Upsurge of Enterovirus D68, the Netherlands, 2016

Abstract

In June and July 2016, we identified 8 adults and 17 children with respiratory enterovirus D68 infections. Thirteen children required intensive care unit admission because of respiratory insufficiency, and 1 had concomitant acute flaccid myelitis. Phylogenetic analysis showed that all of 20 sequences obtained belong to the recently described clade B3.

First Report of a Fatal Case Associated with EV-D68 Infection in Hong Kong and Emergence of an Interclade Recombinant in China Revealed by Genome Analysis

“…In this study, one subclade D1 strain was detected in the elderly (case 4) with pneumonia, which is in line with our previous study showing that adults/the elderly in Hong Kong were exclusively infected by subclade D1 (“A2”) [14]. Although subclade D1 strains have been circulating globally [22,36,41], the clinical characteristics of patients infected by these strains were not reported in other studies. Further epidemiological investigations on subclade D1 strains are needed to determine if this lineage also has a predilection for infecting adults/the elderly in other countries or continents.…”

Outbreak of enterovirus D68 of the new B3 lineage in Stockholm, Sweden, August to September 2016

“…There are indications that EV-D68 may be resurging in 2016 [11,12], but due to lack of systematic surveillance the true disease burden is unclear [7,11]. Here we report a recent large outbreak of EV-D68 infections in Stockholm, Sweden.…”

“…Available data indicate that the B3 lineage arose recently in the evolution of EV-D68 and is actively spreading in parts of Europe [12] and the US during the 2016 season (unpublished GenBank sequences). It is unclear if the apparent epidemiological success of this lineage in 2016 is due antigenic drift or if the risk of severe disease differs from other EV-D68s, such as the B1 lineage that caused the worldwide outbreak in 2014.…”

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

“…The extent of EV-D68 circulation is underestimated because of the scarcity of laboratories equipped to detect it and poor awareness among physicians. However, in the past decade, EV-D68 has emerged as a major respiratory pathogen, especially in children ( 1 , 4 ). Moreover, concurrent with the unprecedented respiratory outbreak of EV-D68 in North America in 2014, an apparent increased incidence of acute flaccid myelitis (AFM), consistent with poliolike illness, has been reported in several US states ( 5 ).…”

“…These neurologic cases have been temporally associated with EV-D68 infection, although virus sequences were detected almost exclusively in respiratory specimens. Concurrently, EV-D68 was circulating in Europe, where the disease burden was more moderate than in the United States ( 4 ). Indeed, EV-D68 has been only rarely detected in the cerebrospinal fluid (CSF) of children with neurologic involvement ( 6 , 7 ).…”