Increase in Enterovirus D68 Infections in Young Children, United Kingdom, 2006–2016

Everlyn Kamau; Heli Harvala; Soile Blomqvist; Dung Nguyen; Peter Horby; Richard Pebody; Peter Simmonds


Emerging Infectious Diseases. 2019;25(6):1200-1203. 

In This Article

Abstract and Introduction


We determined the change in seroprevalence of enterovirus D68 (EV-D68) in the United Kingdom in age-stratified cohorts from 2006 to 2016, the period during which EV-D68 emerged as a cause of severe respiratory disease occasionally leading to paralysis. Infections were acquired primarily in infants and young children, and incidence was markedly higher in 2016.


Enterovirus D68 (EV-D68) is a member of the Enterovirus D species (genus Enterovirus; family Picornaviridae). EV-D68 is distributed worldwide and is typically associated with upper respiratory tract infections. Although EV-D68 infections were infrequently reported in the United States and elsewhere before 2010,[1,2] multiple novel clades of EV-D68 have emerged worldwide[3] and have been associated with occasional outbreaks of more severe respiratory infections.[4] However, it was not until 2014 that a series of large-scale EV-D68 outbreaks resulting in severe illness and death were reported from the United States and Canada and subsequently, in 2016, from Europe (Netherlands, Spain, Germany, Italy, Ireland, Austria, France, Luxembourg), Japan, China, and elsewhere in Asia.[4–6]

While primarily regarded as a respiratory pathogen, EV-D68 has been occasionally associated with acute flaccid myelitis (AFM).[7] This apparent change in tropism for cells in the central nervous system[8] may be linked to the emergence of novel genetically distinct EV-D68 lineages.[3] An alternative possibility is that the increased number of reports of severe, AFM-associated infections with EV-D68 reflects larger-scale changes in population immunity that have enabled outbreaks to occur in potentially vulnerable age groups. Severe infections typically target infants >6 months of age, when maternal antibody protection wanes.[4] The World Health Organization recently identified EV-D68 as a potential major public health risk and recommends enhanced surveillance and more effective diagnostics.[9] We investigated potential changes in exposure to EV-D68 in the general population of the United Kingdom over the period in which the worldwide outbreaks of EV-D68 occurred.