Abstract
A widespread outbreak of enterovirus D68 (EV-D68) was detected in association with respiratory illness in children across Canada and the United States during the autumn of 2014. The majority of cases were mild, but some were associated with more severe illness requiring hospitalization; some of the cases also had neurological symptoms including paralysis, and three deaths were reported in British Columbia. EV-D68 is one of many enteroviruses that include Coxsackieviruses, echovirusesand polio virus. Other than polio virus, there are no vaccines available for the prevention of enterovirus infections, nor are there any antiviral medications that have been approved for their treatment. More than 46 different serotypes have been identified to be circulating in Canada over the last 25 years. Until 2014, EV-D68 was rare. Routine genotyping surveillance done by Canada's National Microbiology Laboratory (NML) identified only 85 isolates of EV-D68 between 1991 and 2013, while 282 were detected between July and October 2014. The complexity of the epidemiology of these enteroviruses demonstrates the need for genotype surveillance, to detect outbreaks spatially and temporally, to determine their relative incidence and impact on the population, and to investigate evolutionary trends, such as recombination events, that are thought to play an important part in strain variation and emergence of epidemic strains. In particular, it is important to carry out virological testing on unusual cases of paralysis in children, and to genotype and sequence any viruses identified. Submission of specimens (virus cultures, stool, cerebrospinal fluid or respiratory specimens) from any such cases to the National Centre for Enteroviruses at NML is encouraged.
Highlights
Enterovirus D68 (EV-D68) captured public attention between August and October of 2014 when a widespread outbreak was detected in association with respiratory illness in children across Canada and the United States (1−6)
The majority of cases were mild, but some were associated with more severe illness requiring hospitalization; some of the cases had neurological symptoms including paralysis, and three deaths were reported in British Columbia
In the United States, the Centers for Disease Control and Prevention (CDC) tested about 2,600 specimens for EV-D68 during the late summer of 2014 and found that about 36% of them were positive for the virus, including 12 patients who died, and the infection was confirmed in 1,152 patients in 49 states [7]
Summary
Enterovirus D68 (EV-D68) captured public attention between August and October of 2014 when a widespread outbreak was detected in association with respiratory illness in children across Canada and the United States (1−6). In the United States, the Centers for Disease Control and Prevention (CDC) tested about 2,600 specimens for EV-D68 during the late summer of 2014 and found that about 36% of them were positive for the virus, including 12 patients who died, and the infection was confirmed in 1,152 patients in 49 states [7]. In Canada, the National Microbiology Laboratory (NML) tested 970 specimens for EV-D68 and identified 282 positive cases between August and October of 2014. It has been suggested that the EV-D68 outbreak in the United States could be related to an increase in cases of acute flaccid myelitis, an unexplained neurological illness involving limb weakness in children that coincided with the increased detection of EV-D68 [8]. There is a need to carry out further laboratory-based epidemiological surveillance for possible links between enterovirus infection and emerging paralytic illnesses
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