dated Sept 12, 2014
• Routes of transmission for EV-D68 are not fully understood.
• Infection control guidelines for hospitalized patients with EV-D68 infection should include standard precautions, and contact precautions in certain situations, as is recommended for all enteroviruses (http://www.cdc.gov/hicpac/pdf/isolation/Isolation2007.pdf ).
• As EV-D68 is a cause of clusters of respiratory illness, similar to rhinoviruses, droplet precautions also should be considered as an interim recommendation until there is more definitive information available on appropriate infection control.
• As EV-D68 is a non-enveloped virus, environmental disinfection of surfaces in healthcare settings should be performed using a hospital-grade disinfectant with an EPA label claim for any of several non-enveloped viruses (e.g. norovirus, poliovirus, rhinovirus). Disinfectant products should be used in accordance with the manufacturer’s instructions for the specific label claim and in a manner consistent with environmental infection control recommendations
Alcohol is less effective against these non-enveloped viruses, but I haven't seen definitive recommendations to resort to hand-washing.
The AAPHOSPMED listserv (AAP Section on Hospital Medicine) began discussing this on Sept 8 while still awaiting the MMWR publication. Some of the participants have been heavily involved in Kansas City, Chicago, Denver and Atlanta.
Based on those postings, most hospitalists are treating presumed EV-D68 respiratory distress with steroids and albuterol. The difference has been that they have been less likely to start the children on long-term inhaled corticosteroids (ICS,) while typically the vast majority of children who have an asthma exacerbation severe enough to be hospitalized get started on ICS.
Kevin Powell MD PhD FAAP
Saint Louis, MO
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