Duration of Enterovirus D68 RNA Shedding in the Upper Respiratory Tract and Transmission among Household Contacts, Colorado, USA

Emerg Infect Dis. 2023 Nov;29(11):2315-2324. doi: 10.3201/eid2911.230947.


Enterovirus D68 (EV-D68) causes cyclical outbreaks of respiratory disease and acute flaccid myelitis. EV-D68 is primarily transmitted through the respiratory route, but the duration of shedding in the respiratory tract is unknown. We prospectively enrolled 9 hospitalized children with EV-D68 respiratory infection and 16 household contacts to determine EV-D68 RNA shedding dynamics in the upper respiratory tract through serial midturbinate specimen collections and daily symptom diaries. Five (31.3%) household contacts, including 3 adults, were EV-D68-positive. The median duration of EV-D68 RNA shedding in the upper respiratory tract was 12 (range 7-15) days from symptom onset. The most common symptoms were nasal congestion (100%), cough (92.9%), difficulty breathing (78.6%), and wheezing (57.1%). The median illness duration was 20 (range 11-24) days. Understanding the duration of RNA shedding can inform the expected rate and timing of EV-D68 detection in associated acute flaccid myelitis cases and help guide public health measures.

Keywords: Colorado; EV-D68; Enterovirus D68; USA; acute flaccid myelitis; natural history; respiratory infections; virus shedding; viruses.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adult
  • Child
  • Colorado / epidemiology
  • Disease Outbreaks
  • Enterovirus D, Human* / genetics
  • Enterovirus Infections* / epidemiology
  • Humans
  • RNA
  • Respiratory System
  • Respiratory Tract Infections* / epidemiology


  • RNA

Supplementary concepts

  • acute flaccid myelitis