title: Enterovirus D68 disease and molecular epidemiology in Australia.
abstract: BACKGROUND
  Enterovirus D68 (EV-D68) has received considerable recent attention as a cause of widespread respiratory illness. Neurological syndromes such as acute flaccid paralysis following EV-D68 infection have also been reported in a small number of cases.
  
  
  OBJECTIVE
  To summarize the clinical and epidemiological characteristics of laboratory confirmed EV-D68 cases in Australia.
  
  
  METHODS
  We combined EV-D68 data acquired through laboratory surveillance in Western Australia with cases from national enterovirus surveillance and regional acute flaccid paralysis (AFP) surveillance. Clinical data was obtained for EV-D68 cases and capsid protein sequences were used for phylogenetic analysis.
  
  
  RESULTS
  Sporadic cases of EV-D68 were recorded in Australia since 2008, with peaks in activity during 2011 and 2013. EV-D68 was primarily associated with respiratory disease, but was also detected in cerebrospinal fluid of one patient and faeces of two patients presenting with AFP.
  
  
  CONCLUSIONS
  EV-D68 has been circulating in Western Australia and is likely to have also been present in the wider region for a number of years, causing primarily respiratory disease. Detection of EV-D68 in cerebrospinal fluid of one patient and in faeces of two AFP cases reinforces the association between EV-D68 and neurological disease.
authors.affiliation: PathWest Laboratory Medicine WA, Perth, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Australia. Electronic address: Avram.levy@health.wa.gov.au.
authors.forename: Avram
authors.initials: A
authors.lastname: Levy
authors.affiliation: National Enterovirus Reference Laboratory, VIDRL, Doherty Institute, Melbourne, Australia; School of Applied Sciences, RMIT University, Melbourne, Australia.
authors.forename: Jason
authors.initials: J
authors.lastname: Roberts
authors.affiliation: PathWest Laboratory Medicine WA, Perth, Australia.
authors.forename: Jurissa
authors.initials: J
authors.lastname: Lang
authors.affiliation: PathWest Laboratory Medicine WA, Perth, Australia; Current affiliate: Communicable Disease Control Directorate, Health Department of Western Australia, Perth, Australia.
authors.forename: Simone
authors.initials: S
authors.lastname: Tempone
authors.affiliation: Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Sydney, Australia; Discipline of Paediatrics and Child health and the Marie Bashir Institute for Emerging Infectious Diseases and Biosecurity, Sydney Medical School, Sydney, Australia.
authors.forename: Alison
authors.initials: A
authors.lastname: Kesson
authors.affiliation: National Referral Hospital, Honiara, Solomon Islands.
authors.forename: Alfred
authors.initials: A
authors.lastname: Dofai
authors.affiliation: The Royal Children's Hospital, Melbourne, Australia; The University of Melbourne, Department of Paediatrics, Melbourne, Australia.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Daley
authors.affiliation: National Enterovirus Reference Laboratory, VIDRL, Doherty Institute, Melbourne, Australia; School of Applied Sciences, RMIT University, Melbourne, Australia.
authors.forename: Bruce
authors.initials: B
authors.lastname: Thorley
authors.affiliation: PathWest Laboratory Medicine WA, Perth, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Perth, Australia.
authors.forename: David J
authors.initials: DJ
authors.lastname: Speers
mesh_terms: D000293:Adolescent; D001315:Australia / Q000453:epidemiology; D036022:Capsid Proteins / Q000235:genetics; D002648:Child; D002675:Child, Preschool; D004770:Enterovirus / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification; D004769:Enterovirus Infections / Q000134:cerebrospinal fluid / Q000150:complications* / Q000453:epidemiology* / Q000821:virology; D005243:Feces / Q000821:virology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D010264:Paraplegia / Q000453:epidemiology* / Q000209:etiology / Q000821:virology; D010802:Phylogeny; D012141:Respiratory Tract Infections / Q000453:epidemiology / Q000821:virology*; D018571:Sentinel Surveillance; D055815:Young Adult
chemical_list: D036022:Capsid Proteins
keywords: Background; Emerging diseases; Laboratory surveillance; Respiratory viruses; Viral infections