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

Dispatch

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

On This Page

• The Study
• Conclusions
• Suggested Citation

Figures

• Figure 1
• Figure 2

Tables

• Table 1
• Table 2

Technical Appendicies

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• RIS[TXT - 2 KB]

Janine Reiche, Sindy Böttcher, Sabine Diedrich, Udo Buchholz, Silke Buda, Walter Haas, Brunhilde Schweiger, and Thorsten Wolff 

Author affiliations: Robert Koch Institute, Berlin, Germany

Suggested citation for this article

Abstract

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 (2–5).

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.

Acknowledgment

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.

References

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3. Centers for Disease Control and Prevention. Clusters of acute respiratory illness associated with human enterovirus 68–Asia, Europe, and United States, 2008–2010. MMWR Morb Mortal Wkly Rep. 2011;60:1301–4 .PubMed
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7. National Collaborating Centre for Infectious Diseases. Disease debrief: EV-D68 [cited 2014 Nov 5]. http://www.nccid.ca/disease-debrief-ev-d68#Q1
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10. Lang M, Mirand A, Savy N, Henquell C, Maridet S, Perignon R, Acute flaccid paralysis following enterovirus D68 associated pneumonia, France, 2014.Euro Surveill. 2014;19:20952 .PubMed
11. Centers for Disease Control and Prevention. Notes from the field: acute flaccid myelitis among persons aged ≤21 years—United States, August 1–November 13, 2014. MMWR Morb Mortal Wkly Rep. 2015;63:1243–4 .PubMed
12. Poelman R, Scholvinck EH, Borger R, Niesters HG, van Leer-Buter C. The emergence of enterovirus D68 in a Dutch University Medical Center and the necessity for routinely screening for respiratory viruses. J Clin Virol. 2015;62:1–5. DOIPubMed
13. Meijer A, van der Sanden S, Snijders BE, Jaramillo-Gutierrez G, Bont L, van der Ent CK, Emergence and epidemic occurrence of enterovirus 68 respiratory infections in The Netherlands in 2010. Virology. 2012;423:49–57 . DOIPubMed
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Figures

• Figure 1. Detection of enterovirus D68 (EV-D68), Germany, week 32–44, 2014.
• Figure 2. Phylogenetic analysis of selected enterovirus D68 (EV-D68) strains based on nucleotide sequences of A) partial viral protein (VP) 4/VP2 region (357 nt) corresponding to nt 733–1089 in the Fermon...

Tables

• Table 1. Demographic and clinical characteristics of 25 patients infected with enterovirus D68, Germany, weeks 32–44, 2014
• Table 2. Detection of rhinovirus and enterovirus by national outpatient ARI sentinel surveillance, Germany, weeks 36–20, 2009–2010 and 2010–2011

Technical Appendix

• . Supplemental methods used for detection of enterovirus D68–associated acute respiratory infections, Germany, 2014.  307 KB

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