Rapid communication Open Access
Like 1


Enterovirus D68 (EV-D68) was detected in 93 patients from five European countries between 1 January 2019 and 15 January 2020, a season with expected low circulation. Patients were primarily children (n = 67, median age: 4 years), 59 patients required hospitalisation and five had severe neurologic manifestations. Phylogenetic analysis revealed two clusters in the B3 subclade and subclade A2/D. This circulation of EV-D68 associated with neurological manifestations stresses the importance of surveillance and diagnostics beyond expected peak years.


Article metrics loading...

Loading full text...

Full text loading...



  1. Kramer R, Sabatier M, Wirth T, Pichon M, Lina B, Schuffenecker I, et al. Molecular diversity and biennial circulation of enterovirus D68: a systematic screening study in Lyon, France, 2010 to 2016. Euro Surveill. 2018;23(37):1700711.  https://doi.org/10.2807/1560-7917.ES.2018.23.37.1700711  PMID: 30229724 
  2. Messacar K, Pretty K, Reno S, Dominguez SR. Continued biennial circulation of enterovirus D68 in Colorado. J Clin Virol. 2019;113:24-6.  https://doi.org/10.1016/j.jcv.2019.01.008  PMID: 30825833 
  3. Uprety P, Curtis D, Elkan M, Fink J, Rajagopalan R, Zhao C, et al. Association of enterovirus D68 with acute flaccid myelitis, Philadelphia, Pennsylvania, USA, 2009-2018. Emerg Infect Dis. 2019;25(9):1676-82.  https://doi.org/10.3201/eid2509.190468  PMID: 31407660 
  4. Cottrell S, Moore C, Perry M, Hilvers E, Williams C, Shankar AG. Prospective enterovirus D68 (EV-D68) surveillance from September 2015 to November 2018 indicates a current wave of activity in Wales. Euro Surveill. 2018;23(46):1800578.  https://doi.org/10.2807/1560-7917.ES.2018.23.46.1800578  PMID: 30458915 
  5. Bal A, Sabatier M, Wirth T, Coste-Burel M, Lazrek M, Stefic K, et al. Emergence of enterovirus D68 clade D1, France, August to November 2018. Euro Surveill. 2019;24(3):1800699.  https://doi.org/10.2807/1560-7917.ES.2019.24.3.1800699  PMID: 30670143 
  6. Pellegrinelli L, Giardina F, Lunghi G, Uceda Renteria SC, Greco L, Fratini A, et al. Emergence of divergent enterovirus (EV) D68 sub-clade D1 strains, northern Italy, September to October 2018. Euro Surveill. 2019;24(7):1900090.  https://doi.org/10.2807/1560-7917.ES.2018.24.7.1900090  PMID: 30782269 
  7. The United Kingdom Acute Flaccid Paralysis Afp Task Force. An increase in reports of acute flaccid paralysis (AFP) in the United Kingdom, 1 January 2018-21 January 2019: early findings. Euro Surveill. 2019;24(6):1900093. PMID: 30755296 
  8. González-Sanz R, Taravillo I, Reina J, Navascués A, Moreno-Docón A, Aranzamendi M, et al. Enterovirus D68-associated respiratory and neurological illness in Spain, 2014-2018. Emerg Microbes Infect. 2019;8(1):1438-44.  https://doi.org/10.1080/22221751.2019.1668243  PMID: 31571527 
  9. Midgley SE, Christiansen CB, Poulsen MW, Hansen CH, Fischer TK. Emergence of enterovirus D68 in Denmark, June 2014 to February 2015. Euro Surveill. 2015;20(17):21105.  https://doi.org/10.2807/1560-7917.ES2015.20.17.21105  PMID: 25955773 
  10. Meijer A, van der Sanden S, Snijders BE, Jaramillo-Gutierrez G, Bont L, van der Ent CK, et al. Emergence and epidemic occurrence of enterovirus 68 respiratory infections in The Netherlands in 2010. Virology. 2012;423(1):49-57.  https://doi.org/10.1016/j.virol.2011.11.021  PMID: 22177700 
  11. Dyrdak R, Grabbe M, Hammas B, Ekwall J, Hansson KE, Luthander J, et al. Outbreak of enterovirus D68 of the new B3 lineage in Stockholm, Sweden, August to September 2016. Euro Surveill. 2016;21(46):30403.  https://doi.org/10.2807/1560-7917.ES.2016.21.46.30403  PMID: 27918255 
  12. Dyrdak R, Mastafa M, Hodcroft EB, Neher RA, Albert J. Intra- and interpatient evolution of enterovirus D68 analyzed by whole-genome deep sequencing. Virus Evol. 2019;5(1):vez007.  https://doi.org/10.1093/ve/vez007  PMID: 31037220 
  13. Hadfield J, Megill C, Bell SM, Huddleston J, Potter B, Callender C, et al. Nextstrain: real-time tracking of pathogen evolution. Bioinformatics. 2018;34(23):4121-3.  https://doi.org/10.1093/bioinformatics/bty407  PMID: 29790939 
  14. Holm-Hansen CC, Midgley SE, Fischer TK. Global emergence of enterovirus D68: a systematic review. Lancet Infect Dis. 2016;16(5):e64-75.  https://doi.org/10.1016/S1473-3099(15)00543-5  PMID: 26929196 
  15. Dyda A, Stelzer-Braid S, Adam D, Chughtai AA, MacIntyre CR. The association between acute flaccid myelitis (AFM) and Enterovirus D68 (EV-D68) - what is the evidence for causation? Euro Surveill. 2018;23(3):e.  https://doi.org/10.2807/1560-7917.ES.2018.23.3.17-00310  PMID: 29386095 
  16. Messacar K, Asturias EJ, Hixon AM, Van Leer-Buter C, Niesters HGM, Tyler KL, et al. Enterovirus D68 and acute flaccid myelitis-evaluating the evidence for causality. Lancet Infect Dis. 2018;18(8):e239-47.  https://doi.org/10.1016/S1473-3099(18)30094-X  PMID: 29482893 
  17. Yea C, Bitnun A, Robinson J, Mineyko A, Barton M, Mah JK, et al. Longitudinal outcomes in the 2014 acute flaccid paralysis cluster in Canada. J Child Neurol. 2017;32(3):301-7.  https://doi.org/10.1177/0883073816680770  PMID: 28193112 
  18. Knoester M, Helfferich J, Poelman R, Van Leer-Buter C, Brouwer OF, Niesters HGM, et al. Twenty-nine cases of enterovirus-D68-associated acute flaccid myelitis in Europe 2016: a case series and epidemiologic overview. Pediatr Infect Dis J. 2019;38(1):16-21.  https://doi.org/10.1097/INF.0000000000002188  PMID: 30234793 
  19. Antona D, Kossorotoff M, Schuffenecker I, Mirand A, Leruez-Ville M, Bassi C, et al. Severe paediatric conditions linked with EV-A71 and EV-D68, France, May to October 2016. Euro Surveill. 2016;21(46):30402.  https://doi.org/10.2807/1560-7917.ES.2016.21.46.30402  PMID: 27918268 

Data & Media loading...

Submit comment
Comment moderation successfully completed
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error