Abstract
In 2014, the United States (US) experienced a nationwide outbreak of enterovirus D68 (EV-D68) infection with 1,152 cases reported mainly in hospitalised children with severe asthma or bronchiolitis. Following the US alert, 11 laboratories of the French enterovirus (EV) surveillance network participated in an EV-D68 survey. A total of 6,229 respiratory samples, collected from 1 July to 31 December 2014, were screened for EV-D68 resulting in 212 EV-D68-positive samples. These 212 samples corresponded to 200 EV-D68 cases. The overall EV-D68 positivity rates among respiratory samples were of 5% (184/3,645) and 1.1% (28/2,584) in hospitalised children and adults respectively. The maximum weekly EV-D68 positivity rates were of 16.1% for children (n = 24/149; week 43) and 2.6% for adults (n = 3/115; week 42). Of 173 children with EV-D68 infection alone, the main symptoms were asthma (n = 83; 48.0%) and bronchiolitis (n = 37; 21.4%). One child developed acute flaccid paralysis (AFP) following EV-D68-associated pneumonia. Although there was no significant increase in severe respiratory tract infections reported to the French public health authorities, 10.7% (19/177) of the EV-D68 infected children and 14.3% (3/21) of the EV-D68 infected adults were hospitalised in intensive care units. Phylogenetic analysis of the viral protein 1 (VP1) sequences of 179 EV-D68 cases, revealed that 117 sequences (65.4%), including that of the case of AFP, belonged to the B2 variant of clade B viruses. Continuous surveillance of EV-D68 infections is warranted and could benefit from existing influenza-like illness and EV surveillance networks.
Highlights
Enterovirus D68 (EV-D68) was first identified in the United States (US) in 1962 in four paediatric patients with acute respiratory infections (ARI) [1,2,3,4,5,6,7,8,9,10,11]
Respiratory tract samples were systematically tested for human rhinoviruses and enteroviruses (HRV/EV) by the reverse-transcription polymerase chain reaction (RT-PCR) assays routinely used at each participating laboratory
Performances of the HRV/EV assays and the EV-D68 real-time RT-PCR were comparable among the participating laboratories, as tested on dilutions of a titrated EV-D68 Fermon strain
Summary
Enterovirus D68 (EV-D68) was first identified in the United States (US) in 1962 in four paediatric patients with acute respiratory infections (ARI) [1,2,3,4,5,6,7,8,9,10,11]. Until 2014, only sporadic cases of infection with this virus as well as small outbreaks (10 publications during 2006–2011) were reported in Asia, Europe and the US [1,2,3,4,5,6,7,8,9,10,11], with disease manifestations mainly ranging from mild respiratory symptoms to severe ARI requiring intensive care and mechanical ventilation. In late September 2014, a French child developed severe acute flaccid paralysis (AFP) following EV-D68 pneumonia [19]. Taking all these factors into account, the National Institute of Public Health encouraged the French EV surveillance network to conduct a systematic analysis of respiratory samples collected from hospitalised patients to evaluate both the level of EV-D68 circulation and its clinical impact
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