Abstract
Despite the recent emergence of enterovirus D68 (EV-D68), its clinical impact on adult population is less well defined. To better define the epidemiology of EV-D68, 6,800 nasopharyngeal aspirates (NPAs) from 2010–2014 were subject to EV-D68 detection by RT-PCR and sequencing of 5′UTR and partial VP1. EV-D68 was detected in 30 (0.44%) NPAs from 22 children and 8 adults/elderlies. Sixteen patients (including five elderly) (53%) had pneumonia and 13 (43%) patients were complicated by small airway disease exacerbation. Phylogenetic analysis of VP1, 2C and 3D regions showed four distinct lineages of EV-D68, clade A1, A2, B1 and B3, with adults/elderlies exclusively infected by clade A2. The potentially new clade, B3, has emerged in 2014, while strains closely related to recently emerged B1 strains in the United States were also detected as early as 2011 in Hong Kong. The four lineages possessed distinct aa sequence patterns in BC and DE loops. Amino acid residues 97 and 140, within BC and DE-surface loops of VP1 respectively, were under potential positive selection. EV-D68 infections in Hong Kong usually peak in spring/summer, though with a delayed autumn/winter peak in 2011. This report suggests that EV-D68 may cause severe respiratory illness in adults/elderlies with underlying co-morbidities.
Highlights
IntroductionIn contrast to other EVs which often cause systemic diseases such as HFMD, enterovirus D68 (EV-D68) is mainly associated with respiratory tract infections
enterovirus D68 (EV-D68), a member of the species EV-D, has recently emerged in various countries
The peak season of EV-D68 usually occurred in late-spring/summer (May to August), except in 2011 when more cases were detected in late-autumn/early-winter (October to December)
Summary
In contrast to other EVs which often cause systemic diseases such as HFMD, EV-D68 is mainly associated with respiratory tract infections. EV-D68 mainly affects infants, children and adolescents, while infections in adults were less commonly reported. Increasing reports of EV-D68 infections have recently been noted in various countries from Africa, America, Asia and Europe[27,28,29,31,35,36,37]. A fatal case of EV-D68 was recently reported in a 10-year-old boy who presented with respiratory symptoms and complicated by encephalitis To better define the disease impact and clinical spectrum of EV-D68, we examined the clinical and molecular epidemiology of EV-D68 among hospitalized patients with suspected respiratory virus infections in Hong Kong. The partial VP1, 2C and 3D genes of EV-D68 strains were sequenced to study the genetic diversity and evolutionary dynamics
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