The US Centers for Disease Control and Prevention (CDC)’s Health Alert Network (HAN) has provided certain recommendations to inform healthcare providers, infection control professionals, clinical laboratories, and public health departments about the recent increase in pediatric cases of severe respiratory illness in several regions of the USA.
Testing patient-collected specimens have confirmed that the illness is associated with rhinovirus and/or enterovirus infection. Further genotyping has detected enterovirus D68 in some specimens.
Rhinoviruses and enteroviruses belong to the Enterovirus genus and share similar clinical symptoms. While rhinoviruses are typically associated with acute respiratory illness, enteroviruses may cause other clinical presentations, including febrile rash, aseptic meningitis, encephalitis, or acute flaccid myelitis.
Patients infected with rhinoviruses or enterovirus D68 share similar respiratory symptoms. Acute flaccid myelitis caused by enterovirus D68 is a rare but serious neurological illness that primarily affects children and causes sudden limb weakness.
Because of the genomic similarities, rhinoviruses and enteroviruses cannot be separately detected by common multiplex respiratory assays. Genomic sequencing or enterovirus D68-specific reverse transcription-polymerase chain reaction (RT-PCR) is required to differentiate between the viruses.
The first outbreak of enterovirus D68 infection in the USA was observed in 2014. Afterward, the major outbreaks were documented in the fall of 2016, 2018 and less markedly in 2020.
In August 2022, healthcare providers and hospitals informed the US CDC about recent induction in respiratory illness among children in several regions of the USA. The children tested positive for rhinovirus and/or enterovirus. The presence of enterovirus D68 infection has also been detected in some children.
The number of enterovirus D68 infections detected in 2022 is higher than in previous years. However, the induction in enterovirus D68-related respiratory illnesses has typically preceded the cases of acute flaccid myelitis. This highlights the need for more rigorous monitoring of acute flaccid myelitis in the coming weeks.
Recommendations provided by CDC HAN for healthcare providers
The CDC HAN has provided several recommendations for healthcare providers to manage the outbreaks of rhinovirus and enterovirus among children effectively.
According to the recommendations, healthcare providers should consider the possibility of enterovirus D68 infection in children present with acute, severe respiratory illness. Respiratory specimens collected from severely ill patients should also be tested for rhinoviruses and enteroviruses when the cause of respiratory infection is unknown.
Because no vaccines or antiviral medicines are available, the patients should be provided with supporting clinical interventions for rhinoviruses and enteroviruses, including enterovirus D68. The clusters of severe respiratory illness should be reported to the local or state health department.
The possibility of acute flaccid myelitis should be strongly considered in patients with sudden limb weakness following respiratory illness. Biological specimens should be collected from different sources (cerebrospinal fluid, serum, stool, and respiratory tract) immediately after the onset of limb weakness and tested for acute flaccid myelitis and polio. The cases of acute flaccid myelitis should be reported to the local or state public health department.
Recommendations for infection control professionals
The CDC HAN recommends infection control professionals isolate patients with rhinovirus or enterovirus infection in a single-person room. Healthcare workers should wear appropriate personal protective equipment depending on the type of infection. In healthcare setups, surfaces should be cleaned with hospital-grade disinfectants.
During high respiratory illness activity, in-person visitation should be delayed for those with respiratory symptoms or pre-existing respiratory illness. Other visitors should always wear well-fitting masks in the facility.
Recommendations for public health departments
Public health departments are recommended to use the “patient summary form” to report CDC about acute flaccid myelitis cases. The departments should advise sick individuals to stay at home and maintain personal hygiene to reduce viral transmission.
The health departments should also consider increasing public awareness about the importance of face masking as a preventive measure against circulating respiratory viruses.
Recommendations for the public
The CDC HAN advises the general population to protect themselves from acquiring and spreading respiratory viruses, including rhinoviruses and enterovirus D68, by implementing certain control measures.
People should consider washing their hands with soap and water for 20 seconds and avoid touching their eyes, nose, and mouth with unwashed hands. They should avoid close contact with sick people. Similarly, Sick people should isolate themselves to prevent further spreading.
People should use a tissue or upper shirt sleeve instead of hands to cover coughs and sneezes. In households with infected members, commonly touched surfaces should be properly and frequently cleaned and disinfected.
People with respiratory symptoms should wear a face mask in public places. They should immediately contact healthcare providers if experiencing breathing difficulty or limb weakness. Parents of children experiencing similar symptoms should also seek immediate medical help.