Surveillance of Enterovirus D68 (EV-D68)

Advisory Alert

September 20, 2016

*Cette information est seulement disponible en anglais.

Dear Colleagues:

In the fall of 2014, an increase of Enterovirus D68 (EV-D68) infections was reported in North America, with some patients presenting with severe respiratory symptoms. Rare cases of acute flaccid paralysis (AFP) were also reported that may have been related to EV-D68 infection. At that time, enhanced laboratory testing and surveillance was initiated to further understand the potential for severe outcomes.

Over the past month, other provinces have informed Ontario of a small number of EV-D68 positive laboratory findings in children, including a small number with neurologic manifestations. Currently, there is emerging evidence in Ontario of pediatric EV-D68 cases; thus, heightened surveillance to monitor the transmission and potential severity of infection associated with EV-D68 is essential.

Ontario health care providers are being asked to consider laboratory testing during the late summer and early fall season for patients with severe respiratory illness, especially, children, and when clusters of severe respiratory illness are identified. Testing patients with mild illness, or outside of the late summer/early fall season is of limited clinical utility.

Health care providers are also asked to notify the Sudbury & District Health Unit should a patient with EV-D68 present with AFP, or unusual or severe clinical manifestations requiring hospitalization. Note that AFP in children under 15 years of age is a reportable condition in Ontario.

Health care providers ordering EV-D68 testing are asked to complete a Clinical Summary Form available at along with General test Requisition Form These can be found on the Public Health Ontario (PHO) website.

In addition, PHO has updated their EV-D68 webpage with general information on the virus and how to contact the laboratories when submitting specimens for EV-D68 testing.

Should you have any additional questions or require specific information regarding reporting EV-D68 or AFP in one of your patients, please contact the communicable disease program as per below.

For all reporting, inquiries or comments, please contact the Sudbury & District Health Unit at 705.522.9200, ext. 301.


P. Sutcliffe, MD, MHSc, FRCPC
Medical Officer of Health



This item was last modified on September 20, 2016