Enterovirus D68

Enterovirus D68 (EV-D68) is a contagious respiratory infection that mostly affects children. It can lead to acute flaccid myelitis (AFM), a disorder that causes permanent muscle weakness. Most people with EV-D68 have mild symptoms and recover without serious problems. The virus easily spreads to others when you cough or sneeze.


What is enterovirus D68 (EV-D68)?

Enterovirus D68 (EV-D68) is a contagious virus that causes respiratory infections, mostly in children and teens. But adults can get it, too. It typically causes mild cold-like symptoms. Unless you or your child are very sick, you might not know you have EV-D68.

Some people who get the virus develop life-threatening respiratory problems. A small number of children with EV-D68 infections develop a nervous system disorder called acute flaccid myelitis (AFM). This disorder causes extreme muscle weakness. Rarely, a child with AFM has permanent paralysis.


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What are enteroviruses?

Enteroviruses are a group of viruses that cause different types of contagious infections. In total, there are more than 300 types of enteroviruses.

EV-D68 is an enterovirus subtype that affects the respiratory system. Healthcare providers place EV-D68 in the nonpolio enterovirus category. There are more than 100 nonpolio enteroviruses.

Like the virus that causes polio, some of these enteroviruses affect the nervous system. They cause a range of health problems, including:

How common is enterovirus D68?

Hundreds of different types of enteroviruses infect 10 million to 30 million Americans every year. Numbers for EV-D68 infections are difficult to pinpoint. People with mild symptoms don’t seek medical care and don’t get an enterovirus test.

In 2014, almost 1,400 children and adults were hospitalized with severe respiratory infections due to EV-D68. This marked the first national EV-D68 outbreak that caused high numbers of severe symptoms. There were also outbreaks in 2016 and 2018. Millions of people likely had EV-D68 in each of those years but had milder symptoms.


How does enterovirus D68 affect pregnancy?

Most pregnant women have developed some level of immunity (protection) to EV-D68 illnesses due to previous exposures. The virus doesn’t appear to cause problems during pregnancy.

If you have the virus at the time of childbirth or while breastfeeding, there’s a small chance your baby may get it. It’s rare for the virus to cause serious problems in an infant. Still, you should talk to your healthcare provider if you feel ill while pregnant or breastfeeding.

Symptoms and Causes

How does enterovirus D68 spread?

EV-D68 is a contagious virus. You can catch it anytime, but infections are most common from August to November.

The virus lives in mucus, saliva (spit), phlegm in the lungs and stool (poop). It spreads through:

  • Airborne droplets when an infected person sneezes or coughs.
  • Contact with an infected person’s poop (for instance, when changing a diaper or helping a child use the toilet).
  • Kissing someone who has the virus.
  • Sharing eating utensils and cups.
  • Touching contaminated doorknobs, toys or other surfaces.


What are the symptoms of enterovirus D68?

Children and teens are more likely to have noticeable symptoms of EV-D68 because they haven’t had time to build up immunity to the virus.

EV-D68 typically causes mild cold-like symptoms, such as:

People who have asthma or weak immune systems may develop more severe symptoms. With these conditions, you or your child might have wheezing and difficulty breathing. These symptoms require prompt medical attention.

Can you get enterovirus D68 more than once?

Yes. EV-D68 is like the cold or flu. You can get the virus anytime you’re around someone who has it. However, your immune system gets better at fighting off the virus with each exposure. That’s why adults tend to have mild or nonexistent symptoms when they get EV-D68.

Diagnosis and Tests

How is enterovirus D68 diagnosed?

Your healthcare provider may suspect EV-D68 based on symptoms and reports of outbreaks in the area. A blood test can confirm the presence of an enterovirus.

It takes highly specialized lab tests to pinpoint the EV-D68 virus in a person’s nasal secretions or blood. Your provider may need to send samples to your state’s health department or the Centers for Disease Control and Prevention (CDC) to definitively diagnose an EV-D68 infection.

Management and Treatment

How is enterovirus D68 managed or treated?

Mild symptoms of EV-D68 infection typically improve in a week or two with minimal at-home care. Antiviral medications aren’t effective against this virus.

You can take these steps to ease symptoms:

What are the complications of enterovirus D68?

People who have breathing difficulties or develop problems like pneumonia need hospitalization. During the 2014 outbreak, 14 people died, and more than 130 children developed acute flaccid myelitis (AFM). There was also a jump in the number of children developing AFM after the EV-D68 outbreaks in 2016 and 2018.

Experts believe the virus may settle in spinal fluid, leading to AFM. Signs of AFM appear suddenly and are similar to that of a stroke:

  • Arm or leg weakness.
  • Slurred speech.
  • Facial drooping.

AFM typically develops a few weeks after a child recovers from a respiratory infection. Seek immediate medical attention if AFM symptoms appear.


How can I prevent enterovirus D68?

You can slow or stop the spread of EV-D68 infection by practicing good hygiene, including:

  • Sneeze or cough into the crook of the elbow.
  • Disinfect high-touch surfaces like toys, countertops and doorknobs.
  • Don’t share eating utensils, cups, towels or clothing.
  • Separate ill children from healthy family members and classmates, when possible.
  • Wash hands often with soap and water for at least 20 seconds.

Outlook / Prognosis

What is the prognosis (outlook) for people who have enterovirus D68?

Most people who get EV-D68 don’t know they have the virus. They may have a mild cold-like illness — if they have any symptoms at all. People who need hospitalization for severe breathing problems often recover.

The most severe health complication is AFM. Over time, children with AFM may regain some degree of strength and function. Physical and occupational therapies can help. For a small number of children, the paralysis is permanent.

Living With

When should I call the doctor?

You should call your healthcare provider if you experience:

What questions should I ask my doctor?

You may want to ask your healthcare provider:

  • What is the best way to treat my symptoms?
  • How can I prevent spreading the infection to others?
  • Am I at risk for other problems?
  • Should I look out for signs of complications?

A note from Cleveland Clinic

EV-D68 isn’t a common enterovirus, but outbreaks do happen. Most people don’t experience serious problems and may never know they have the virus. Children and adults with respiratory or immunity problems are more likely to need hospitalization. EV-D68 may lead to a rare problem called acute flaccid myelitis (AFM) that causes lifelong muscle weakness. You can take steps to lower the spread of EV-D68 and other viral infections among family members and others.

Medically Reviewed

Last reviewed on 05/10/2021.

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