Enterovirus D68-associated respiratory and neurological illness in Spain, 2014–2018

Rubén González-Sanz,Irene Taravillo,Jordi Reina,Ana Navascués,Antonio Moreno-Docón,Maitane Aranzamendi,María Pilar Romero,Margarita Del Cuerpo,Carmen Pérez-González,Sonia Pérez-Castro,Almudena Otero,María Cabrerizo

doi:10.1080/22221751.2019.1668243

Abstract

ABSTRACT During 2014, enterovirus D68 (EV-D68) outbreaks were described globally, causing severe respiratory diseases in children and, in some cases, subsequent paralysis. In this study, the type characterization of enterovirus (EV) detected in respiratory illnesses and the epidemiology and clinical association of EV-D68 infections in Spain over a five-year period were described. A total of 546 EV-positive samples from hospitalized patients with respiratory infections were included. EV-D68 was the most frequently detected type (46.6%, 191/410 typed EV). Other EV from species A (25.1%), B (27.8%) and C (0.5%) were also identified. EV-D68 infections were more associated with bronchitis while EV-A/B types were more frequent in upper respiratory illness (p < 0.01). EV-D68 was also detected in patients with neurological symptoms (nine meningitis/meningoencephalitis and eight acute flaccid paralysis cases). Phylogenetic analysis of 3′-VP1 region showed most Spanish EV-D68 sequences from 2014 to 2016 belonged to subclades B2/B3, as other American and European strains circulating during the same period. However, those detected in 2017 and 2018 clustered to the emerged subclade D1. In summary, different EV can cause respiratory infections but EV-D68 was the most prevalent, with several strains circulating in Spain at least since 2014. Association between EV-D68 infection and neurological disease was also described.

Highlights

Enteroviruses (EV) are responsible for a wide range of diseases in humans including febrile illness, myocarditis and neurologic illness, such as aseptic meningitis, encephalitis or paralysis [1]
Since 2014, an increasing number of Enterovirus D68 (EV-D68) outbreaks associated with severe respiratory diseases, mainly in children, have been occurring in different countries, first in the United States (US) and Canada, followed by Europe and Asia
Clusters of cases with neurological complications such as myelitis or acute flaccid paralysis were reported in the same geographical areas [9,10,11,12,13,14,15,16,17,18,19,20,21]

Summary

Introduction

Enteroviruses (EV) are responsible for a wide range of diseases in humans including febrile illness, myocarditis and neurologic illness, such as aseptic meningitis, encephalitis or paralysis [1]. EV can be found in the respiratory tract and some types, especially from species C and D cause upper and lower respiratory symptoms [2]. Since the first isolation in 1962 [3], Enterovirus D68 (EV-D68) has been associated almost exclusively with respiratory diseases. It shares similar biological characteristics with rhinoviruses, which are currently classified together with EV in the genus Enterovirus within the Picornaviridae family [4]. EVD68 has acid sensitivity and grows at lower optimal temperatures in some cell lines than other EV [5]. There was a significant increase of cases with neurological complications after the respiratory episode, mainly acute flaccid myelitis [11]

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Methods

Conclusion