Government
of Canada
Gouvernement
du Canada
MEMORANDUM
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NOTE DE SERVICE
Security Classification - Classification de sécurité

To
À
All Community Health Nurses
Our File - Notre référence
Health Directors
Your File - Votre référence
From
De
Dr. Christine Kennedy, Regional Community
Medicine Specialist
Valerie Muchenje, Regional Communicable
Disese Manager
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Date
September 17, 2014
Enterovirus D68 (EV-D68)
Media reports in August and September have indicated an increase in detected EV-D68 cases in the United
States, and cases have now been confirmed in British Columbia and Alberta.
EV-D68 is a specific enterovirus that causes respiratory illness ranging from mild to severe. Symptoms can
include a cold-like illness with coughing and wheezing to severe infections requiring admission to a hospital.
Children and teenagers appear to be at increased risk of infection from EV-D68, although the virus can infect
adults as well. Children with asthma seem to have a higher risk for severe respiratory illness.
EV-D68 can be present in respiratory secretions from the nose and throat and can spread from an infected
person when they cough or sneeze. Touching surfaces or objects contaminated with these secretions may
also result in infection if the virus then gets into the body by touching the mouth, nose or eyes.
Infection Control:
Community members should be advised that they can avoid respiratory infections by taking the following
actions:




Washing hands frequently with soap and water or an alcohol-based hand rub, including after touching
commonly touched objects and surfaces, before touching the face, before preparing food and before
eating;
Avoiding touching the face as much as possible;
Staying at least two metres (six feet) away from people who are ill;
Frequently cleaning surfaces and objects that are commonly touched.
Any person with respiratory symptoms should:

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Stay home from work, school and other activities;
Cough and sneeze into their elbow and not their hand;
Wash their hands frequently with soap and water or an alcohol-based hand rub.
People with asthma should ensure that they have their puffers readily available and know how to use them
properly. They should be advised to seek medical attention right away if wheezing does not respond to puffers
or if they have difficulty breathing.
Patients with symptoms of acute respiratory infection, including those with suspected EV-D68, should be
placed on droplet and contact precautions
Testing:
For most viruses, knowing the specific type of virus does not change patient care. Laboratory testing
(nasopharyngeal swab, throat swab) should be considered for patients with severe respiratory illness,
especially children, among whom symptomatic enterovirus infections, including EV-D68, are more common.
Testing can also be considered if clusters of severe respiratory illness are identified. Testing patients with mild
illness is of limited clinical utility.
Provincial testing recommendations will likely change once the epidemiology and prevalence of EV-D68 is
more clearly documented in Ontario.
Additional information regarding EV-D68 can be found on the Public Health Ontario website at:
http://www.publichealthontario.ca/EV-D68
Hand Hygiene
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As seasonal flu and cold season approaches and we anticipate an increase in respiratory illnesses at this time
of year, the importance of health care provider hand hygiene can’t be emphasized enough. Weekly hand
hygiene e-mails are being sent to CHNs as a friendly reminder of the importance of this infection control
practice and to keep it in the front of everyone’s minds. Please remember the Four Moments of Hand Hygiene
and the importance of point of care hand hygiene practices.
Information on best practices for hand hygiene in health care settings can be found at:
http://www.publichealthontario.ca/en/eRepository/2010-12%20BP%20Hand%20Hygiene.pdf
Ebola
There has been significant media coverage lately regarding the spread of this virus in West Africa. There has
never been a case in Canada, and the risk to Canada from ebola is very low. There have been actions taken
by the province of Ontario to ensure preparedness for ebola within the health care system, including general
education sessions which have been recorded. These recorded sessions, as well as general information on
ebola can be found at:
www.publichealthontario.ca/ebola
If you have any questions regarding the above information, please contact your communicable disease nurse.
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