Co-circulation of multiple enterovirus D68 subclades, including a novel B3 cluster, across Europe in a season of expected low prevalence, 2019/20

Abstract

Enterovirus D68 (EV-D68) was detected in 93 patients from five European countries between 1 January 2019 and 15 January 2020, a season with expected low circulation. Patients were primarily children (n = 67, median age: 4 years), 59 patients required hospitalisation and five had severe neurologic manifestations. Phylogenetic analysis revealed two clusters in the B3 subclade and subclade A2/D. This circulation of EV-D68 associated with neurological manifestations stresses the importance of surveillance and diagnostics beyond expected peak years.

Molecular Epidemiology and Evolutionary Trajectory of Emerging Echovirus 30, Europe

“…This study underpins the strength of the ENPEN consortium, which brings together virologists, public health experts, infectious disease doctors, and scientists across Europe to enable rapid detection and early warning through standardized surveillance. Previous studies using Nextstrain with 2 EV-D68 datasets have shown the value of combining demographic and phylogenetic analysis, both as retrospective (33) and real-time analysis (34). The E30 dataset and the 2 EV-D68 datasets (33,34) available on Nextstrain represent large nonpolio enterovirus datasets that support real- Differences in surveillance systems, case definitions, and sample selection between institutes and countries make standardized data collection difficult, particularly for denominator data.…”

“…Previous studies using Nextstrain with 2 EV-D68 datasets have shown the value of combining demographic and phylogenetic analysis, both as retrospective (33) and real-time analysis (34). The E30 dataset and the 2 EV-D68 datasets (33,34) available on Nextstrain represent large nonpolio enterovirus datasets that support real- Differences in surveillance systems, case definitions, and sample selection between institutes and countries make standardized data collection difficult, particularly for denominator data. The differences in data collection proved to be a limitation in our study, and the extent of the circulation of the different strains remains unknown.…”

“…Previous studies using Nextstrain with 2 EV-D68 datasets have shown the value of combining demographic and phylogenetic analysis, both as retrospective ( 33 ) and real-time analysis ( 34 ). The E30 dataset and the 2 EV-D68 datasets ( 33 , 34 ) available on Nextstrain represent large nonpolio enterovirus datasets that support real-time tracking of viruses over time and across countries. These data are of considerable value in infection containment and control of nonpolio enteroviruses.…”

Enterovirus D68 molecular and cellular biology and pathogenesis

“…However, many of the previously identified sites of sequence similarity to neurotropic enteroviruses in subclade B1 were not present ( 69 ). Nonetheless, the B3 subclade was dominant in the 2016 and 2018 outbreaks in the United States and Europe, including among patients with AFM ( 70 , 71 , 72 , 73 ), and in 2018, all US isolates were from clade B3 ( 74 ).…”

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