Enterovirus D68: What EMS Needs to Know

The news media has brought the newest outbreak in this country to the forefront—Enterovirus D68. Enterovirus D68 involves a respiratory viral infection that affects young children and, for many, is having a profound effect requiring hospitalization and placement in intensive care. This outbreak has raised many questions in the EMS community over the use of PPE. In order to answer this question, let’s review some key points.

1. There is an established season for this viral infection—between July and October. Approximately 10 to 15 million enterovirus infections occur in the United States each year, and infants, children and teenagers are most likely to get infected with enteroviruses and become sick.
2. This outbreak started just as a new school year began, and most of the children affected are in the 4–5-year-old age group.
3. There are several different serotypes of this virus D68–71. This outbreak is related to serotype D68.
4. EV-D68 has been reported to cause a mild to severe respiratory illness—runny nose, cough, difficulty breathing—with and without a fever.
5. Only about 25%–30% of children infected present with a fever. They do present with a cough and difficulty breathing. Many act as though they have asthma but without a history of asthma. However, children with asthma are the ones most in need of hospital care.
6. EV-D68 can be found in respiratory secretions such as saliva, nasal mucus or sputum. The virus likely spreads from person to person when an infected person coughs or sneezes, or a person touches contaminated surfaces.

With this information in mind, noting the mode of transmission, we now can identify the PPE and type of precautions needed for EMS providers.

Clearly, the routine use of standard precautions—good handwashing and the use of gloves when in contact with respiratory secretions and contaminated surfaces—is a given. Additionally, droplet precautions are recommended; since the patient many be coughing and/or having difficulty breathing and need oxygen, EMS should wear a surgical mask when within 3 feet of the patient. Droplet transmitted diseases do not travel more than 3 feet or remain suspended the air. If suctioning or intubating, also wear eye protection. Respirators are NOT needed.

Cleaning and disinfection post-transport is directed to high contact items and surfaces. This would apply to items that were used for patient care and areas the patient was in contact with. No special cleaning solution is needed, nor does the vehicle need to be aired out after transport. No special solution is needed.

References

Transmission-based precautions. Droplet Precautions, Centers for Disease Control and Prevention, Atlanta, GA.

Midgley CM, Jackson MA, et al. Severe Respiratory Illness Associated with Enterovirus D68—Missouri and Illinois, 2014. MMWR, 2014 Sep; 63(36): 798–99.

Brooks K. Ready reference to Microbes, 2nd ed. The Association for Professionals in Infection Control and Epidemiology, 2007.