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Low-level Circulation of Enterovirus D68–Associated Acute Respiratory Infections, Germany, 2014 - Volume 21, Number 5—May 2015 - Emerging Infectious Disease journal - CDC

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Low-level Circulation of Enterovirus D68–Associated Acute Respiratory Infections, Germany, 2014 - Volume 21, Number 5—May 2015 - Emerging Infectious Disease journal - CDC


Volume 21, Number 5—May 2015


Low-level Circulation of Enterovirus D68–Associated Acute Respiratory Infections, Germany, 2014

Janine Reiche, Sindy Böttcher, Sabine Diedrich, Udo Buchholz, Silke Buda, Walter Haas, Brunhilde Schweiger, and Thorsten WolffComments to Author 
Author affiliations: Robert Koch Institute, Berlin, Germany


We used physician sentinel surveillance to identify 25 (7.7%) mild to severe infections with enterovirus D68 (EV-D68) in children and adults among 325 outpatients with acute respiratory infections in Germany during August–October 2014. Results suggested low-level circulation of enterovirus D68 in Germany. Viruses were characterized by sequencing viral protein (VP) 1 and VP4/VP2 genomic regions.
Enterovirus D68 (EV-D68) belongs to the family Picornaviridae, genus Enterovirus, species Enterovirus D. Since its initial discovery in 1962 (1), EV-D68 infections in humans have been reported rarely. However, since 2008, clusters of acute respiratory infections (ARIs) associated with EV-D68 have been reported worldwide, including Europe (25).
During mid-August 2014–January 2015, the United States and Canada had nationwide outbreaks of EV-D68 infections associated with severe respiratory disease (6,7). The US Centers for Disease Control and Prevention and state public health laboratories confirmed 1,153 persons in 49 states and the District of Columbia infected by EV-D68 (8). Over the same period, >200 specimens tested were positive for EV-D68 throughout Canada (7). Clinical symptoms ranged from mild to severe disease requiring intensive care and mechanical ventilation. Children were predominantly affected, in particular if they had asthma or wheezing (6,9). After ARIs, symptoms of neurologic illness or acute flaccid myelitis developed in an increasing number of children (10,11).
To describe EV-D68 circulation in a large country in Europe in the fall of 2014, we investigated specimens from patients with respiratory illness for EV-D68. This investigation was conducted within the national outpatient ARI sentinel surveillance in Germany.

Dr. Reiche is a staff scientist in the Division of Influenza Viruses and Other Respiratory Viruses, National Reference Centre for Influenza, Robert Koch Institute, Berlin, Germany. Her research focuses on molecular epidemiology and characterization of respiratory viruses and evaluation of diagnostic methods.


We thank all primary care physicians for participating in the national ARI sentinel surveillance system and technical staff, especially Susi Hafemann and Berit Lenz, for expert technical assistance.


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Technical Appendix

Suggested citation for this article: Reiche J, Böttcher S, Diedrich S, Buchholz U, Buda SD, Haas W, et al. Low-level circulation of enterovirus D68–associated acute respiratory infections, Germany, 2014. Emerg Infect Dis. 2015 May [date cited]. http://dx.doi.org/10.3201/eid2105.141900
DOI: 10.3201/eid2105.141900

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