Abstract
A substantial amount of epidemiological data has been reported on Enterovirus D68 (EV-D68) infections after the 2014 outbreak. Our goal was to map the case fatality rate (CFR) and prevalence of current and past EV-D68 infections. We conducted a systematic review (PROSPERO, CRD42021229255) with published articles on EV-68 infections in PubMed, Embase, Web of Science and Global Index Medicus up to January 2021. We determined prevalences using a model random effect. Of the 4,329 articles retrieved from the databases, 89 studies that met the inclusion criteria were from 39 different countries with apparently healthy individuals and patients with acute respiratory infections, acute flaccid myelitis and asthma-related diseases. The CFR estimate revealed occasional deaths (7/1353) related to EV-D68 infections in patients with severe acute respiratory infections. Analyses showed that the combined prevalence of current and past EV-D68 infections was 4% (95% CI = 3.1-5.0) and 66.3% (95% CI = 40.0-88.2), respectively. The highest prevalences were in hospital outbreaks, developed countries, children under 5, after 2014, and in patients with acute flaccid myelitis and asthma-related diseases. The present study shows sporadic deaths linked to severe respiratory EV-D68 infections. The study also highlights a low prevalence of current EV-D68 infections as opposed to the existence of EV-D68 antibodies in almost all participants of the included studies. These findings therefore highlight the need to implement and/or strengthen continuous surveillance of EV-D68 infections in hospitals and in the community for the anticipation of the response to future epidemics.
Highlights
Enteroviruses (EVs) are a major public health concern worldwide
Enterovirus D68 (EV-D68) are detected in apparently healthy subjects and patients with acute respiratory illnesses, acute flaccid myelitis, and asthma-related illnesses
Enterovirus D68 was first described in 1962 and exhibited sporadic circulation until August 2014 when outbreaks of EV-D68 infections were reported in the USA and Canada mainly in children with acute flaccid myelitis and severe acute respiratory disease
Summary
Enteroviruses (EVs) are a major public health concern worldwide. The majority of EV infections are subclinical, they can be associated with a broad spectrum of clinical illnesses mainly in children, including acute respiratory illness, meningitis, encephalitis, myocarditis, pericarditis, conjunctivitis, gastrointestinal diseases, hand-foot-and-mouth disease (HFMD), inflammatory muscle diseases, and rarely, its can lead to neurological complications in severe cases [1,2,3]. Enteroviruses are members of the genus Enterovirus (Picornaviridae family). They are non-enveloped, positive-sense single strand RNA viruses with of approximately 7400–7500 nucleotides in length. While Human rhinoviruses tropism is restricted to the respiratory tract, the vast majority of Human enteroviruses infect the gastrointestinal tract, the central nervous system, respiratory tract and other organs such as heart and cause a significant morbidity and mortality worldwide
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