Enterovirus 68 epidemiology and demographics

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: João André Alves Silva, M.D. [2]; Alejandro Lemor, M.D. [3] Syed Hassan A. Kazmi BSc, MD [4]

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Overview

The disease caused by EV-D68 infection is considered a rare entity. The true incidence and prevalence are not known, but a recent rise in reported cases has been observed. Although old data suggested predominance among children between the ages 4 to 5 years, new cases reveal adult preponderance. EV-D68 infection is more prevalent among males, with no variation by race or ethnicity. People with respiratory infections such as asthma, chronic obstructive pulmonary disease and atopy are also more prone to develop severe infection with EV-D68.

Prevalence and Incidence

EV-D68 infection is considered extremely rare. The true prevalence and incidence are not known. Recent data suggests that increased awareness and earlier diagnosis of the disease might be attributed to a rising trend in prevalence of EV-D68.

USA

  • Less than one in a million people in the United States get acute flaccid myelitis (AFM) from EV-D68 each year.
  • The Center for Disease Control (CDC) reports a total of 26 cases in USA between 1987 to 2005, 11 of which occurred in 2003 alone.[1] EV-D68 was reported in San Diego among military personnel in 2004-2005 and in New York City in 2009.
  • From August 2014 through October 2018, CDC has received information on a total of 396 confirmed cases of acute flaccid myelitis (AFM) from EV-D68 across the US; most of the cases have occurred in children
  • Even with an increase in cases since 2014, AFM remains a very rare condition.

2014 Nationwide Outbreak

  • In summer and fall 2014, the United States experienced a nationwide outbreak of EV-D68 associated with severe respiratory illness.
  • From mid-August 2014 to January 15, 2015, CDC or state public health laboratories confirmed a total of 1,153 people in 49 states and the District of Columbia with respiratory illness caused by EV-D68.
  • Almost all of the confirmed cases were among children, many whom had asthma or a history of wheezing. Additionally, there were likely many thousands of mild EV-D68 infections for which people did not seek medical treatment and/or get tested. This was the first documented nationwide outbreak of EV-D68. EV-D68 cases in years since 2014 have been reported more sporadically, which is considered typical.
  • CDC received about 2,600 specimens for enterovirus testing during 2014, which was substantially more than usual. About 36% of those tested positive for EV-D68. About 33% tested positive for an enterovirus or rhinovirus other than EV-D68.

2018 New York Outbreak

  • In October 2018, the New York State Department of Health (NYSDOH) confirmed 39 cases of the enterovirus EV-D68 in children across the state.
Acute Flaccid Myelitis number of confirmed cases from August 2014 to October 2018 based on AFM case definition: Onset of acute limb weakness and an MRI showing a spinal cord lesion largely restricted to gray matter


Philippines

  • During the period between October 2008 and March 2009, an outbreak of EV-D68 was detected in the Eastern Visayas region of the Philippines among pediatric patients hospitalized with pneumonia.[2]

Japan

  • In Japan, the first cases of EV-D68 were reported in 2005. From 2005 to 2010, less than 10 cases were discovered annually. However, almost 120 new cases occurred in 2010 alone. Most of the patients presented with an acute respiratory illness characterized by cough, dyspnea, and/or wheezing.[3]

Netherlands

  • In 2010, all patients with pneumonia and pneumonia-like symptoms were prospectively studied and their samples were sequenced. A total of 24 cases were attributed to EV-D68, 50% of which were less than 20 years of age.

Italy

  • Between 2008 and 2009, 12 cases of enterovirus 68 were reported in Italy among patients with viral respiratory infections.[4]

Age

  • Approximately 80% of reported cases of EV-D68 infection occurred among children.
  • The age at presentation ranges between 1 month to 78 years.
  • Based on older data, the median age at infection is 4-5 years; but new reports are consistently revealing adult preponderance[5][6][7]

Gender

Race


References

  1. Khetsuriani, N.; Lamonte-Fowlkes, A.; Oberst, S.; Pallansch, MA. (2006). "Enterovirus surveillance--United States, 1970-2005". MMWR Surveill Summ. 55 (8): 1–20. PMID 16971890. Unknown parameter |month= ignored (help)
  2. Imamura, T.; Fuji, N.; Suzuki, A.; Tamaki, R.; Saito, M.; Aniceto, R.; Galang, H.; Sombrero, L.; Lupisan, S. (2011). "Enterovirus 68 among children with severe acute respiratory infection, the Philippines". Emerg Infect Dis. 17 (8): 1430–5. doi:10.3201/eid1708.101328. PMID 21801620. Unknown parameter |month= ignored (help)
  3. "Clusters of acute respiratory illness associated with human enterovirus 68--Asia, Europe, and United States, 2008-2010". MMWR Morb Mortal Wkly Rep. 60 (38): 1301–4. 2011. PMID 21956405. Unknown parameter |month= ignored (help)
  4. 4.0 4.1 Piralla, Antonio; Girello, Alessia; Grignani, Michela; Gozalo-Margüello, Monica; Marchi, Antonietta; Marseglia, Gianluigi; Baldanti, Fausto (2014). "Phylogenetic characterization of enterovirus 68 strains in patients with respiratory syndromes in Italy". Journal of Medical Virology. 86 (9): 1590–1593. doi:10.1002/jmv.23821. ISSN 0146-6615.
  5. Piralla, Antonio; Lilleri, Daniele; Sarasini, Antonella; Marchi, Antonietta; Zecca, Marco; Stronati, Mauro; Baldanti, Fausto; Gerna, Giuseppe (2012). "Human rhinovirus and human respiratory enterovirus (EV68 and EV104) infections in hospitalized patients in Italy, 2008–2009". Diagnostic Microbiology and Infectious Disease. 73 (2): 162–167. doi:10.1016/j.diagmicrobio.2012.02.019. ISSN 0732-8893.
  6. Tokarz R, Firth C, Madhi SA, Howie SR, Wu W, Sall AA; et al. (2012). "Worldwide emergence of multiple clades of enterovirus 68". J Gen Virol. 93 (Pt 9): 1952–8. doi:10.1099/vir.0.043935-0. PMC 3542132. PMID 22694903.
  7. "Clusters of Acute Respiratory Illness Associated with Human Enterovirus 68 --- Asia, Europe, and United States, 2008--2010".
  8. Lu, Q.-B.; Wo, Y.; Wang, H.-Y.; Wei, M.-T.; Zhang, L.; Yang, H.; Liu, E.-M.; Li, T.-Y.; Zhao, Z.-T.; Liu, W.; Cao, W.-C. (2013). "Detection of enterovirus 68 as one of the commonest types of enterovirus found in patients with acute respiratory tract infection in China". Journal of Medical Microbiology. 63 (Pt_3): 408–414. doi:10.1099/jmm.0.068247-0. ISSN 0022-2615.
  9. Imamura, Tadatsugu; Suzuki, Akira; Lupisan, Socorro; Kamigaki, Taro; Okamoto, Michiko; Roy, Chandra Nath; Olveda, Remigio; Oshitani, Hitoshi (2014). "Detection of enterovirus 68 in serum from pediatric patients with pneumonia and their clinical outcomes". Influenza and Other Respiratory Viruses. 8 (1): 21–24. doi:10.1111/irv.12206. ISSN 1750-2640.
  10. Jacobson, Lara M.; Redd, John T.; Schneider, Eileen; Lu, Xiaoyan; Chern, Shur-Wern W.; Oberste, M. Steven; Erdman, Dean D.; Fischer, Gayle E.; Armstrong, Gregory L.; Kodani, Maja; Montoya, Jennifer; Magri, Julie M.; Cheek, James E. (2012). "Outbreak of Lower Respiratory Tract Illness Associated With Human Enterovirus 68 Among American Indian Children". The Pediatric Infectious Disease Journal. 31 (3): 309–312. doi:10.1097/INF.0b013e3182443eaf. ISSN 0891-3668.
  11. Meijer, Adam; van der Sanden, Sabine; Snijders, Bianca E.P.; Jaramillo-Gutierrez, Giovanna; Bont, Louis; van der Ent, Cornelis K.; Overduin, Pieter; Jenny, Shireen L.; Jusic, Edin; van der Avoort, Harrie G.A.M.; Smith, Gavin J.D.; Donker, Gé A.; Koopmans, Marion P.G. (2012). "Emergence and epidemic occurrence of enterovirus 68 respiratory infections in The Netherlands in 2010". Virology. 423 (1): 49–57. doi:10.1016/j.virol.2011.11.021. ISSN 0042-6822.