Lack of hygiene etiquette, such as coughing and sneezing without covering one’s nose and mouth or washing hands inappropriately, is the most important risk factor for the development of acute EV-D68 infection. Extremes of age, pulmonary comorbidities such as asthma and cystic fibrosis, and other systemic comorbidities are considered significant risk factors for developing worse clinical disease among patients with EV-D68.

Since EV-D68 may be transmitted via aerosol or direct contact, proper hygiene and etiquette via regular hand washes for at least 20 seconds and covering the nose and mouth during coughing and sneezing are highly recommended lifestyle practices to prevent transmission of EV-D68.

• All patient populations are susceptible to EV-D68 infection. However, extremes of age is considered an important risk factor for worse clinical disease.
• Younger children, who lack previous immunity against the virus, and elderly patients, who have a decreased immune response, are more likely to develop worse disease manifestations ^[1]
• Immunocompromised patients have an increased risk of developing disease manifestations when exposed to EV-D68.

Patients with pulmonary comorbidities are susceptible to severe lower respiratory tract disease when infected with EV-D68. Presence of pulmonary co-morbidities is associated with more admissions to the intensive care unit, need for mechanical ventilation, and death due to the infection. The most common pulmonary co-morbidities desribed in the literature include the following^[2]:

• Asthma
• Cystic fibrosis
• Chronic pulmonary disease requiring home oxygen supplementation
• Lung transplantation

Advanced systemic diseases not related to the respiratory system, such as hepatic cirrhosis, are also considered a risk factor for worse outcome in EV-D68 infections.