Enterovirus D68

EV-D68 Infections Reported

Hospitals in Missouri and Illinois are seeing more children than usual with severe respiratory illness caused by enterovirus D68 for this time of the  year.

Several other states are investigating clusters of children with severe respiratory illness, possibly due to enterovirus D68.

CDC is watching this situation closely and helping the states with testing of specimens.


Q: What is enterovirus D68?

A: Enterovirus D68 (EV-D68) is one of many non-polio enteroviruses. This virus was first identified in California in 1962, but it has not been commonly reported in the United States.

Q: What are the symptoms of EV-D68 infection?

A: EV-D68 can cause mild to severe respiratory illness.

  • Mild symptoms may include fever, runny nose, sneezing, cough, and body and muscle aches.
  • Most of the children who got very ill with EV-D68 infection in Missouri and Illinois had difficulty breathing, and some had wheezing. Many of these children had asthma or a history of wheezing.

Q: How does the virus spread?

A: Since EV-D68 causes respiratory illness, the virus can be found in an infected person’s respiratory secretions, such as saliva, nasal mucus, or sputum. EV-D68 likely spreads from person to person when an infected person coughs, sneezes, or touches contaminated surfaces.

States with  Lab-confirmed EV‑D68 Infections

States with Confirmed EV-D68 InfectionsFrom mid-August to September 17, 2014, a total of 140 people in 16 states have been confirmed to have respiratory illness caused by EV-D68.                                               Learn more about states with confirmed cases.

Q: How many people have been confirmed to have EV-68 infection?

A: From mid-August to September 17, 2014, a total of 140 people in 16 states were confirmed to have respiratory illness caused by EV-D68. (See States with Lab-confirmed Enterovirus D68.) The cases of EV-D68 infection were confirmed by the CDC or state public health laboratories that notified CDC.

Q: How common are EV-D68 infections in the United States?

A: EV-D68 infections are thought to occur less commonly than infections with other enteroviruses. However, CDC does not know how many infections and deaths from EV-D68 occur each year in the United States. Healthcare professionals are not required to report this information to health departments. Also, CDC does not have a surveillance system that specifically collects information on EV-D68 infections. Any data that CDC receives about EV-D68 infections or outbreaks are voluntarily provided by labs to CDC’s National Enterovirus Surveillance System (NESS). This system collects limited data, focusing on circulating types of enteroviruses and parechoviruses.

Q: What time of the year are people most likely to get infected?

A: In general, the spread of enteroviruses is often quite unpredictable, and different types of enteroviruses can be common in different years with no particular pattern. In the United States, people are more likely to get infected with enteroviruses in the summer and fall.

We’re currently in middle of the enterovirus season, and EV-D68 infections are likely to decline later in the fall.

Keep your child from getting and spreading Enterovirus D68

Q: Who is at risk?

A: In general, infants, children, and teenagers are most likely to get infected with enteroviruses and become ill. That’s because they do not yet have immunity (protection) from previous exposures to these viruses.  We believe this is also true for EV-D68.

Among the EV-D68 cases in Missouri and Illinois, children with asthma seemed to have a higher risk for severe respiratory illness.

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Q: How is it diagnosed?

A: EV-D68 can only be diagnosed by doing specific lab tests on specimens from a person’s nose and throat.

Many hospitals and some doctor’s offices  can test ill patients to see if they have enterovirus infection. However, most cannot do specific testing to determine the type of enterovirus, like EV-D68. Some state health departments and CDC can do this sort of testing.

CDC recommends that clinicians only consider EV-D68 testing for patients with severe respiratory illness and when the cause is unclear.

Respiratory illnesses can be caused by many different viruses and have similar symptoms. Not all respiratory illnesses occurring now are due to EV-D68. Anyone with respiratory illness should contact their doctor if they are having difficulty breathing, or if their symptoms are getting worse.

Q: What are the treatments?

A: There is no specific treatment for people with respiratory illness caused by EV-D68.

For mild respiratory illness, you can help relieve symptoms by taking over-the-counter medications for pain and fever. Aspirin should not be given to children.

Some people with severe respiratory illness may need to be hospitalized .

There are no antiviral medications currently available for people who become infected with EV-D68.

Q: How can I protect myself?

A: You can help protect yourself from respiratory illnesses by following these steps:

  • Wash hands often with soap and water for 20 seconds, especially after changing diapers.
  • Avoid touching eyes, nose and mouth with unwashed hands.
  • Avoid kissing, hugging, and sharing cups or eating utensils with people who are sick.
  • Disinfect frequently touched surfaces, such as toys and doorknobs, especially if someone is sick.

Also, see an graphic  that shows these  prevention steps.

Since people with asthma are higher risk for respiratory illnesses, they should regularly take medicines and maintain control of their illness during this time. They should also take advantage of influenza vaccine since people with asthma have a difficult time with respiratory illnesses.

Q: What should people with asthma and children suffering from reactive airway disease do?

A: CDC recommends:

  • discuss and update your asthma action plan with your primary care provider.
  • take your prescribed asthma medications as directed, especially long term control medication(s).
  • be sure to keep your reliever medication with you.
  • if you develop new or worsening asthma symptoms, follow the steps of your asthma action plan. If your symptoms do not go away, call your doctor right away.
  • parents should make sure the child’s caregiver and/or teacher is aware of his/her condition, and that they know how to help if the child experiences any symptoms related to asthma.

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Q: Is there a vaccine?

A: No. There are no vaccines for preventing EV-D68 infections.

Q: What should clinicians do?

A: Clinicians should

  • consider EV-D68 as a possible cause of acute, unexplained severe respiratory illness, even if the patient does not have fever.
  • ensure that the patient has an asthma action plan. Reinforce use of this plan, including adherence to prescribed long-term control medication. Encourage people with asthma who are experiencing an exacerbation to seek care early. See Asthma Care Quick Reference. Adobe PDF file [12 pages, from the National Institutes of Health]External Web Site Icon
  • report suspected clusters of severe respiratory illness to local and state health departments. EV-D68 is not nationally notifiable, but state and local health departments may have additional guidance on reporting.
  • consider laboratory testing of respiratory specimens for enteroviruses when the cause of respiratory illness in severely ill patients is unclear.
  • consider testing to confirm the presence of EV-D68. State health departments can be approached for diagnostic and molecular typing for enteroviruses.

Before sending specimens for diagnostic and molecular typing:

  • contact your state or local health department.
  • submit specimens (nasopharyngeal and oropharyngeal swabs are preferred or any other type of respiratory specimens) using CDC instructions and complete specimen submission form 50.34.
  • complete a patient summary form  for each patient for whom specimens are being submitted. Please send a printed copy of the form at the same time as specimen submission.
  • follow infection control measures; see health alert for more information.

Q: What is CDC doing about EV-D68?

A: CDC is helping states with diagnostic and molecular typing for EV-D68.

CDC is also working with state and local health departments and clinical and state laboratories to

  • enhance their capacity to identify and investigate outbreaks, and
  • perform diagnostic and molecular typing tests to improve detection of enteroviruses and enhance surveillance.



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Getting Your Family Prepared for a Disaster

What to Tell Your Children about Disasters

It is important to warn children, without overly alarming them, about disasters. Tell children that a disaster is something that could hurt people or cause damage. Explain that nature sometimes provides “too much of a good thing” – fire, rain, or wind. Talk about things that could happen during a storm, like the fact that the lights or phone might not work. Tell children there are many people who can help them during a disaster, so that they will not be afraid of firemen, policemen, paramedics, or other emergency officials.

Teach children:

  • How to call for help.
  • When to use emergency numbers​.
  • To call the family contact if they are separated.

Staying Calm in an Emergency

The most important role a parent can play in an emergency situation is to stay calm. Children of all ages can easily pick up on their parents’ fears and anxieties. In a disaster, they’ll look to you for help and for clues on how to act. If you react with alarm, a child may become more scared. If you seem overcome with a sense of loss, a child may feel their losses more strongly. Experts agree that you should be honest with your children and explain what’s going on. Just be sure to base the amount of information and level of detail on what’s appropriate for their age level.

Children and Their Response to Disaster

Children depend on daily routines: They wake up, eat breakfast, go to school, and play with friends. When emergencies or disasters interrupt this routine, children may become anxious; not want parents out of their sight/refuse to go to school or child care; or feel guilty that they caused the disaster by something they said or did. Children’s fears also may stem from their imagination, and you should take these feelings seriously. Your words and actions can provide reassurance. When talking with your child, be sure to present a realistic picture that is both honest and manageable.

Be aware that after a disaster, children are most afraid that:

  • The event will happen again.
  • Someone will be injured or killed
  • They will be separated from the family
  • They will be left alone

Common Child Behaviors after a Disaster

Children may be upset over the loss of a favorite toy, blanket, teddy bear or other items; undergo a personality change–from being quiet, obedient andcaring to loud, noisy and aggressive or from outgoing to shy and afraid; have nightmares or be afraid to sleep alone or with the light off; become easily upset, cry or whine; lose trust in adults because the adults in their life were unable to control the disaster; or revert to younger behavior such as bedwetting and thumb sucking.

Special Needs of Children after a Disaster

Parents should remember that the psychological effects of a natural disaster don’t go away once the emergency has passed. Children can suffer from nightmares or other problems for years after a disaster. Children are better able to cope with a traumatic event if parents, teachers and other adults support and help them with their experiences.
Help should start as soon as possible after the event. Some children may never show distress because they don’t feel upset, while others may not give evidence of being upset for several weeks or even months. Even if children do not show a change in behavior, they may still need your help. Parents should be on the lookout for signs that their kids need some extra counseling​.

What Parents Can Do to Help Children Cope after a Disaster

Talk with children about how they are feeling and listen without judgment. Let them know they can have their own feelings, which might be different than others. Let children take their time to figure things out and to have their feelings. Don’t rush them or pretend that they don’t think or feel as they do.

Here are some suggested ways to reduce your child’s fear and anxiety:

  • Keep the family together as much as possible. While you look for housing and assistance, try to keep the family together and make children a part of what you are doing. Otherwise, children could get anxious and worry that their parents won’t return.
  • Calmly and firmly explain the situation. As best as you can, tell children what you know about the disaster. Explain what will happen next. For example, say, “Tonight, we will all stay together in the shelter.” Get down to the child’s eye level and talk to them.
  • Encourage children to talk. Let them talk about the disaster and ask questions as much as they want. Encourage children to describe what they’re feeling. Help them learn to use words that express their feelings, such as happy, sad, angry, mad and scared. Just be sure the words fit their feelings–not yours.
  • Listen to what they say. If possible, include the entire family in the discussion. Reassure them that the disaster was not their fault in any way. Assure fearful children that you will be there to take care of them. Children should not be expected to be brave or tough, or to “not cry.”
  • Include children in recovery activities. Give children chores that are their responsibility. This will help children feel they are part of the recovery. Having a tasks help children feel empowered and give them a way to feel in control and useful.
  • Go back as soon as possible to former routines. Maintain a regular schedule for children.
  • Let them have some control, such as choosing what outfit to wear or what meal to have for dinner.
  • Allow special privileges such as leaving the light on when they sleep for a period of time after the disaster.
  • Find ways to emphasize to the children that you love them.

Turn off the TV

Once you arrive at a shelter, hotel, or a relative’s home, disaster related TV programs should be restricted. News coverage of disasters​—especially if children see their own town or school on TV–can be traumatic to children of all ages. If children watch TV coverage of the disaster, parents should watch with them and talk about it afterwards.

Activities to Get Children Talking about a Disaster

Encourage children to draw or paint pictures of how they feel about their experiences. Write a story together of the event. You might start with: Once upon a time there was a terrible ______ and it scared us all ______. This is what happened: ______. End the story with how things are getting better.

​How to Get Your Family Ready Before a Disaster

It’s important for all family members to know how to react in an emergency, because when a disaster strikes, you may need to act quickly. Discuss possible disaster plans with your children–in a very general way–so that they will know what to do in various situations. For example, if you live in a part of the country that is prone to tornadoes, it is important for your children to know what to do if a tornado is coming. Remember that it is possible that you and your children may be in different places when a disaster strikes; for example at school and work. Also, older children may be home alone when faced with an emergency.

Create a Family Disaster Plan

You can create a Family Disaster Plan by taking some simple steps. It’s important for all family members to know how to react in an emergency because the best protection is knowing what to do.

  • Talk with your children about the dangers of disasters that are likely in your area and how to prepare for each type.
  • Make sure they know where to go in your home to stay safe during an earthquake, tornado, hurricane, or other disasters likely for your area.
  • Teach your child how to recognize danger signals. Make sure your child knows what smoke detectors, fire alarms and local  community warning systems (horns, sirens) sound like and what to do when they hear them.
  • Explain to children how and when to call for help. Keep emergency phone numbers (your local Emergency Phone Number List) where family members can find them.
  • Pick an out-of-state family contact person who family members can “check-in” with if you are separated during an emergency. For children who are old enough help them to memorize the person’s name and phone number, or give them a copy of the emergency list included in the kit.
  • Agree on a meeting place away from your home (a neighbor or relative’s house or even a street corner) where you would get together if you were separated in an emergency. Give each family member an emergency list with the name, address and phone number of the meeting place. For children who are old enough help them to memorize the person’s name, address and phone number.
  • Put together a disaster supplies kit for your family.
  • Practice your Family Disaster Plan every six months so that everyone will remember what to do when in an emergency.

It’s important for all family members to know how to react in an emergency because the best protection is knowing what to do.

Kids Get Ready Kit

Assemble a special “Get Ready Kit: for kids. Explain to your children that you might need to leave your house during a disaster and sleep somewhere else for a while.

Here are some items you can your children could put into a backpack or container so it will be ready if needed:

  • A few favorite books, crayons, and paper.
  • Favorite small toys like dolls or action figures.
  • A board game.
  • A desk of cards.
  • A puzzle.
  • A favorite stuffed animal.
  • A favorite blanket or pillow.
  • A picture of your family and pets.
  • A box with special treasures that will help you feel safe.


Most shelters can’t take pets, so plan what to do in case you have to evacuate. Call your local Humane Society to ask if there is an animal shelter in your area. Prepare a list of kennels and veterinarians who could shelter them in an emergency. Keep a list of “pet friendly” motels outside your area.

Disaster Supplies

Every family should have disaster supplies in their home. Needed supplies include food, water and other things that you might need in an emergency. In a hurricane, earthquake, or flood​, you could be without electricity for a week or more, or the water supply may be polluted. There also may be times, such as during a flood or a heavy winter storm, that you might not be able to leave your house for a few days. Your family may never need to use your disaster supplies, but it’s always best to be prepared. To make getting these items fun, you could have a family “Scavenger Hunt” and have family members see how many of these items they can find in your home.

Additional Information:


Last Updated
Adapted from Family Readiness Kit: Preparing to Handle Disasters, 2nd Edition
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Labor Day Holiday

Pediatrics West will be closed Monday, September 1, 2014 in observance of Labor Day.
As always, please feel contact our nurses 24 hours a day with any urgent matters at 978-577-0437.
Hours for the holiday weekend are as follows:
Saturday, August 30th – Westford office only from 8am – 3pm
Sunday, August 31st- Westford office only from 9am – 1pm
Monday, September 1st – All offices CLOSED
All offices resume regular hours beginning Tuesday, September 2, 2014
Monday through Friday – 7:00am – 8:00pm
Walk-In hours
Monday through Friday – 7:00am – 9:00am
Please review the walk-in criteria before heading to the office.
Our walk-in criteria was designed to accommodate simple illnesses for children ages 5 and older.
More complicated problems should be booked into the schedule to allow for more appropriate scheduling.
Call 978-577-0437 to book an appointment.
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Car Seat Guidelines 2014

Know the Stages:

  • Birth up to Age 2 – Rear-facing car seat. For the best possible protection, infants and children should be buckled in a rear-facing car seat, in the back seat, until age 2 or when they reach the upper weight or height limit of their seat. Check the seat’s owner’s manual and/or labels on the seat for weight and height limits.
  • Age 2 up to at least Age 5 – Forward-facing car seat. When children outgrow their rear-facing seat they should be buckled in a forward-facing car seat, in the back seat, until at least age 5 or when they reach the upper weight or height limit of their seat. Check the seat’s owner’s manual and/or labels on the seat for weight and height limits.
  • Age 5 up until seat belts fit properly – Booster seat. Once children outgrow their forward-facing seat they should be buckled in a belt positioning booster seats until seat belts fit properly. Seat belts fit properly when the lap belt lays across the upper thighs (not the stomach) and the shoulder belt lays across the chest (not the neck). Remember to keep children properly buckled in the back seat for the best possible protection.
  • Once Seat Belts Fit Properly – Children no longer need to use a booster seat once seat belts fit them properly. Seat belts fit properly when the lap belt lays across the upper thighs (not the stomach) and the shoulder belt lays across the chest (not the neck). For the best possible protection keep children 12 and under properly buckled in the back seat.

Back Seat is Safest. All children aged 12 and under should be properly buckled in the back seat. Airbags can kill young children riding in the front seat. Never place a rear-facing car seat in front of an air bag. Buckle children in the middle of the back seat when possible, because it is the safest spot in the vehicle.

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