Enterovirus D68 (EV-D68), first detected in 1962, is one of more than 100 non-polio enteroviruses. This year’s aggressive strain is said to be related to strains detected back in 2012 and 2013. But that doesn't mean it's any easier for healthcare facilities to test for enterovirus D68.
Unfortunately, testing for EV-D68 has proven difficult because although on-the-spot tests can detect the presence of an enterovirus, many cannot perform the typing analysis necessary to attribute the virus to a particular strain. Additionally, it’s not always clear when to test for enterovirus and when to attribute symptoms to other respiratory illnesses.
When to Test for Enterovirus D68
Doctors note that children with asthma or other breathing problems are more likely to develop serious symptoms, and that wheezing coupled with traditional cold and flu symptoms is cause for concern.
Whether you’re a parent, a physician, or both, if a child or patient has expressed any difficulty breathing or is wheezing, along with other symptoms of respiratory illness, it’s a good idea to have them tested for enterovirus D68.
How to Test for Enterovirus D68
So how can healthcare professionals test for suspected enterovirus 68 infection? The CDC and some state health departments can perform enterovirus typing.
If a patient is exhibiting symptoms beyond those of a mild respiratory infection, physicians can take a sample to be sent out for testing, identification, and recording. For enterovirus typing, the CDC will use real-time or nested PCR testing.
Like most respiratory illnesses, nasopharyngeal (NP) swabs and oropharyngeal (OP) swabs are the preferred method of specimen collection for testing, though stool samples and rectal swabbing are also appropriate.
How to Submit an Enterovirus Virus Sample for Nested PCR Typing
To submit an NP or OP swab sample to the CDC for enterovirus testing, ship a minimum of 1 ml of specimen in viral transport medium. Freeze at (-20) degrees Celsius and pack for shipping on dry ice.
Our UniTranz-RT™ Transport System is appropriate for the preservation and transport of enterovirus 68. You can choose our viral transport medium system on its own, with flocked swabs (for superior collection and elution of specimen), or with polyester tipped swabs. The systems are packaged as a unit to make sampling, preserving, and transporting specimen as simple as possible.
All submitted specimens must include CDC form 50.34 and a patient summary form for each patient for whome specimens are being submitted. Finally, before sending specimens, the CDC asks that proper infection control measures are followed.
How to Help Your Patients Now
As a healthcare professional, you’ll likely encounter a number of anxious parents. Some children diagnosed with this year’s EV-D68 have experienced unexplained paralysis or extreme muscle weakness in their limbs. A few individuals diagnosed with the virus have died; though it’s unclear whether all the deaths can be directly attributed to EV-D68.
But before parents go encasing their children in plastic bubbles, you can help them maintain a realistic perspective by reminding them of the following information:
1) Not Every Case of EV-D68 is Serious
Many people will contract the virus and experience little more than mild flu-like symptoms including: fever, stuffy nose, cough, and muscle aches. “Few people who contract EV-D68 develop symptoms other than a runny nose and a cough," said Dr. Andi Shane, associate professor of pediatrics and global health at Emory University's School of Medicine and Children's Healthcare of Atlanta.
2) The Impact of EV-D68 Will Be Much Smaller than the Flu
The number of cases of enterovirus D68 will pale in comparison to the number of cases of the flu, which can kill hundreds of children in a given season. (Reassuring, no?). This might be a good opportunity to remind parents about the importance of getting their children (and themselves) vaccinated for the flu.
3) Hand Washing is the Best Protection
There is currently no specific treatment for EV-D68, so prevention is still the best medicine. In addition to collecting samples and reminding them of the relative rarity of the virus, you can help concerned parents by demonstrating (and having their children participate in) proper hand-washing procedures and by stressing the importance of good hand hygiene for staving off illness.
Want more information about using Puritan swabs or transport systems to test for viruses this cold and flu season?
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Goodman, Brenda. Reviewed by Bhargava, Hansa, MD. Enterovirus D68: What Parents Need to Know. Cold, Flu, & Cough Health Center. September 9, 2014. Updated October 6, 2014. Retrieved October 9, 2014 from: http://www.webmd.com/cold-and-flu/news/20140909/enterovirus-d68-parents
Specimen Collection, Storage, & Shipment. Non-Polio Enterovirus. Centers for Disease Control and Prevention. Retrieved October 9, 2014 from: http://www.cdc.gov/non-polio-enterovirus/lab-testing/specimen-collection.html
St. James, Janet. Enterovirus testing frustrating, doctor says. September 10, 2014. Retrieved October 9, 2014 from: http://www.usatoday.com/story/news/nation/2014/09/10/enterovirus-testing-frustrating-doctor-says/15373675/
Enterovirus D68 for Health Care Professionals. Non-Polio Enterovirus. Centers for Disease Control and Prevention. October 1, 2014. Retrieved October 9, 2014 from: http://www.cdc.gov/non-polio-enterovirus/hcp/EV-D68-hcp.html