Enterovirus D68 – The New Polio?

Abstract

Enterovirus D68 (EV-D68) has emerged over the recent years, with large outbreaks worldwide. Increased occurrence has coincided with improved clinical awareness and surveillance of non-polio enteroviruses. Studies showing its neurotropic nature and the change in pathogenicity have established EV-D68 as a probable cause of Acute Flaccid Myelitis (AFM). The EV-D68 storyline shows many similarities with poliovirus a century ago, stimulating discussion whether EV-D68 could be ascertaining itself as the “new polio.” Increasing awareness amongst clinicians, incorporating proper diagnostics and integrating EV-D68 into accessible surveillance systems in a way that promotes data sharing, will be essential to reveal the burden of disease. This will be a necessary step in preventing EV-D68 from becoming a threat to public health.

Detection of Enterovirus D68 in wastewater samples from the United Kingdom during outbreaks reported globally between 2015 and 2018

“…Genetically related EV-D68 strains were also found during the same period in Canada, Europe and Asia with more than 2,000 cases reported in 20 countries (Kramer et al 2018). These outbreaks were temporally and geographically associated with an increase in AFM cases, particularly in the USA, and a similar association was observed in Europe, Argentina and the USA in 2016 (Cassidy et al 2018). An increase in AFM cases was again reported in the USA in 2018 with 230 confirmed cases mostly between August and November (Centers for Disease Control and Prevention (CDC) 2019).…”

“…Following this event, identification of EV-D68 in wastewater samples showed very close resemblance to clinical data reported in the UK, where peaks of EV-D68 detection in human respiratory samples were observed in January 2016, July 2016 and September 2018, and very few cases were reported between November 2016 and July 2018, as shown in the two separate studies from Wales and England discussed above (Cottrell et al 2018, Public Health England 2019). Reports of EV-D68 detection were also abundant in other European countries during the same periods in 2016 and 2018 (Bal et al 2019, Cassidy et al 2018). An upsurge of EV-D68 detection in wastewater samples from both locations was observed between August and December 2018 in agreement with recent reports of increased EV-D68 detection likely associated with AFM cases in the UK, following similar reports in the USA (Centers for Disease Control and Prevention (CDC) 2019, The United Kingdom Acute Flaccid Paralysis Afp Task 2019).…”

“…Infection with enterovirus D68 (EV-D68) has been associated with severe respiratory disease in humans with increasing evidence of its link to neurological complications causing acute flaccid myelitis (AFM), a polio-like syndrome resulting in long-term or permanent disability (Cassidy et al 2018). Although EV-D68 was first identified in 1962, it was rarely reported until 2008 when small outbreaks started to emerge in what appears to be mostly a biannual distribution (Kramer et al 2018).…”

Screening for enteroviral meningitis in infants and children—Is it useful in clinical practice?

“…Most cases occur in healthy infants with nonsevere infection. However, consideration should also be given if presenting more acutely unwell with unusual complications, particularly given the potential for changing epidemiology, outbreaks and/or more pathogenic EV strains (eg EV D68/71) . In contrast, not all children who have EV related viremia will have meningitis.…”

Enterovirus-Infektionen: Epidemiologie, Klinik und Diagnostik

“…Da sie säurestabil sind, können sie die Magenpassage überstehen. In den letzten Jahren zeigte sich die zunehmende klinische Bedeutung der Enterovirus-Typen A71 (Spezies A) und D68 (Spezies D) [8,9].…”