Laboratory Testing for Non-Polio Enterovirus

Key points

  • ÐÇ¿ÕÓéÀÖ¹ÙÍø laboratories routinely conduct testing for non-polio enteroviruses and parechoviruses.
  • ÐÇ¿ÕÓéÀÖ¹ÙÍø and some health departments test with molecular sequencing methods, or a real-time reverse transcription polymerase chain reaction (rRT-PCR) lab test.
  • Submissions to ÐÇ¿ÕÓéÀÖ¹ÙÍø for diagnostic testing require pre-approval.
Surface view of EV-D68 looking down an icosahedrtal 2-fold axis.

Overview

Clinicians consider EV-D68 as a possible cause of acute, serious respiratory illness. If not already part of a typical diagnostic routine, lab tests should be done when the cause of respiratory infection in seriously ill patients is unclear.

Services and outreach

ÐÇ¿ÕÓéÀÖ¹ÙÍø laboratories routinely conduct testing for non-polio enteroviruses and parechoviruses, such as:

  • Qualitative molecular testing; pan-enterovirus and pan-parechovirus.
  • Molecular testing, followed by sequencing to identify enterovirus and parechovirus types (formerly serotypes).
  • Testing for less common picornaviruses (excluding Hepatitis A).

The ÐÇ¿ÕÓéÀÖ¹ÙÍø helps state laboratories with testing by:

  • Sharing new diagnostic technologies and providing training on how to perform these techniques.
  • Helping them identify enteroviruses and par echoviruses they have been unable to test.
  • Guiding how to properly collect and ship clinical specimens to the ÐÇ¿ÕÓéÀÖ¹ÙÍø for confirming and typing picornaviruses.

Contact ÐÇ¿ÕÓéÀÖ¹ÙÍø ‎

Health departments may contact the ÐÇ¿ÕÓéÀÖ¹ÙÍø for further enterovirus typing or other lab testing procedures.
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Types of tests

Infection with non-polio enteroviruses or parechoviruses can be confirmed by:

  • Polymerase chain reaction (PCR) assays and sequencing.
  • Isolating the virus in cell culture, followed by PCR assays for virus identification.

Specimen collection overview

Non-polio enteroviruses and parechoviruses can be detected in stool or rectal swabs and respiratory specimens (including from the throat).

Depending on the symptoms, other specimen types such as cerebrospinal fluid, blister fluid, and blood can be collected for testing.

Keep Reading: Collecting Specimens for Non-Polio Enterovirus Testing

Submitting specimens

For EV-D68 testing, contact health department first‎

Please contact your health department for enterovirus diagnostic testing and molecular typing before sending specimens. Some state laboratories may have EV-D68 RT-PCR or EV molecular typing capacity. Others may suggest submission to ÐÇ¿ÕÓéÀÖ¹ÙÍø.
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  1. Before submitting to ÐÇ¿ÕÓéÀÖ¹ÙÍø: Request pre-approval for all submission to ÐÇ¿ÕÓéÀÖ¹ÙÍø for diagnostic testing. This is because specimen submission requirements for CLIA diagnostic testing are currently being updated.
    1. Please contact [email protected] for testing non-AFM specimens.
    2. Please contact [email protected] before submitting any AFM specimens.
  2. Preferred specimens: Submit nasopharyngeal and oropharyngeal swabs, or any other type of upper respiratory specimens.
  3. Specimen submission form: Complete ÐÇ¿ÕÓéÀÖ¹ÙÍø specimen submission form (ÐÇ¿ÕÓéÀÖ¹ÙÍø Form 50.34).
  4. Shipping and handling: Follow collection, storage, and shipment guidelines.

Interpreting results

A positive laboratory test for non-polio enteroviruses and parechoviruses from certain specimens, such as rectal or respiratory swab, does not necessarily mean the virus is the cause of infection. Non-polio enteroviruses and parechoviruses can be shed for several weeks after the symptoms have resolved.

Reporting results

Report suspected clusters of unexplained severe acute respiratory illness to local and state health departments. EV-D68 is not nationally notifiable, but state and local health departments may have additional guidance on molecular typing and reporting.

Resources

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Content Source:
National Center for Immunization and Respiratory Diseases; Division of Viral Diseases
  • . In Red Book: 2018 Report of the Committee on Infectious Diseases. 31st ed. Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Elk Grove Village, IL: American Academy of Pediatrics; 2018.