title: European surveillance for enterovirus D68 during the emerging North-American outbreak in 2014.
abstract: BACKGROUND
  In August and September 2014, unexpected clusters of enterovirus-D68 (EV-D68) infections associated with severe respiratory disease emerged from North-America. In September, the European Centre for Disease Prevention and Control (ECDC) asked European countries to strengthen respiratory sample screening for enterovirus detection and typing in cases with severe respiratory presentations.
  
  
  OBJECTIVE
  To provide a detailed picture of EV-D68 epidemiology in Europe by conducting a retrospective and prospective laboratory analysis of clinical specimens.
  
  
  METHODS
  An initiative supported by the European Society for Clinical Virology (ESCV) and ECDC was launched to screen for EV-D68 in respiratory specimens between July 1st and December 1st 2014 in Europe and to sequence the VP1 region of detected viruses for phylogenetic analytic purposes.
  
  
  RESULTS
  Forty-two institutes, representing 51 laboratories from 17 European countries, analyzed 17,248 specimens yielding 389 EV-D68 positive samples (2.26%) in 14 countries. The proportion of positive samples ranged between 0 and 25% per country. These infections resulted primarily in mild respiratory disease, mainly detected in young children presenting with wheezing and in immuno-compromised adults. The viruses detected in Europe are genetically very similar to those of the North-American epidemic and the majority (83%) could be assigned to clade B. Except for 3 acute flaccid paralysis (AFP) cases, one death and limited ICU admissions, no severe cases were reported.
  
  
  CONCLUSIONS
  The European study showed that EV-D68 circulated in Europe during summer and fall of 2014 with a moderate disease burden and different pathogenic profile compared to the North-American epidemic.
authors.affiliation: The University of Groningen, University Medical Center Groningen, Department of Medical Microbiology, Division of Clinical Virology, Groningen, The Netherlands. Electronic address: r.poelman@umcg.nl.
authors.forename: Randy
authors.initials: R
authors.lastname: Poelman
authors.affiliation: National Enterovirus Reference Centre, Laboratoire de Virologie, Centre de Biologie Est des Hospices Civils de Lyon, Bron, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Schuffenecker
authors.affiliation: The University of Groningen, University Medical Center Groningen, Department of Medical Microbiology, Division of Clinical Virology, Groningen, The Netherlands.
authors.forename: Coretta
authors.initials: C
authors.lastname: Van Leer-Buter
authors.affiliation: National Enterovirus Reference Centre, Laboratoire de Virologie, Centre de Biologie Est des Hospices Civils de Lyon, Bron, France; Virpath Lab, EA4610, Faculté de Médecine Lyon Est, Université Claude Bernard Lyon1, Université de Lyon, Lyon, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Josset
authors.affiliation: The University of Groningen, University Medical Center Groningen, Department of Medical Microbiology, Division of Clinical Virology, Groningen, The Netherlands.
authors.forename: Hubert G M
authors.initials: HG
authors.lastname: Niesters
authors.affiliation: National Enterovirus Reference Centre, Laboratoire de Virologie, Centre de Biologie Est des Hospices Civils de Lyon, Bron, France; Virpath Lab, EA4610, Faculté de Médecine Lyon Est, Université Claude Bernard Lyon1, Université de Lyon, Lyon, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Lina
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D030016:Enterovirus D, Human / Q000302:isolation & purification*; D004769:Enterovirus Infections / Q000453:epidemiology* / Q000473:pathology / Q000821:virology*; D062665:Epidemiological Monitoring; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D058889:Molecular Typing; D009656:North America / Q000453:epidemiology; D011446:Prospective Studies; D012189:Retrospective Studies; D017422:Sequence Analysis, DNA; D015678:Viral Structural Proteins / Q000235:genetics; D055815:Young Adult
chemical_list: D015678:Viral Structural Proteins
keywords: Enterovirus D68; Molecular epidemiology; Respiratory infection; VP1 sequencing