title: Molecular and epidemiological study of enterovirus D68 in Taiwan.
abstract: OBJECTIVE
  As an immunofluorescence assay for enterovirus D68 (EV-D68) is not available in the enteroviruses surveillance network in Taiwan, EV-D68 may be the actual pathogen of untypeable enterovirus-suspected isolates.
  
  
  METHODS
  The untypeable isolates collected from 2007 through 2014 were identified by nucleic acid amplification-based methods and sequencing of the VP1 region to analyze the phylogeny and epidemiology of EV-D68 in Taiwan.
  
  
  RESULTS
  Twenty-nine EV-D68 isolates were sequenced, including 15 Cluster 3 and 14 Cluster 1 viruses. Approximately 41% of the patients were children under 5 years of age and their infections peaked in August. The ratio of male to female patients was 1.5 and 3.67 for Cluster 3 and Cluster 1, respectively. Fever and respiratory symptoms were commonly reported in EV-D68-infected patients. The results of phylogenetic analyses showed that EV-D68 isolates between 2007 and 2014 belonged to different clusters and existed for years, indicating that endemic circulation of EV-D68 existed in Taiwan.
  
  
  CONCLUSIONS
  This study showed that EV-D68 has been endemic in Taiwan for some years despite a small number of positive cases. The continuous monitoring and efforts towards the improvement of diagnostic techniques are required to complete the surveillance system. This study provided the genetic and epidemiological information which could contribute to understanding the etiology and epidemiology of EV-D68.
authors.affiliation: Center for Research, Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan.
authors.forename: Yuan-Pin
authors.initials: YP
authors.lastname: Huang
authors.affiliation: Center for Research, Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan.
authors.forename: Tsuey-Li
authors.initials: TL
authors.lastname: Lin
authors.affiliation: Center for Research, Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan.
authors.forename: Ting-Han
authors.initials: TH
authors.lastname: Lin
authors.affiliation: Center for Research, Diagnostics and Vaccine Development, Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan; School of Medical Laboratory Science and Biotechnology, Taipei Medical University, Taipei, Taiwan. Electronic address: wuhs@cdc.gov.tw.
authors.forename: Ho-Sheng
authors.initials: HS
authors.lastname: Wu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004770:Enterovirus / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification*; D030016:Enterovirus D, Human; D004769:Enterovirus Infections / Q000453:epidemiology* / Q000821:virology*; D016021:Epidemiologic Studies; D005260:Female; D005838:Genotype; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D010802:Phylogeny; D017422:Sequence Analysis, DNA; D013624:Taiwan / Q000453:epidemiology; D015678:Viral Structural Proteins / Q000235:genetics; D055815:Young Adult
chemical_list: D015678:Viral Structural Proteins
keywords: enterovirus D68; epidemiology; phylogeny