Enterovirus D68 detection in respiratory specimens: Association with severe disease

Abstract

Molecular techniques increased the number of documented respiratory infections. In a substantial number of cases the causative agent remains undetected. Since August 2014, an increase in Enterovirus(EV)-D68 infections was reported. We aimed to investigate epidemiology and clinical relevance of EV-D68. From June to December 2014 and from September to December 2015, 803 and 847 respiratory specimens, respectively, were tested for respiratory viruses with a multiplex RT-PCR. This multiplex RT-PCR does not detect EV-D68. Therefore, 457 (2014) and 343 (2015) specimens with negative results were submitted to an EV-specific-RT-PCR. EV-positive specimens were tested with an EV-D68-specific-RT-PCR and genotyped. Eleven specimens of 2014 tested positive in the EV-specific-RT-PCR and of these seven were positive in the EV-D68-specific-RT-PCR. Typing confirmed these as EV-D68. Median age of EV-D68-positive patients was 3 years (1 month-91 years). Common symptoms included fever (n = 6, 86%), respiratory distress (n = 5, 71%), and cough (n = 4, 57%). All EV-D68-positive patients were admitted to hospital, 4 (57%) were admitted to intensive care units and 6 (86%) received oxygen. One patient suffered from acute flaccid paralysis. Seven specimens of 2015 were positive in the EV-specific-RT-PCR but negative in the EV-D68-specific-RT-PCR. In conclusion, use of an EV-specific-RT-PCR allowed us to detect EV-D68 circulation in autumn 2014 that was not detected by the multiplex RT-PCR and was associated with severe disease.

A Novel Neutralizing Antibody Specific to the DE Loop of VP1 Can Inhibit EV-D68 Infection in Mice

“…E nterovirus D68 (EV-D68) is a major causative agent of mild to severe upper and lower respiratory illnesses and is prevalent in North America, Europe, and Asia in recent years (1)(2)(3). Patients infected with EV-D68 exhibit fever, sneezing, rhinorrhea, cough, sore throat, pneumonia, asthma exacerbation, and acute flaccid myelitis, with the possibility of death (2,(4)(5)(6)(7). No prophylactic vaccine or therapeutic drug against EV-D68 infection is yet available.…”

Respiratory illness and acute flaccid myelitis in the Tokai district in 2018

“…compared the clinical features of severe respiratory illnesses caused by rhinovirus and EV‐D68 and found that children aged 5–11 years were more commonly infected with EV‐D68, perhaps explaining the correlation between AFM and respiratory illness in children aged 7–12 years in the present study – if indeed EV‐D68 was the major cause of respiratory illness. Several studies have also shown that EV‐D68 triggers severe respiratory illness in adolescents and young adults . Respiratory illness requiring ICU admission is uncommon in adolescents.…”

“…Several studies have also shown that EV-D68 triggers severe respiratory illness in adolescents and young adults. [2][3][4][5] Respiratory illness requiring ICU admission is uncommon in adolescents. The effect of EV-D68 infection on adolescent ICU admission may therefore be strong even if the number of such patients is not great.…”

“…EV-D68 causes a severe respiratory illness that sometimes requires admission to the intensive care unit (ICU) and artificial ventilation in both children and adults. [2][3][4] Previous studies have shown that the peak incidences of AFM and severe respiratory illness coincide. 5 In Japan, an EV-D68 outbreak occurred in the autumn of 2015 in association with a cluster of AFM cases 6 and an increased level of severe respiratory illness.…”

“…Enterovirus D68 (EV‐D68) seems to be the principal cause of acute flaccid myelitis (AFM) since the 2014 outbreak in the USA; however, a causal relationship has yet to be firmly established. EV‐D68 causes a severe respiratory illness that sometimes requires admission to the intensive care unit (ICU) and artificial ventilation in both children and adults . Previous studies have shown that the peak incidences of AFM and severe respiratory illness coincide .…”