Letter to the editor: Need for a European network for enterovirus D68 surveillance after detections of EV-D68 of the new B3 lineage in Sweden and Italy, 2016

Detection by Direct Next Generation Sequencing Analysis of Emerging Enterovirus D68 and C109 Strains in an Environmental Sample From Scotland

“…Ten patients had severe respiratory or neurological symptoms and one died. This outbreak coincided in time with an upsurge of isolations of related strains between June and September 2016 reported in other European countries and the United States, which correlated with an increase in EV-related severe infections ( Pariani et al, 2017 ; Wang et al, 2017 ). Two recent meta-analysis studies published independently concluded that, while more research is needed on some aspects such as a dose–response relationship, application of the Bradford Hill criteria, a set of nine principles applied to examine causality, supported a causal relationship between EV-D68 and AFM ( Dyda et al, 2018 ; Messacar et al, 2018 ).…”

“…It is also important to consider that sewage might not only represent human urine and feces secretions but also wastewater from showering and other sources containing representatives of the human microbiome and virome. The EV-D68 sewage strain from Scotland clustered within genetic subclade B3 and preceded in time a large number of reported 2016 clinical isolates from Europe and the United States that were genetically related ( Pariani et al, 2017 ; Wang et al, 2017 ), which demonstrates the value of ES for the early detection of EV strains potentially causing outbreaks. The EV-C109 sewage strain from Scotland was genetically very close to EV-C109 strains found in the same year in clinical samples from Denmark and Netherlands which further demonstrates the widespread circulation of this serotype in Europe.…”

Enterovirus D68–Associated Acute Flaccid Myelitis in Immunocompromised Woman, Italy

“…Recent findings in a mouse model provide evidence of a specific tropism of EV-D68 for spinal cord motor neurons, suggesting that direct viral injury, rather than a postinfection immune-mediated process, is the most likely mechanism of neuronal cell loss and paralysis ( 13 ). The phylogenetic analysis indicates that the strain detected in the patient described here, like one recently detected in a child with neurologic illness ( 14 ), is genetically linked to those involved in the recent outbreak in the Netherlands ( 4 ). …”

Management strategies of enterovirus D68 outbreaks: current perspectives

“…3,11 In the following year, 2015, few or no EV-D68 cases were reported, after which an upsurge of cases re-occurred in 2016, both in Europe and in the USA. 12,13 During the summer of 2016, an increase in cases was reported in the Netherlands, the majority of which affected children younger than 5 years old. 14 In Sweden, 74 EV-D68 confirmed cases, among which there was one fatal case and another 10 presenting with severe respiratory or neurological symptoms, were reported during August-September 2016.…”