Detection of Enterovirus D68 in Wastewater Samples from the UK between July and November 2021

Abstract

Infection with enterovirus D68 (EV-D68) has been linked with severe neurological disease such as acute flaccid myelitis (AFM) in recent years. However, active surveillance for EV-D68 is lacking, which makes full assessment of this association difficult. Although a high number of EV-D68 infections were expected in 2020 based on the EV-D68′s known biannual circulation patterns, no apparent increase in EV-D68 detections or AFM cases was observed during 2020. We describe an upsurge of EV-D68 detections in wastewater samples from the United Kingdom between July and November 2021 mirroring the recently reported rise in EV-D68 detections in clinical samples from various European countries. We provide the first publicly available 2021 EV-D68 sequences showing co-circulation of EV-D68 strains from genetic clade D and sub-clade B3 as in previous years. Our results show the value of environmental surveillance (ES) for the early detection of circulating and clinically relevant human viruses. The use of a next-generation sequencing (NGS) approach helped us to estimate the prevalence of EV-D68 viruses among EV strains from other EV serotypes and to detect EV-D68 minor variants. The utility of ES at reducing gaps in virus surveillance for EV-D68 and the possible impact of nonpharmaceutical interventions introduced to control the COVID-19 pandemic on EV-D68 transmission dynamics are discussed.

Multimodal Surveillance Model for Enterovirus D68 Respiratory Disease and Acute Flaccid Myelitis among Children in Colorado, USA, 2022

“…EV-D68 is thought to be primarily transmitted and shed in respiratory secretions; fecal shedding is less common because most strains are acid-labile and degrade in the gastrointestinal tract ( 7 ). Our study is consistent with other published studies ( 34 , 35 ) that have demonstrated that even pathogens that are predominantly shed other than in feces, such as EV-D68, can still be detected and tracked through wastewater because of the high sensitivity of that method. Our study confirms that wastewater surveillance developed for poliovirus can be extended to EV-D68 and in the future probably beyond to other known and emerging enteroviruses associated with AFM.…”

Two years of longitudinal measurements of human adenovirus group F, norovirus GI and GII, rotavirus, enterovirus, enterovirus D68, hepatitis A virus,Candida auris, and West Nile virus nucleic-acids in wastewater solids: A retrospective study at two wastewater treatment plants

“…The highest concentration observed was 72,000 cp/g at OSP and 280,000 cp/g at SJ. A similar seasonal pattern in EVD68 in wastewater in 2022 was reported in Texas 61 , as well as in Israel 62 and the United Kingdom 63 . The study in Israel reports good agreement between wastewater concentrations of EVD68 and confirmed laboratory cases of EVD68 infections 62 .…”

Off-season circulation and characterization of enterovirus D68 with respiratory and neurological presentation using whole-genome sequencing

“…EV-D68 was also detected from one fecal sample from a patient presenting with respiratory and diarrhea illness. Although EV-D68 detection from fecal samples is uncommon, it could provide an alternative for widespread population surveillance studies ( Corpuz et al, 2020 ; Tedcastle et al, 2022 ). It is important to note that the true burden and circulation within the community is difficult to estimate, given that community surveillance is not performed and subtype differentiation is typically only performed for severer cases following clinical consultation.…”