Prospective surveillance of enterovirus D68 is contributing to a better understanding of its epidemiology and should be continued, according to a report in the Morbidity and Mortality Weekly Report, published by the Center for Disease Control and Prevention (CDC).

In 2014 a nationwide outbreak of enterovirus D68 occurred. Enterovirus D68 is associated with acute respiratory illness and the epidemiology is not fully understood as a result of limited clinical testing and voluntary reporting to the CDC. To better understand the epidemiology, the CDC established an active, prospective enterovirus D68 surveillance in pediatric patients at 7 medical centers in the United States through the New Vaccine Surveillance Network (NVSN). This report summarized the preliminary characterization of enterovirus D68 testing at NVSN sites between July and October of 2017 and 2018.

The NVSN conducted active, prospective, population-based surveillance for acute respiratory infection in children/adolescents (aged <18 years) at 7 American medical centers (in Cincinnati, Ohio; Houston, Texas; Kansas City, Missouri; Nashville, Tennessee; Pittsburg, Pennsylvania; Rochester, New York; and Seattle, Washington). At each site, patients with acute respiratory infection provided respiratory specimens such as included mid-turbinate nasal swabs, oropharyngeal swabs, or both, that were then tested for enterovirus D68 and validated via real-time PCR. All enterovirus D68 detections were further analyzed by patient sex and age, year, month, site, and admission status.

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Based on the active prospective surveillance, enterovirus D68 was detected in 2  (0.08%) of the 2433 patients with acute respiratory infections who were tested in 2017 and 358 patients (13.9%) of the 2579 tested in 2018; in 2018, detections peaked in September. During 2017, the 2 patients positive for enterovirus D68 were in Houston and Rochester; during 2018, EV-D68-positive patients were located in all 7 sites with 67.6% of them needing hospitalization. In 2018, 47.2% of the enterovirus D68 detections occurred in September but the peaks of detection varied by site. Cincinnati and Kansas City peaked in late August through September; Houston, Rochester, and Pittsburg peaked in mid-September; Nashville and Seattle peaked in October. Further, the median age of patients who tested positive for EV-D68 throughout 2017 and 2018 was 3 years and 58.9% were male. Of interest, all enterovirus D68-positive specimens from 2018 that were sequenced by the CDC were all lineage B3.

Overall, the study authors concluded that, “Continued surveillance for [enterovirus D68]-associated [acute respiratory infection] is needed to better understand the epidemiology of EV-D68 in the United States.”


Kujawski SA, Midgley CM, Rha B, et al. Enterovirus D68-associated acute respiratory illness – new vaccine surveillance network, United Sates, July – October, 2017 and 2018. Morb Mortal Wkly Rep. 2019;68:277-280.

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This article originally appeared on Infectious Disease Advisor