Enteroviruses are small, very contagious pathogens made of ribonucleic acid (RNA) and protein. Some of the most commonly known are polio viruses, but there are many non-polio forms.
Enterovirus D68 (EV-D68) is one of the non-polio enteroviruses. Enterovirus D68 (EV-D68) infections are thought to occur less commonly than infections with other enteroviruses. EV-D68 was first identified in California in 1962. Compared with other enteroviruses, EV-D68 has been rarely reported in the United States for the last 40 years.
That is until a recent outbreak in the Midwest that CDC virologist Mark Pallansch was quoted by CNN as saying could be "just the tip of the iceberg in terms of severe cases."
EV-D68 commonly affects children (generally 6 months to 16 years, according to the CDC) and can range from mild to severe. About 60 of the current 475 cases reported at Children's Mercy Hospital in Kansas City have required hospitalization and intensive care.
"I've practiced for 30 years in pediatrics, and I've never seen anything quite like this," said Dr. Mary Anne Jackson, the hospital's division director for infectious diseases, according to the CNN story.
According to the Enterovirus Foundation:
"Enteroviruses are acid stable and able to survive exposure to the tough environment of the gastrointestinal tract. They can also survive chlorine, freezing, and can live on surfaces for several days, long enough to allow for transmission by fomites such as door handles, pillow cases, and dust. The virus can be killed with standard disinfectant..."
Because the virus is unusual and this is already the largest outbreak known in the United States, disinfectants generally do not have a specific kill claim for this strain. The Enterovirus Foundation information seems to indicate that a good, general-purpose disinfectant product will do the necessary job. From that information, it could be inferred that cleaning and disinfecting touchpoints frequently, using your normal disinfection regimen, should help reduce the chances for transmission of this previously rare virus.
Because EV-D68 is also spread in sneeze and cough droplets that can be inhaled, consideration of N-95 masks (limited quantity now on sale) is another possible precaution should your school or institution be affected.
Because the incubation period for the respiratory infection caused by this strain is between 3 and 10 days, people can be infected before symptoms emerge. Because this virus is easily transmitted, a policy to consider in schools is that students experiencing coughing and sneezing should be evaluated. However, as fall weed pollens have already started in both Kansas and Missouri, and are expected to be very high by the weekend, it may be difficult to tell an actual cold or EV-D68 infection from common allergies upon casual review.
Symptoms of EV-D68
EV-D68 has been described as having symptoms similar to a "bad summer cold." And, in fact, enterovirus is often a cause of the "summer" cold. The important signals for seeking treatment appear to be unusual or extended difficulty in breathing. The CNN article listed fever or wheezing as possible clues, as well as a rash in some cases, added to the cold symptoms.
Remind students and workers to cover sneezes, wash hands frequently, and hand sanitize where appropriate.