Enterovirus D68

EV-D68 can cause mild to severe respiratory illness. Symptoms may include rhinorrhoea, cough and myalgia, and in severe cases wheezing and difficulty breathing, resulting in hospitalisation.

In addition, EV-D68 has been associated with neurological symptoms such as aseptic meningitis, acute flaccid myelitis (AFM), and potentially Guillain-Barré syndrome in adults.

EV-D68 is spread via infectious respiratory secretions, such as saliva, nasal mucus and sputum. Vulnerable groups include children, teenagers and immunocompromised adults.

EV-D68 can cause mild to severe respiratory illness or no symptoms at all. Mild symptoms may include runny nose, sneezing, cough, and body and muscle aches. Serious symptoms may include wheezing, difficulty breathing, or pneumonia.

EV-D68 can also cause acute flaccid myelitis (AFM), an uncommon but dangerous neurological condition that mostly affects children. Onset of AFM symptoms can start several weeks after an EV-D68 infection. AFM causes the muscles and reflexes in the body to become weak. Symptoms include:

• Arm or leg weakness
• Loss of muscle tone and reflexes
• Pain in the neck, back, arms, or legs
• Difficulty swallowing or slurred speech
• Difficulty moving the eyes or drooping eyelids
• Facial droop or weakness

Period of Infectivity: While symptomatic (has been reported up to 21 days).

If NIAS staff are aware that the patient has a suspected or confirmed case this should be communicated to the Control Room (Emergency or Non-emergency as appropriate) and the staff in the receiving unit when transferring the patient to ensure effective patient care and management.

• Droplet precautions (FRSM) should be used for routine care.
• Airborne precautions (FFP3 mask) should be used if an aerosol generating procedure for example intubation /extubation etc. is being undertaken.
• Hand Hygiene should be completed as per the 5 moments in line with usual practice.
• Eye protection should be risk assessed for any concern regarding a splash risk.
• A Fluid Resistant Surgical Mask should be worn.
• Gloves and Aprons should be worn.
• The patient should be transported via ambulance with no other patients present.
• The patient should be asked to wear a Fluid Resistant Surgical Mask (if tolerated and does not interfere with their treatment needs)
• Laundry should be treated as contaminated, placed into an alginate bag and placed into a red laundry bag.

All equipment and the ambulance should have an in-between patient clean, paying particular attention to touch points.

If appropriate PPE is worn there is no follow up required for staff.

If staff have had a breach in PPE they should remain vigilant for any signs or symptoms. There is no prophylaxis required and staff do not need to remain off work if asymptomatic.

If staff develop symptoms they should remain off work and contact their Line manager/ Occupational Health.