CDC Health Alert Network Provides Recommendations for Managing Recent Increase in Severe Respiratory Illness in Children

The U.S. Centers for Disease Control and Prevention (CDC) Health Alert Network (HAN) has provided certain recommendations to inform health care providers, infection control professionals, clinical laboratories, and public health of the recent increase in pediatric cases of severe respiratory disease. in many parts of the United States.

Study: Severe respiratory illnesses associated with rhinoviruses and/or enteroviruses, including EV-D68 – Multistate, 2022. Image Credit: Pixel-Shot/Shutterstock

Analysis of patient specimens has confirmed that the disease is associated with rhinovirus and/or enterovirus infection. Further genotyping detected enterovirus D68 in some specimens.


Rhinoviruses and enteroviruses belong to the Enterovirus gender and share similar clinical symptoms. While rhinoviruses are usually associated with acute respiratory illness, enteroviruses can cause other clinical manifestations, including febrile rash, aseptic meningitis, encephalitis, or acute flaccid myelitis.

Patients infected with rhinoviruses or enterovirus D68 share similar respiratory symptoms. Acute flaccid myelitis caused by enterovirus D68 is a rare but serious neurological disease that mainly affects children and causes sudden limb weakness.

Due to genomic similarities, rhinoviruses and enteroviruses cannot be detected separately by common multiplex breath tests. Genomic sequencing or enterovirus D68-specific reverse polymerase chain reaction (RT-PCR) is required to differentiate the viruses.

The first outbreak of enterovirus D68 infection in the United States was observed in 2014. Subsequently, major outbreaks were documented in the fall of 2016, 2018, and less markedly in 2020.

In August 2022, health care providers and hospitals notified the US CDC of recent induction of respiratory illnesses in children in several regions of the United States. The children tested positive for rhinovirus and/or enterovirus. The presence of enterovirus D68 infection has also been detected in some children.

The number of enterovirus D68 infections detected in 2022 is higher than in previous years. However, induction of enterovirus D68-related respiratory disease has usually preceded cases of acute flaccid myelitis. This highlights the need for more rigorous surveillance of acute flaccid myelitis in the coming weeks.

Recommendations provided by CDC HAN for healthcare providers

CDC HAN has provided several recommendations for healthcare providers to effectively manage rhinovirus and enterovirus outbreaks in children.

Recommendations are that health care providers should consider the possibility of enterovirus D68 infection in children with acute and severe respiratory illness. Respiratory specimens taken from critically ill patients should also be tested for rhinoviruses and enteroviruses when the cause of the respiratory infection is unknown.

Since no vaccines or antiviral drugs are available, patients should receive supportive clinical interventions for rhinoviruses and enteroviruses, including enterovirus D68. Clusters of severe respiratory illness should be reported to the local or state health department.

The possibility of acute flaccid myelitis should be strongly considered in patients with sudden limb weakness following respiratory disease. Biological samples should be taken from different sources (cerebrospinal fluid, serum, stool and respiratory tract) immediately after the onset of limb weakness and tested for acute flaccid myelitis and poliomyelitis. Cases of acute flaccid myelitis should be reported to the local or national public health department.

Recommendations for Infection Control Professionals

CDC HAN recommends that infection control professionals isolate patients infected with rhinovirus or enterovirus in a single room. Healthcare workers should wear appropriate personal protective equipment depending on the type of infection. In healthcare settings, surfaces should be cleaned with hospital-grade disinfectants.

During high respiratory disease activity, in-person visits should be delayed for people with respiratory symptoms or pre-existing respiratory disease. Other visitors must always wear properly fitting masks in the facility.

Recommendations for public health services

It is recommended that public health departments use the “Patient Summary Form” to report cases of acute flaccid myelitis to the CDC. Departments should advise sick people to stay home and maintain personal hygiene to reduce viral transmission.

Health services should also consider increasing public awareness of the importance of face masks as a preventative measure against circulating respiratory viruses.

Recommendations for the public

CDC HAN advises the general population to protect themselves against the acquisition and spread of respiratory viruses, including rhinoviruses and enterovirus D68, by implementing certain control measures.

People should consider washing their hands with soap and water for 20 seconds and avoid touching their eyes, nose and mouth with unwashed hands. They should avoid close contact with sick people. Likewise, sick people should self-isolate to prevent further spread.

People should use a handkerchief or shirt sleeve top instead of their hands to cover coughs and sneezes. In households with infected members, frequently touched surfaces should be properly and frequently cleaned and disinfected.

People with respiratory symptoms should wear a face mask in public places. They should contact health care providers immediately if they experience difficulty breathing or limb weakness. Parents of children with similar symptoms should also seek immediate medical attention.

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