Epidemiology and clinical manifestations of different enterovirus and rhinovirus types show that EV‐D68 may still have an impact on severity of respiratory infections

Abstract

Respiratory infections are often caused by enteroviruses (EVs). The aim of this study was to identify whether certain types of EV were more likely to cause severe illness in 2016, when an increasing spread of upper respiratory infections was observed in Gothenburg, Sweden. The EV strain in 137 of 1341 nasopharyngeal samples reactive for EV by polymerase chain reaction could be typed by sequencing the viral 5′-untranslated region and VP1 regions.Phylogenetic trees were constructed. Patient records were reviewed. Hospital care was needed for 46 of 74 patients with available medical records. The majority of the patients (83) were infected with the rhinovirus (RV). The remaining 54 were infected with EV A, B, C, and D strains of 13 different types, with EV-D68 and CV-A10 being the most common (17 vs. 14). Significantly more patients with EV-D68 presented with dyspnea, both when compared with other EV types (p = 0.003) and compared to all other EV and RV infections (p = 0.04). Phylogenetic analysis of the sequences revealed the spread of both Asian and European CV-A10 strains and 12 different RV C types. This study showed an abundance of different EV types spreading during a year with increased upper respiratory increased infections. EV-D68 infections were associated with more severe disease manifestation. Other EV and RV types were more evenly distributed between hospitalized and nonhospitalized patients. The EV type CV-A10 was also found in infected patients, which warrants further studies and surveillance, as this pathogen could cause more severe disease and outbreaks of hand, foot, and mouth disease.

Epidemiological surveillance of respiratory pathogens in wastewater in Belgium

“…Most infections are mild with fever and/or common cold symptoms, but some types, especially those belonging to EV A–D, may cause meningitis, encephalitis, paralysis, neonatal sepsis, myalgia, myocarditis, or exanthema. Of note, EV-D68 has recently been shown to cause large outbreaks of more severe disease with complications such as acute flaccid myelitis [24], [25]. Although EV/RV in general were detected continuously in the wastewater, EV-D68 detection was limited to early September 2021 until early December 2021, with the highest concentrations in October 2021.…”

Respiratory viruses: new challenges for old enemies

“…[57] A study conducted in Sweden in 2016 showed increased circulation of the virus during that epidemic season and greater severity of the virus compared to other enteroviruses with increased need for hospitalization and medication, both in children above and below 5 years of age. [58] During the 2014 United States outbreak, the clinical symptoms appeared to be even more severe with 59% of hospitalized patients requiring intensive care unit admission and often invasive or noninvasive ventilation. [57] The following epidemic seasons appear to have been clinically milder but the true incidence of EV-D68 infection may be underestimated due to the inability of standard diagnostic panels to discriminate between Rhinovirus and EV-D68.…”