Enterovirus D68: Precautions, Surveillance, Yes; Alarm, No

By Betsy Todd, MPH, RN, CIC, AJN clinical editor

EV68-infographicAs news coverage focuses on the latest clusters of suspected—and, in some instances, confirmed—cases of human enterovirus D68 (EV-D68) as they occur in successive regions of the U.S., here’s a quick primer on what is known about EV-D68.

Is this a new, dangerous virus?
EV-D68, a non-polio enterovirus, is not a “novel” virus—the term used to describe emerging infections such as SARS and MERS. It’s more accurate to describe it as the CDC does: it is an “increasingly recognized” cause of respiratory infections, especially in children.

EV-D68 was first isolated in 1962. While reports of EV-D68 since then have been sporadic, the CDC in 2011 reported on clusters of this viral infection in Georgia, Pennsylvania, and Arizona as well as in Asia and Europe. It’s likely that there are hundreds or even thousands of EV-D68 infections every year in the U.S. But as with many other viral infections, they will range in severity, and an infection that looks like “a cold” isn’t usually brought to the attention of a health care provider.

According to the CDC, most enterovirus infections are actually asymptomatic; this may be the case with EV-D68 as well.

Diagnostic testing for EV-D68 involves RT-PCR and gene sequencing. Most hospital labs therefore are unable to test for it. Some readily available diagnostic tests […]

What to Teach Patients and Their Families About Asthma

What do you need to know about asthma, and what should you teach your patients about its prevention and management? This month’s CE article gives a comprehensive and accessible overview, with medication, symptom, and common allergen tables, as well as advice like the following about the use of “action plans,” which may be particularly helpful with patients with “moderate or severe persistent asthma, a history of exacerbations, or poorly controlled asthma.” 

Action plans should be simple and easy to use. Many use a traffic light analogy, describing green, yellow, and red zones for which specific actions are prescribed. In the green (“go”) zone, patients’ [peak expiratory flow rate] PEFR is 80% to 100% of their personal best and they have no symptoms. These patients can continue using their daily medications and taking steps to limit exposure to triggers, as described in their plan. When patients’ PEFR is 50% to 80% of their personal best and they have symptoms, they’ve entered the yellow (“caution”) zone, and practitioners may consider prescribing alternative antiinflammatory medications and, possibly, a higher dose or more frequent use of the rescue medication. Patients whose PEFR drops below 50% of their personal best and whose symptoms fail to improve significantly with prescribed rescue medications are in the red (“danger–stop”) zone. They should increase medication as indicated in their action plan and call their health care provider immediately. If unable to reach their provider, they should stop what they’re […]