Re-emergence of enterovirus D68 in Europe after easing the COVID-19 lockdown, September 2021

Abstract

We report a rapid increase in enterovirus D68 (EV-D68) infections, with 139 cases reported from eight European countries between 31 July and 14 October 2021. This upsurge is in line with the seasonality of EV-D68 and was presumably stimulated by the widespread reopening after COVID-19 lockdown. Most cases were identified in September, but more are to be expected in the coming months. Reinforcement of clinical awareness, diagnostic capacities and surveillance of EV-D68 is urgently needed in Europe.

Detection of Enterovirus D68 in Wastewater Samples from the UK between July and November 2021

“…The observed recent upsurge of EV-D68 detections in wastewater samples in the UK reported here, mirroring that observed in clinical samples in various European countries, including the UK [14], follows a silent period with no EV-D68 detections reported in 2020 in Europe and USA, where a large number of EV-D68 infections and possible association with AFM cases were expected based on clear biannual patterns observed since 2014 [13,14]. The fact that an increase in EV-D68 infections and/or AFM cases did not occur during 2020 as expected has been attributed to the contingency measures introduced to fight the COVID-19 pandemic by reducing human physical interactions and exposure to infectious agents.…”

“…However, other reasons such as limited sampling and laboratory testing for EV-D68 might have also contributed to the observed decrease in EV-D68 detections. A recent upsurge of EV-D68 infections, consistent with the known seasonality of this virus typically peaking between September and November, has been reported in several European countries, including the UK [14]. This sudden rise in EV-D68 detections has been attributed to the widespread relaxation of COVID-19 mitigation measures such as travel restrictions, school closures, use of face masks, and physical distancing, as has also been suggested for similar resurgences of other respiratory viruses.…”

“…As reported for other respiratory and enteric viruses [11,12], the number of EV-D68 detections largely decreased during the COVID-19 pandemic [13,14], which might result from interrupted transmission due to pandemic control measures limiting human physical interactions and increasing body hygiene. However, other reasons such as limited sampling and laboratory testing for EV-D68 might have also contributed to the observed decrease in EV-D68 detections.…”

“…EV-D68 was detected in wastewater samples from London and Glasgow between July and November 2021, before the first clinical cases were reported in the UK in August this year [14,33]. EV-D68 strains belonging to genetic clade D and sub-clade B3 were detected in both locations.…”

Letter to the Editor on the original article: Lower prevalence of congenital cytomegalovirus infection in Portugal: possible impact of COVID-19 lockdown?

“…It is likely that the lockdown measures and behavioral interventions to reduce SARS-CoV-2 transmission in Spain during 2020-2021 also impacted on CMV transmission and cCMV prevalence. In fact, a dramatic decrease in respiratory syncytial virus infections in the 2020 winter season [5] and a re-emergence of enterovirus D68 after easing the lockdown in 2021 [6] have also been reported, both viruses sharing the contact transmission route with CMV. We agree with Fernandez et al [1] that our findings reinforce the role of behavioral risk reduction interventions to prevent cCMV in pregnant women.…”