Epidemiological and clinical characteristics of patients infected with enterovirus D68, France, July to December 2014

Abstract

In 2014, the United States (US) experienced a nationwide outbreak of enterovirus D68 (EV-D68) infection with 1,152 cases reported mainly in hospitalised children with severe asthma or bronchiolitis. Following the US alert, 11 laboratories of the French enterovirus (EV) surveillance network participated in an EV-D68 survey. A total of 6,229 respiratory samples, collected from 1 July to 31 December 2014, were screened for EV-D68 resulting in 212 EV-D68-positive samples. These 212 samples corresponded to 200 EV-D68 cases. The overall EV-D68 positivity rates among respiratory samples were of 5% (184/3,645) and 1.1% (28/2,584) in hospitalised children and adults respectively. The maximum weekly EV-D68 positivity rates were of 16.1% for children (n = 24/149; week 43) and 2.6% for adults (n = 3/115; week 42). Of 173 children with EV-D68 infection alone, the main symptoms were asthma (n = 83; 48.0%) and bronchiolitis (n = 37; 21.4%). One child developed acute flaccid paralysis (AFP) following EV-D68-associated pneumonia. Although there was no significant increase in severe respiratory tract infections reported to the French public health authorities, 10.7% (19/177) of the EV-D68 infected children and 14.3% (3/21) of the EV-D68 infected adults were hospitalised in intensive care units. Phylogenetic analysis of the viral protein 1 (VP1) sequences of 179 EV-D68 cases, revealed that 117 sequences (65.4%), including that of the case of AFP, belonged to the B2 variant of clade B viruses. Continuous surveillance of EV-D68 infections is warranted and could benefit from existing influenza-like illness and EV surveillance networks.

Upsurge of Enterovirus D68, the Netherlands, 2016

“…During the 2014 outbreak, most EV-D68 sequences belonged to clades B1 and B2, although A1 and A2 were also represented ( 2 , 14 ). Larger epidemiologic and genotyping studies are needed to evaluate whether the distinction within clade B is tenable and whether our clinical findings are typical for subclade B3.…”

Enterovirus D68 Infection Among Children With Medically Attended Acute Respiratory Illness, Cincinnati, Ohio, July–October 2014

“…Although children with asthma were more likely to have medically attended EV-D68 infection and were more often admitted from the ED, hospital outcomes were similar between children with and without preexisting asthma. Some reports have shown a more severe clinical course among hospitalized children with EV-D68 infection who have preexisting asthma [4, 9], whereas others have not observed this difference [8]. It is possible that differences in study design or power could explain differences in findings.…”

“…During the 2014 outbreak, a history of asthma or reactive airway disease was common among children with medically attended EV-D68 infection [8] and in some studies was associated with more severe illness [4, 9]. …”

Enterovirus D68 detection in respiratory specimens: Association with severe disease

“…Phylogenetic analysis of the VP1 region showed that all typeable EV‐D68 specimens belonged to clade B (Fig. ) which was the predominant clade in Europe in 2014 . The VP1 sequences of the studied strains displayed close genetic relationships with the VP1 sequences of strains circulating in the Auvergne region of France in October and November 2014 (LN681334, LN681338), in Denmark in October 2014 (KR108024), and in HongKong (KT762405) in March 2014 (Fig.…”

“…Circulation of EV‐D68 has been reported since 1962 and has been associated with sporadic cases of respiratory disease and small outbreaks . Since August 2014, an increase in infections caused by EV‐D68 has been reported in the USA, Canada, and in Europe …”