Enterovirus D68


  • A viruses in the Enterovirus family
  • Infection in the U.S. rarely identified
  • Outbreak in Missouri and Illinois in 8/2014

Clinical Features

  • Mild to severe respiratory distress, otherwise not well defined, spread via respiratory secretions and body fluids
  • 30 confirmed cases in Kansas City and Chicago via PCR of nasopharyngeal secretions with the following features: age range 6 weeks to 16 years, febrile- 23%, prior asthma/wheezing- 70%, 20% required NIV, 7% required intubation[1]
  • All patients in Kansas City showed hypoxemia and difficulty breathing

Differential Diagnosis


  • CXR
  • Labs
  • Cultures
  • Serum Studies(check with micro lab regarding available studies)- Enteroviral infections reportable to (NESS) National Enteroviral Surveillance System


  • Supportive care
  • Close observation for respiratory failure and possible need for NIV or ETI
  • No antiviral medications available


  • Wash hands often with soap and water for 20 seconds, especially after changing diapers
  • Avoid touching eyes, nose and mouth with unwashed hands
  • Avoid kissing, hugging, and sharing cups or eating utensils with people who are sick
  • Disinfect frequently touched surfaces, such as toys and doorknobs, especially if someone is sick


  • Admit to ICU for respiratory support and observation

See Also

External Links

CDC - Enterovirus D68


  1. Midgley CM, Jackson MA, Selvarangan R, et al. Severe Respiratory Illness Associated with Enterovirus D68 — Missouri and Illinois, 2014. MMWR. 2014; 63(36):798-799