What is the prevalence of enteroviruses in the US?

Updated: Mar 17, 2021
  • Author: Robert A Schwartz, MD, MPH; Chief Editor: Michael Stuart Bronze, MD  more...
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Nonpolio enteroviruses are responsible for 10-20 million symptomatic infections per year and are more prevalent among children of lower socioeconomic class, probably because of crowding, poor hygiene, and opportunities for fecal contamination.

AHC was first recognized in the United States in 1981 during an epidemic in Florida; few cases have been reported since. The prevalence is higher in southern areas than in northern areas.

Between 2002 and 2004, echoviruses 9 and 30 were the most commonly reported enterovirus serotypes in the United States. [24] In contrast, other enterovirus serotypes (eg, echovirus 1, coxsackievirus B6, and enteroviruses 68 and 69) are rarely reported and appear to have little epidemic potential. [25] However, difficulty in isolation of enterovirus 68 (EV68, EV-D68, EVD-68, HEV68) may bias the data, leading to an underestimation of its prevalence. [26] Acute flaccid myelitis is a severe poliomyelitis-like illness that was first identified in 2014 with a cluster in Colorado, with additional reports in 2016 and 2018. [27]

Enterovirus D68 had been a rarely detected respiratory virus, but is now a widespread pathogen producing increasing rates of severe respiratory illness and acute flaccid myelitis in children worldwide. 

The 2014 outbreak of enterovirus 68 (also called enterovirus D68) was documented in at least six US states, including Colorado, Illinois, Iowa, Kansas, Kentucky, and Missouri, among others. In China, it had been noted since 2016. [30] From mid-August to September 11, 2014, 82 cases of enterovirus 68 infection had been confirmed by the CDC in the outbreak, although the total number of confirmed cases is higher since this figure does not include cases confirmed by individual state laboratories. This outbreak was notable for its high number of hospitalizations involving infected children. [31] It is probable that there were different EV-D68 strains in China and America with mutations accounting for different prevalence. [30] Foster et al have suggested that DV-68 infection may act as a trigger for childhood asthma. [32]

Coxsackievirus A is likely underrepresented because only some serotypes are readily isolated in cell culture. [33]

National or regional outbreaks of aseptic meningitis are occasionally reported, such as the echovirus 30 outbreaks in the United States between 1989 and 1992 and in 2003 and echovirus 13 and echovirus 18 outbreaks in 2001. Aseptic meningitis is no longer a nationally notifiable disease in the United States.

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