Enterovirus D68: 5 ways formulary managers can help

In recent months, the incidence of enterovirus D68 (EV-D68) infection has markedly increased across the United States, notably affecting young pediatric patients. Hospitalizations of children with severe respiratory illness associated with this non-polio enterovirus have concurrently risen.^1,2

A total of 691 cases of EV-D68 have been confirmed in 46 states so far this year.³ Some children have experienced more severe symptoms such as hypoxemia, wheezing, and difficulty breathing, a particular concern in those who have respiratory illnesses like asthma, although not all patients have had this underlying condition.¹ As well, there have been reports of paralysis among affected children in Colorado. Finally, a 4-year-old child in New Jersey and a toddler in Michigan were confirmed as having died of the infection.⁴

What can be done by hospital-based formulary managers to assist in the prevention, evaluation, and treatment of EV-D68?

1/Provide guidelines on infection control

Vigilance by healthcare professionals regarding prevention of the spread of EV-D68 is critical. Make certain all hospital healthcare personnel know that infection control guidelines for patients hospitalized with EV-D68 include standard and contact precautions. Droplet precautions are also needed because EV-D68 is a cause of clusters of respiratory illness.^1,2

Healthcare personnel should be instructed about performing environmental disinfection of surfaces within the hospital with a hospital-grade disinfectant.¹ Consistent practice of hand hygiene should be stressed. Using an alcohol-based hand rub (ABHR) along with gloves for protection provides overall effectiveness against many healthcare pathogens. Hand hygiene using either ABHR or soap and water should be performed prior to donning gloves and on the removal of them.²

2/Stress careful evaluation

Stress that providers should always consider EV-D68 as a potential cause when faced with a patient who has an acute, unexplained severe respiratory illness. They should consider this possibility even in patients who do not present with fever.² Children have been the patients presenting with EV-D68 thus far, but providers should know that it may occur in adults.¹

Healthcare professionals need to know that the CDC strongly advises them to consider laboratory testing of respiratory specimens for enteroviruses in cases of severely ill patients with a respiratory infection and uncertain causation. Typing by molecular sequencing is required for confirmation of the presence of the virus. State or local health departments can be contacted by providers for further enterovirus typing. They may also contact the CDC for consultation: 800-CDC-INFO (800-232-4636).²

3/Review related treatment issues

As patients with asthma may be at greater risk of severe respiratory illness related to EV-D68, providers need to underscore the importance of their having an asthma action plan. These patients must adhere to using their prescribed long-term control medication. They should also be told to seek care early when experiencing an exacerbation of their asthma.²

There is no known antiviral drug that has been shown to be effective in treating EV-D68.  

Handouts to help educate the parents of young patients about EV-D68 and what they can do to protect themselves and their families from exposure are available from the CDC.⁵

4/Emphasize importance of reporting

All healthcare providers should be made aware that it is essential to let local and state health departments know about suspected clusters of severe respiratory illness.²

5/Inform about latest developments

As the season for EV-D68 continues through the fall, keep providers informed about the latest developments. Beginning October 14, 2014, a new, faster lab test for detecting the virus is being used by the CDC, which will allow better understanding of the outbreak and more immediate monitoring of changes. CDC will review and update data on ongoing investigations every Wednesday. For updates online go to: http://www.cdc.gov/non-polio-enterovirus/outbreaks/EV-D68-outbreaks.html.³

References

1. Health Alert Network. Centers for Disease Control and Prevention. Severe respiratory illness associated with Enterovirus D68-multiple states, 2014. September 12, 2014. http://emergency.cdc.gov/han/han00369.asp. Accessed October 14, 2014.

2. Centers for Disease Control and Prevention. Non-polio enterovirus. Enterovirus D68 for health care professionals. Updated October 1, 2014.  http://www.cdc.gov/non-polio-enterovirus/hcp/EV-D68-hcp.html. Accessed October 14, 2014.

3. Centers for Disease Control and Prevention. Enterovirus D68 in the United States, 2014. Updated October 14, 2014.  http://www.cdc.gov/non-polio-enterovirus/outbreaks/EV-D68-outbreaks.html. Accessed October 14, 2014.

4. Ohlheiser A. Michigan toddler dies after becoming infected with Enterovirus. Washington Post, October 13, 2014.