Alert for Providers: Memo on Enterovirus D68

September 19, 2014

UPDATE: Click here for an updated version of the provider memo from NC DPH regarding enterovirus-D68 (EV-D68).  This version replaces the version dated 9/9/2014.


Please click here for information for North Carolina health care providers regarding enterovirus D68 (EV-D68).  With the start of the school year and the approach of fall, we do expect to see increases in visits to health care providers for a wide variety of respiratory illnesses, including influenza. Providers should be aware of EV-D68 as one of many causes of respiratory illness.

  • Contact your local health department (#250-5109 for Buncombe County) to report clusters of severe or unusual respiratory illness or if you have any questions about EV-D68.
  • Contact and Droplet isolation precautions are recommended for patients in whom infection with EV-D68 or another respiratory virus is suspected.
  • Use of antimicrobial soap and water is preferred for hand hygiene, as alcohol-based hand rubs have limited activity against EV-D68 and other enteroviruses.

To date, EV-D68 has not been confirmed in North Carolina.  The NC Communicable Disease Branch is aware that providers in our area have been seeing unusual cases of severe respiratory illness in children, and they have been reviewing the cases of children who have been hospitalized at Mission Hospital.
Facilities or providers interested in the specific detection of EV-D68 can submit specimens to the NC State Laboratory of Public Health (NCSLPH) for submission to the CDC.

  • Testing prioritization will be based on severity of illness.
  • Specimens should be collected within 1 week of illness onset, preferably within 48 hours post-onset
  • Providers should contact their local health department or the Communicable Disease Branch epidemiologist on-call (919-733-3419) prior to submitting specimens.
  • Acceptable specimen types include nasopharyngeal (NP) or oropharyngeal (OP) swabs in viral transport media (> 1ml) or an NP/OP wash or aspirate (> 1ml).
  • Specimens should be shipped on cold packs or dry ice.
  • All specimen submissions must be accompanied by a completed CDC 50.34 DASH form (, a NCSLPH virology form ( and a descriptive case history for prioritization.

Again, if you have any questions about this or any other public health matter, please contact the Buncombe County Disease Control staff at 250-5109 (available 24/7).