title: The emergence of enterovirus D68 in a Dutch University Medical Center and the necessity for routinely screening for respiratory viruses.
abstract: BACKGROUND
  Since August 2014, an increase in infections caused by enterovirus D68 (EV-D68) was reported in the USA and Canada, for the most part in children presenting with severe respiratory symptoms.
  
  
  OBJECTIVE
  To determine whether an increase in severe EV-D68 respiratory infections was observed in our region.
  
  
  METHODS
  Samples from patients with respiratory symptoms were screened for viral pathogens, including rhinovirus and enterovirus. Subsequently, samples positive for rhinovirus and enterovirus were routinely sequenced for phylogenetic analysis. Furthermore, an additional method was used to detect EV-D68 specifically.
  
  
  RESULTS
  During the first three quarters of the year 2014, 1896 respiratory samples were analyzed; 39 (2%) of them tested positive for enterovirus. Eighteen samples tested positive for EV-D68, obtained from 16 different patients admitted to our hospital. Eleven were children below the age of 18, of whom five children needed intensive care treatment. The remaining five samples were from adults, who all had an underlying disease; three were transplant patients (heart, lung and renal transplantation), the other two had an underlying lung condition (COPD, asthma). Phylogenetic analysis showed a close relationship with the strains circulating currently in the USA, all belonging to the known EV-D68 genetic subtypes.
  
  
  CONCLUSIONS
  We observed an increase of EV-D68 infections in our population, both in children as well as in adult. In 2014 there have been 16 cases so far, compared to none in 2011 and 2013 and a single case in 2012. Phylogenetic analysis identified two similar clusters as shown in the USA and Canada.
authors.affiliation: Department of Medical Microbiology, Division of Clinical Virology, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Randy
authors.initials: R
authors.lastname: Poelman
authors.affiliation: Beatrix Children's Hospital, The University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Elisabeth H
authors.initials: EH
authors.lastname: Schölvinck
authors.affiliation: Department of Medical Microbiology, Division of Clinical Virology, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Renze
authors.initials: R
authors.lastname: Borger
authors.affiliation: Department of Medical Microbiology, Division of Clinical Virology, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Hubert G M
authors.initials: HG
authors.lastname: Niesters
authors.affiliation: Department of Medical Microbiology, Division of Clinical Virology, University Medical Center Groningen, Groningen, The Netherlands. Electronic address: c.van.leer@umcg.nl.
authors.forename: Coretta
authors.initials: C
authors.lastname: van Leer-Buter
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D021821:Communicable Diseases, Emerging / Q000453:epidemiology* / Q000821:virology; D030016:Enterovirus D, Human / Q000145:classification* / Q000235:genetics; D004769:Enterovirus Infections / Q000453:epidemiology* / Q000821:virology; D005260:Female; D005838:Genotype; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010802:Phylogeny; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000821:virology; D012621:Seasons; D055815:Young Adult
keywords: Enterovirus D68; Respiratory infections; Routinely screening; VP1 sequencing