Enteroviruses EV-D68, EV-D70, and EV-A71
Boston University
Research Occupational Health Program (ROHP)
617-358-7647
Agent
Enteroviruses EV-D68, EV-D70, and EV-A71 are viruses within the genus Enterovirus and family Picornaviridae. EV-D68 is genetically close to rhinovirus that replicates in the respiratory tract and causes respiratory disease. Since 2014, EV-D68, EV-D70 and EV-A71 have been associated with acute flaccid myelitis.
Disease/Infection
Acute flaccid myelitis, conjunctivitis, respiratory infection, GI infection, hand, foot, and mouth disease
Pathogenicity
These enteroviruses are detected in respiratory secretions, stool, or CSF. Clinically can affect the central nervous system including cranial, peripheral nerves and bulbar symptoms. EV-D70 can cause conjunctivitis.
- Special Populations at Risk
Children and immune compromised hosts
Biosafety Information
Risk Group/BSL
Risk Group 2
Biosafety level 2
Modes of Transmission
| Transmission | |
| Skin Exposure (Needlestick, animal bite, or scratch): | Yes |
| Mucous Membrane Exposure Splash to Eye(s), Nose or Mouth: | Yes |
| Inhalation: | Unlikely |
| Ingestion: | Yes |
Host Range/Reservoir
Reservoir are humans and worldwide and unclear other reservoirs.
Symptoms
Prodromes of respiratory symptoms or GI symptoms precede neurologic symptoms. Clinical features include asymmetrical flaccid limb weakness, cranial nerve deficits, and bulbar symptoms. Can cause severe respiratory symptoms.
Incubation Period
1-10 days, usually 2 days
Viability
The virus is destroyed by heat of 50 degrees centigrade, autoclaving or incineration. It is inactivated by proper dilutions of formaldehyde and bleach.
Survival Outside Host
Enteroviruses can remain infectious for long periods in food and water. They can survive for at least 24 hours on inanimate surfaces.
Information for Lab Workers
Laboratory PPE
Personal protective equipment includes but is not limited to laboratory coats or gowns, disposable gloves, and safety glasses. Face shields may be recommended based on risk assessment.
Containment
BSL-2 practices, containment equipment, and facilities are recommended for all activities utilizing virus infectious culture fluids, environmental samples, clinical materials, and potentially infectious materials collected for any purpose. ABSL-2 practices, containment equipment, and facilities are recommended for studies of virulent viruses in animals.
In Case of Exposure/Disease
- For injuries in the lab which are major medical emergencies (heart attacks, seizures, etc…).
- Medical Campus: call or have a coworker call the Control Center at 617-414–4144.
- Charles River Campus: call or have a coworker call campus security at 617-353-2121.
You will be referred to or transported to the appropriate health care location by the emergency response team.
- For lab exposures (needle sticks, bite, cut, scratch, splash, etc…) involving animals or infectious agents, or for unexplained symptoms or illness call the ROHP 24/7 hour number (1-617-358-ROHP (7647); or, 8-ROHP (7647) if calling from an on-campus location) to be connected with the BU Research Occupational Health Program (ROHP) medical officer. ROHP will refer you to the appropriate health care location.
- Under any of these scenarios, always inform the physician of your work in the laboratory and the agent(s) that you work with.
- Provide the wallet-size agent ID card to the physician.
Vaccination
None available
Information for First Responders/Medical Personnel
Public Health Issues
Person to person transmission can occur through fecal oral route and via infected feces and body fluids. Contact precautions should be used. Respiratory protection provided for EV-D68.
Diagnosis/Surveillance
Enteroviruses usually can be isolated from throat or eye secretions in the first week of illness and from feces, often for several weeks. In the absence of a viral isolate, the diagnosis of enteroviral infection can be established serologically by testing paired acute and convalescent sera for neutralizing antibodies to each of the three enterovirus serotypes. These viruses can be detected with RT-PCR.
First Aid/Post Exposure Prophylaxis
Perform one of the following actions:
| Skin Exposure (Needlestick or scratch): | Immediately go to the sink and thoroughly wash the wound with soap and water for 15 minutes. Decontaminate any exposed skin surfaces with an antiseptic scrub solution. |
| Mucous Membrane Splash to Eye(s), Nose or Mouth: | Exposure should be irrigated vigorously. |
| Splash Affecting Garments: | Remove garments that may have become soiled or contaminated and place them in a double red plastic bag. |
Treatment
No anti-viral therapy available. Supportive treatment necessary based on symptoms. IV Immune Globulin and prednisone have been used to treat acute disease.
References
Pallansch, M.A. & Oberste, M.S. & Lindsay Whitton, J. (2013). Enteroviruses: Polioviruses, coxsackieviruses, echoviruses, and newer enteroviruses. Fields Virology. 490-530.
Government of Canada, Pathogen Safety Date Sheets: Infectious Substances-Enterovirus70.
Knoester. M, et al. The Pediatric Infectious Disease Journal, 2018 Sept. 18. Twenty nine Cases of Enterovirus-D68-Associated Acute Flaccid Myelitis in Europe 2016.
Sun S. et al. Emerging Microbes Infection 2018 June 6;7(1)99. A cross sectional seroepidemiology study of EV-D68 in China.