Enterovirus D68 · What It Is, Transmission, Signs and Symptoms, Treatment, and More

The symptoms of EV-D68 infection range from mild to severe and are similar to those found in other respiratory illnesses, including influenza and the common cold. The incubation period (i.e., the time between exposure to the virus and symptoms onset) of EV-D68 ranges from 3 to 10 days. Most individuals experience either no symptoms at all (i.e., asymptomatic) or mild symptoms such as a runny nose, sore throat, sneezing, cough, and myalgias. Individuals with underlying pulmonary disease (e.g., chronic obstructive pulmonary disease, or COPD) may experience severe symptoms such as wheezing and difficulty breathing, although these are less common. Notably, children with underlying respiratory conditions such as asthma or concomitant bronchiolitis may also experience a more severe disease course (e.g., respiratory distress). 

Rarely, EV-D68 has been known to cause acute flaccid myelitis (AFM), a serious neurologic condition that affects the nervous system, specifically the gray matter of the spinal cord. AFM mostly affects young children and causes weakening of the body’s muscles and reflexes. Other signs and symptoms of AFM include difficulty swallowing, slurred speech, facial droop, and drooping eyelids.  

Diagnosis of EV-D68 infection begins with a thorough review of symptoms and medical history. Although further testing is often not needed due to the self-resolving nature of the disease, a throat or nasal swab can be helpful in determining the etiology of infection (e.g., bacterial or viral) when necessary. Testing for enterovirus is often incorporated into multiplex respiratory panels, which are molecular assays simultaneously testing for various common respiratory pathogens (e.g., coronavirus, enterovirus, influenza). Molecular sequencing methods such as reverse transcription polymerase chain reaction (RT-PCR) are used to identify the specific virus strain. RT-PCR is a gene sequencing method used to detect a pathogen’s genetic material (e.g., RNA from EV-D68) by converting it into DNA and amplifying it for identification and sequencing.  

There is no specific treatment for individuals with EV-D68 infection. Most individuals experience a mild self-limiting disease; therefore, management is achieved through supportive measures to improve symptom burden. Supportive measures include adequate rest and hydration with oral fluids, and over-the-counter medications such as acetaminophen or ibuprofen to manage fever and alleviate muscle aches and pains. Saline nasal sprays and humidifiers may help with nasal congestion and saltwater rinses can help relieve sore throat. If symptoms worsen with significant respiratory compromise (e.g., shortness of breath, wheezing) or signs of AFM are present, emergency medical attention should be sought immediately. Treatment for AFM includes a combination of supportive measures (e.g., hydration); steroids (e.g., dexamethasone); plasmapheresis (i.e., removal or exchange of components of blood plasma); and intravenous immunoglobulin (IVIG), a pooled antibody therapy used to treat various autoimmune, infectious, and inflammatory conditions. Frequent washing of hands with soap and water can help prevent transmission to others.