Abstract
Infection with enterovirus D68 (EV-D68) has been linked with severe neurological disease such as acute flaccid myelitis (AFM) in recent years. However, active surveillance for EV-D68 is lacking, which makes full assessment of this association difficult. Although a high number of EV-D68 infections were expected in 2020 based on the EV-D68′s known biannual circulation patterns, no apparent increase in EV-D68 detections or AFM cases was observed during 2020. We describe an upsurge of EV-D68 detections in wastewater samples from the United Kingdom between July and November 2021 mirroring the recently reported rise in EV-D68 detections in clinical samples from various European countries. We provide the first publicly available 2021 EV-D68 sequences showing co-circulation of EV-D68 strains from genetic clade D and sub-clade B3 as in previous years. Our results show the value of environmental surveillance (ES) for the early detection of circulating and clinically relevant human viruses. The use of a next-generation sequencing (NGS) approach helped us to estimate the prevalence of EV-D68 viruses among EV strains from other EV serotypes and to detect EV-D68 minor variants. The utility of ES at reducing gaps in virus surveillance for EV-D68 and the possible impact of nonpharmaceutical interventions introduced to control the COVID-19 pandemic on EV-D68 transmission dynamics are discussed.
Highlights
Publisher’s Note: MDPI stays neutralInfection with enterovirus D68 has been associated with severe respiratory disease in humans in recent years, with increasing evidence of its link with neurological complications causing acute flaccid myelitis (AFM), a polio-like syndrome resulting in long-term or permanent disability in some infected individuals [1,2,3].EV-D68 was first identified in 1962 but was rarely reported until 2008 when small outbreaks started to emerge in what appears to be mostly a biannual distribution [4,5]
We show the importance of environmental surveillance (ES) for the timely detection of human enteroviruses of clinical relevance and the identification of different EV-D68 genetic variants, as we have shown for SARS-CoV-2 variants of concern throughout the COVID-19 pandemic [20,21,22]
Wastewater samples were processed and analysed as described in Materials and Methods. Modified Pan-EV Entire-Capsid Coding Region RT-PCR Amplification (mECRA) and VP1-nested PCR reactions were conducted using RNA extracted from wastewater concentrates followed by Sanger sequencing analysis of positive VP1 PCR
Summary
Publisher’s Note: MDPI stays neutralInfection with enterovirus D68 has been associated with severe respiratory disease in humans in recent years, with increasing evidence of its link with neurological complications causing acute flaccid myelitis (AFM), a polio-like syndrome resulting in long-term or permanent disability in some infected individuals [1,2,3].EV-D68 was first identified in 1962 but was rarely reported until 2008 when small outbreaks started to emerge in what appears to be mostly a biannual distribution [4,5]. The first known large outbreak of severe respiratory illness associated with EV-D68 infection occurred in the USA between August and December 2014 [6]. Related EVD68 strains were found during the same period in Canada, Europe, and Asia, with more than 2000 cases reported in 20 countries [4]. These outbreaks were temporally and geographically associated with an increase in AFM cases, in the USA, and a similar association was observed in Europe, Argentina, and the USA in 2016 and 2018 [1,7]. EV-D68 circulation in Europe has largely with regard to jurisdictional claims in published maps and institutional affiliations
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