Enterovirus D68 epidemic, UK, 2018, was caused by subclades B3 and D1, predominantly in children and adults, respectively, with both subclades exhibiting extensive genetic diversity

Howson-Wells, Hannah C.; Tsoleridis, Theocharis; Zainuddin, Izzah; Tarr, Alexander W.; Irving, William L.; Ball, Jonathan K.; Berry, Louise; Clark, Gemma; McClure, C. Patrick

Abstract

Enterovirus D68 (EV-D68) has recently been identified in biennial epidemics coinciding with diagnoses of non-polio acute flaccid paralysis/myelitis (AFP/AFM). We investigated the prevalence, genetic relatedness and associated clinical features of EV-D68 in 193 EV-positive samples from 193 patients in late 2018, UK. EV-D68 was detected in 83 (58%) of 143 confirmed EV-positive samples. Sequencing and phylogenetic analysis revealed extensive genetic diversity, split between subclades B3 (n=50) and D1 (n=33), suggesting epidemiologically unrelated infections. B3 predominated in children and younger adults, and D1 in older adults and the elderly (P=0.0009). Clinical presentation indicated causation or exacerbation of respiratory distress in 91.4% of EV-D68-positive individuals, principally cough (75.3%), shortness of breath (56.8%), coryza (48.1%), wheeze (46.9%), supplemental oxygen required (46.9%) and fever (38.9%). Two cases of AFM were observed, one with EV-D68 detectable in the cerebrospinal fluid, but otherwise neurological symptoms were rarely reported (n=4). Both AFM cases and all additional instances of intensive care unit (ICU) admission (n=5) were seen in patients infected with EV-D68 subclade B3. However, due to the infrequency of severe infection in our cohort, statistical significance could not be assessed.

Citation

Howson-Wells, H. C., Tsoleridis, T., Zainuddin, I., Tarr, A. W., Irving, W. L., Ball, J. K., Berry, L., Clark, G., & McClure, C. P. (2022). Enterovirus D68 epidemic, UK, 2018, was caused by subclades B3 and D1, predominantly in children and adults, respectively, with both subclades exhibiting extensive genetic diversity. Microbial Genomics, 8(5), https://doi.org/10.1099/mgen.0.000825

• Journal Article Type: Article
• Acceptance Date: Apr 13, 2022
• Online Publication Date: May 9, 2022
• Publication Date: May 9, 2022
• Deposit Date: Nov 9, 2022
• Publicly Available Date: Nov 9, 2022
• Journal: Microbial Genomics
• Electronic ISSN: 2057-5858
• Publisher: Microbiology Society
• Peer Reviewed: Peer Reviewed
• Volume: 8
• Issue: 5
• DOI: https://doi.org/10.1099/mgen.0.000825
• Keywords: General Medicine
• Public URL: https://nottingham-repository.worktribe.com/output/8049344
• Publisher URL: https://www.microbiologyresearch.org/content/journal/mgen/10.1099/mgen.0.000825