and local health departments, as well as communicating with clinical and state laboratories, they continue to identify and investigate outbreaks, while also helping to improve detection and enhance surveillance.

For more current updates, check out the information they have available here:   

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16 responses to “Concern Over Enterovirus D68 Amidst Death of Asymptomatic Child”

  1. Daria says:

    This is a new kind of polio. It used to be that they suspended the DPT vaccine during polio outbreaks, because having had the shot recently made polio more likely in those vaccine recipients. A friend the other day asked about this boy who died of enterovirus in New Jersey if he had recently had a flu vaccine that might have made it more likely that he get and die of the usually mild enterovirus. Did he?

  2. Jane Serlin says:

    Well, if your friend questioned things, it must be a conspiracy by
    the medical professionals.

  3. jgc56 says:

    No, Daria: EV-68 is not a new kind of polio, anymore than coxsackievirus A or B are new kinds of polio. It’s instead like the coxsackviruses it’s a non-polio enterovirus, which are in fact very common (with more than 100 non-polio enteroviruses identified). Non-polio enteroviruses cause between 10 and 15 million infections in the US every year, resulting in tens of thousands of hospitalizations.

  4. Liz says:

    I didn’t say it was polio, but a new kind of polio. Both are enteroviruses, both are usually mild respiratory infections that most people recover from completely, but a tiny percentage goes on to develop paralysis. For polio, it was 90% who got it had not symptoms, 9% had cold or flu-like symptoms, while less than 1% had paralytic symptoms. Both are more common in summer and early fall. So we have enterovirus 68, another kind of enterovirus, that sprang up in August and has continued on into September and October. It has produced a cold or flu-like illness with severe coughing and sometimes wheezing in the patients who have symptoms. A tiny number of those have developed paralysis, and the reports are not complete, but I’ve read that in at least some cases, the children with paralysis have not recovered from it. Sounds like a new kind of polio to me.

  5. Chris says:

    Polio is mostly transmitted through fecal/oral transmission. There are lots of different enteroviruses. With your criteria you can also say it is a common cold or hand, foot and mouth disease:

  6. Liz says:

    Polio can be transmitted either by contaminated water or be airborne. I would say that any rhinovirus that caused flu-like symptoms and later paralysis would be a kind of polio. Why are you debating this? As soon as they have a vaccine for this virus, I’m sure you’ll be on about how much the disease is like polio.

  7. Lawrence says:

    @Liz – and your evidence is, what exactly? Enteroviruses have been around for quite a while & it just so happens that this one is particularly bad this year….so why are you debating this?

  8. Chris says:

    “flu-like symptoms and later paralysis”

    Measles can also do this. So why isn’t it a new kind of measles? Or even hand, foot and mouth disease?

  9. Lawrence says:

    @Chris – I guess when you believe that everything related to disease in today’s world is part of a conspiracy, you’ll believe anything…..

    (and that “you” is directed at Liz).

  10. Dina says:

    The crucial part is the paralysis caused by an enterovirus. Measles does not cause paralysis. I don’t believe there’s a conspiracy involved with either enterovirus 68 or Ebola. Such epidemics have always been a part of life, and occur without any human promotion. Lawrence, can you find anything I have said which indicates that I think contagious disease is part of a conspiracy? It could be, I”ve read that they used to give infected blankets to Indians to infect them with disease, but I don’t think this has been the case in today’s world. Does this unwarranted assertion reveal a certain paranoia?

  11. Chris says:

    Liz, are you now “Dina”? Please find a username and stick to it, otherwise we will doubt your veracity. Also, actually read the links I provided.

    Dina: “Measles does not cause paralysis.”

    Yes it does. It is one of the effects from the one in a thousand chance of encephalitis, and also a symptom of SSPE. Here is part of an archived article from 2004 about at least one boy paralyzed by measles: Focus: The real victims of Britain’s MMR scare.

    And some links to recent SSPE cases in Germany:

  12. Lawrence says:

    @liz / Dina – there are a number of diseases that can cause paralysis, there is nothing particularly special about this one, other than it appears to be especially virulent this year.

  13. Chris says:

    Lawrence, the name morphing person would have known that if she had bothered to read the second link I posted yesterday. Honestly, it would save us lots of time if he/she would just choose one username and stuck to, and actually read the links, and perhaps even the article at the top of this page.

  14. […] the cookie jar she of course profusely apologized. Well, not exactly. She talked about how she was asymptomatic, she was concerned for her cameraman and she hid an apology of sorts midway through her […]

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