EV‑D68 is back on people’s radar. It’s a respiratory virus that most often looks like a regular cold, but it can sometimes cause worse breathing problems in children and, rarely, a serious neurological condition called acute flaccid myelitis (AFM). Over the last couple of years, multiple kinds of surveillance — clinical testing, pediatric hospital networks, genomic labs, and wastewater monitoring, have shown more EV‑D68 activity in parts of the United States than many communities have seen recently.

This guide explains, in plain language, what the data are showing, how the virus usually behaves, who’s at higher risk, what symptoms to watch for, how doctors test and treat patients, and practical steps families and communities can take to reduce risk.

Why we’re seeing more EV‑D68 now

Before COVID‑19, EV‑D68 tended to show up every late summer or early fall, often following a roughly biennial pattern. When the pandemic changed how we live with less face-to-face interactions, more masks, fewer school exposures – lots of people missed routine contact with common viruses. That left bigger groups of children with less immunity than usual. As COVID‑era restrictions relaxed, EV‑D68 returned in less predictable ways, and surveillance in 2024–2025 documented wider and sometimes patchy circulation across different areas of the country.

Two important points:

• Routine lab tests often report a generic “enterovirus/rhinovirus” positive result; only a subset of samples are typed to confirm EV‑D68, so official counts are indicators, not a complete tally.
• Wastewater surveillance can detect rising EV‑D68 signals in a community before many people go to the doctor, giving an early heads‑up to local health officials and hospitals.

How we know it’s rising: the sources of data

Here are the main tools public health uses to track EV‑D68 and what each tells us:

• National typing data (NESS): When labs submit typed enterovirus results, NESS shows what types are being found across the U.S. In 2024, EV‑D68 made up a large share of typed enterovirus specimens submitted to that system.
• Sentinel pediatric surveillance (NVSN and hospital networks): These systems test children with serious respiratory illness and give a clearer picture of how many kids are getting sick enough to go to the hospital.
• Genomic sequencing studies: Academic and public health labs sequence EV‑D68 to see which subclades are spreading and whether any genetic changes might affect behavior or severity.
• Wastewater monitoring: Municipal and academic wastewater programs detect viral RNA shed into sewage. Elevated EV‑D68 signals in wastewater have shown up in some regions and often line up with later clinical increases.

No single source gives the full picture, but when these streams line up — more enterovirus/rhinovirus tests, typed EV‑D68 positives, matching wastewater signals, and hospital admissions – it’s a strong sign that community circulation is up.

What EV‑D68 typically looks like (symptoms)

Most people who catch EV‑D68 have a mild illness similar to a cold. Typical symptoms include:

• Runny or stuffy nose, sore throat, cough.
• Low‑grade fever, fatigue, decreased appetite.
• Sometimes stomach upset, though that’s less common.

More severe respiratory illness can develop, especially in children with asthma or reactive airways disease:

• Wheezing, chest tightness, fast breathing, severe cough.
• This can lead to hospital treatment for oxygen or breathing support.

Very rarely, EV‑D68 has been associated with AFM, which shows up as sudden weakness in one or more limbs and requires emergency evaluation.

If someone has sudden limb weakness, severe trouble breathing, or signs of a severe neurologic problem (confusion, neck stiffness, inability to move body parts), they need urgent medical care and public health notification.

Who’s most at risk

• Young children: they make up most of the symptomatic cases and hospital visits during EV‑D68 surges.
• Children with asthma or chronic lung disease: they’re more likely to develop severe breathing problems and require hospital care.
• People with weakened immune systems: can have more severe or prolonged illness.

For caregivers: make sure children with asthma have a current action plan and quick access to rescue inhalers; that step alone prevents many emergency visits.

Testing and diagnosis — what doctors do

What gets tested

• If a doctor suspects a viral respiratory infection, they’ll usually collect a nasal or nasopharyngeal swab. Most rapid or multiplex tests will tell you whether enterovirus/rhinovirus RNA is present, but they won’t name the specific enterovirus type (like EV‑D68) unless the sample gets sent for typing.

When typing is done

• Public health or reference labs will perform typing and sequencing when it matters for public health tracking or when patients are severely ill or have neurologic symptoms.

If neurologic signs appear

• For suspected AFM, an MRI of the spine and cerebrospinal fluid (CSF) testing are standard parts of the workup, along with early neurology consultation and prompt reporting to public health.

Treatment — what to expect

There is no specific antiviral medicine or vaccine for EV‑D68. Care focuses on:

• Supportive care at home for mild illness: fluids, rest, fever control.
• For breathing problems: bronchodilators, oxygen, and in severe cases ventilatory support in the hospital. Children with asthma should follow their asthma action plan and seek care early for increased wheezing or breathing trouble.
• For AFM: early hospital care, neurology involvement, and rehabilitation services are key to recovery efforts; long‑term deficits can occur, but early support helps outcomes.

How to reduce the chance of getting or spreading EV‑D68

Because there’s no vaccine, prevention is about common‑sense steps that cut the spread of respiratory viruses:

Everyday actions to reduce spread

• Wash hands frequently with soap and water or use hand sanitizer.
• Cover your mouth and nose when coughing or sneezing; use your elbow if you don’t have a tissue.
• Stay home while you’re sick and keep kids home from school or daycare when they’re ill.
• Clean frequently touched surfaces, especially in childcare settings.

Extra steps for families with higher risk members

• Keep asthma medications and action plans current; make sure rescue inhalers are easy to find and not expired.
• Avoid close contact between sick children and infants or people with weakened immune systems.
• Consider supporting influenza and COVID‑19 vaccinations to reduce overall respiratory illness and hospital strain during respiratory seasons.

Community steps

• Schools and daycares: screen for sick children, enforce exclusion policies when kids have fever or significant respiratory symptoms, and promote hand hygiene.
• Health systems and public health: use wastewater data, typed surveillance, and hospital burden indicators to time messaging and prepare hospital capacity when signals rise.

When to see a doctor

Go to urgent care or the emergency room if:

• A child is breathing fast, can’t talk normally because of breathlessness, has blue lips or face, or is very sleepy or hard to wake.
• Anyone develops sudden weakness in an arm or leg, slurred speech, difficulty swallowing, or severe headache with neck stiffness.
• You can’t keep fluids down and signs of dehydration appear in an infant.

For moderate symptoms, call your pediatrician to get advice about when to come in and whether testing or emergency treatment is needed.

What public health is doing and what’s next

Right now public health agencies are focusing on:

• Improving lab typing and sequencing for severe or clustered cases so they can track which EV‑D68 lineages are spreading.
• Using sentinel pediatric surveillance and hospital data to measure how many children need care and where capacity might be stressed.
• Pairing clinical surveillance with wastewater signals to detect community increases earlier and tailor local guidance and messaging.

Researchers are watching viral genetics to see if particular subclades behave differently and studying how often AFM occurs following EV‑D68 waves so we can better estimate risks and guide prevention in the future.

Quick checklist: what parents, clinicians, and communities should do now

Parents

• Keep sick kids home and call your pediatrician if symptoms worsen or breathing problems start.
• Keep asthma plans and medications current and accessible.
• Practice hand hygiene and teach kids to cover coughs.

Clinicians

• Consider enterovirus testing for severe pediatric respiratory illness and request typing for severe or neurologic cases.
• Report suspected AFM immediately to public health and coordinate specimen submission for typing/sequencing.

Communities and schools

• Reinforce exclusion policies, hand hygiene, and cleaning during periods when EV‑D68 signals rise in local clinical or wastewater surveillance.
• Share clear guidance with families about when to keep children home and when to seek urgent care.

While for most people EV‑D68 behaves like a routine respiratory virus; the real focus should be on protecting young children and people with asthma, watching for worrying signs (severe breathing trouble or sudden limb weakness), and leaning on practical steps like hand hygiene, staying home when sick, up‑to‑date asthma plans, and local public health guidance to reduce risk and strain on hospitals.

Sources & Further Reading (9)

1. National Enterovirus Surveillance System (NESS)  
2. CDC Non‑polio Enterovirus and Parechovirus resources 
3. CDC Acute Flaccid Myelitis (AFM) surveillance and guidance 
4. National Wastewater Surveillance System (NWSS) 
5. New Vaccine Surveillance Network (NVSN)  
6. California Department of Public Health 
7. Peer‑reviewed genomic surveillance study, Journal of Clinical Microbiology 
8. SFGATE local wastewater reporting and coverage – rising virus levels 
9. World Health Organization (WHO) guidance on enterovirus surveillance