September 19, 2022

Severe Respiratory Illnesses Associated with Rhinoviruses and/or Enteroviruses Including EV-D68

Healthcare providers and hospitals in several regions of the United States notified the Centers for Disease Control and Prevention (U.S. CDC) during August 2022 about increases in pediatric hospitalizations in patients with severe respiratory illness who also tested positive for rhinovirus (RV) and/or enterovirus (EV). RVs and EVs can have clinically similar presentations and are indistinguishable from one another on multiplex assays often used in clinical settings. Upon further typing, some specimens have been positive for enterovirus D68 (EV-D68). Concurrently, pediatric acute respiratory illness sentinel surveillance sites are reporting a higher proportion of EV-D68 positivity in children who are RV/EV positive compared to previous years. Although it primarily causes acute respiratory illness, EV-D68 has been associated with acute flaccid myelitis (AFM), a rare but serious neurologic complication involving limb weakness.

The purpose of this Health Alert Network (HAN) Health Advisory is to

1. Notify healthcare providers, laboratories, infection control specialists, and public health departments about recent increases in severe respiratory illness requiring hospitalization in children,
2. Urge healthcare providers to consider EV-D68 as a possible cause of acute, severe respiratory illness (with or without fever) in children,
3. Advise of the potential for an increase in AFM cases in the upcoming weeks, and
4. Provide U.S. CDC and Maine CDC recommendations to healthcare providers, laboratories, infection preventionists, and the public.

Advisory (PDF)