Enterovirus D68

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In October, the National Virus Reference Laboratory (NVRL) was asked to participate in a pan European initiative to identify cases of Enterovirus-D68 (EV-D68). This virus has been associated with an outbreak of severe respiratory illness in the USA with 1,121 cases and 12 deaths reported since August 2014. The vast majority of cases have been in children. Clusters of neurological illness, including acute flaccid paralysis (AFP) have also been reported as having a possible association with EV-D68 infection (http://www.ecdc.europa.eu/en/publications/Publications/Enterovirus-68-detected-in-the-USA-Canada-Europe-second-update-25-November-2014.pdf)

The study was instigated by the European Society of Clinical Virology (ESCV) in collaboration with the European Centre for Disease Control (ECDC). 1010 respiratory samples submitted to the NVRL during peak Enterovirus season were retrospectively tested for EV-D68. From 1010 samples, four cases of Enterovirus D68 infection were identified. All patients made a full recovery. No cases of EV-D68 associated AFP were identified.

The data from the study has been submitted to the ESCV/ECDC working group for review and a report will be issued shortly. The preliminary analysis suggests that EV-D68 is circulating widely in Europe but the severity of symptoms is not on the scale seen in the USA.

With regard to testing, Enterovirus RNA PCR will not be performed as a first line investigation of respiratory samples. However, if initial tests are negative and severe respiratory symptoms are present, second line tests including those for Enteroviruses can be done on request. Please contact 01 716 1240 if required.

In suspected cases of AFP, recommendations suggest at least two stool samples, taken 24 hours apart and within 14 days of onset of illness should be submitted to the NVRL for Enterovirus testing. (http://www.hpsc.ie/AZ/VaccinePreventable/Polio/AcuteFlaccidParalysisAFP/Guidance).Testing of additional samples e.g. respiratory specimens can be facilitated when requested.