title: EV-D68 infection in children with asthma exacerbation and pneumonia in Mexico City during 2014 autumn.
abstract: BACKGROUND
  Human enterovirus D68 (EV-D68) recently caused an increase in mild-to-severe pediatric respiratory cases in North America and some European countries. Even though few of these children presented with acute paralytic disease, direct causal relationship cannot yet be assumed.
  
  
  OBJECTIVE
  The purposes of this report were to describe the clinical findings of an outbreak of EV-D68 infection in Mexico City and identify the genetic relationship with previously reported strains.
  
  
  METHODS
  Between September and December 2014, 126 nasopharyngeal samples (NPS) of hospitalized children <15 years of age with ARI were tested for the presence of respiratory viruses using a multiplex RT-qPCR and EV-D68-specific RT-qPCR. Clinical, epidemiological, and demographic data were collected and associated with symptomatology and viral infections. Phylogenetic analyses were performed using VP1 region.
  
  
  RESULTS
  Enterovirus/rhinovirus infection was detected in 40 patients (31·7%), of which 24 patients were EV-D68-positive. EV-D68 infection prevailed over September and October 2014 and was associated with neutrophilia and lymphopenia, and patients were more likely to develop hypoxemia. Phylogenetic analyses showed that Mexican EV-D68 belongs to the new B1 clade.
  
  
  CONCLUSIONS
  This is the first EV-D68 outbreak described in Mexico and occurred few weeks after the United States reported similar infections. Although EV-D68 belongs to new B1 clade, no neurological affection was observed.
authors.affiliation: Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico.
authors.forename: Joel A
authors.initials: JA
authors.lastname: Vazquez-Perez
authors.affiliation: Instituto de Diagnostico y Referencia Epidemiologicos, Manuel Martinez Baez, Mexico City, Mexico.
authors.forename: Jose E
authors.initials: JE
authors.lastname: Ramirez-Gonzalez
authors.affiliation: Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico.
authors.forename: Yazmin
authors.initials: Y
authors.lastname: Moreno-Valencia
authors.affiliation: Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico.
authors.forename: Victor A
authors.initials: VA
authors.lastname: Hernandez-Hernandez
authors.affiliation: Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico.
authors.forename: Jose A I
authors.initials: JA
authors.lastname: Romero-Espinoza
authors.affiliation: Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico.
authors.forename: Manuel
authors.initials: M
authors.lastname: Castillejos-Lopez
authors.affiliation: Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico.
authors.forename: Andres
authors.initials: A
authors.lastname: Hernandez
authors.affiliation: Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico.
authors.forename: Rogelio
authors.initials: R
authors.lastname: Perez-Padilla
authors.affiliation: Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico.
authors.forename: Lizbeth E
authors.initials: LE
authors.lastname: Oropeza-Lopez
authors.affiliation: Instituto de Diagnostico y Referencia Epidemiologicos, Manuel Martinez Baez, Mexico City, Mexico.
authors.forename: Noe
authors.initials: N
authors.lastname: Escobar-Escamilla
authors.affiliation: Instituto de Diagnostico y Referencia Epidemiologicos, Manuel Martinez Baez, Mexico City, Mexico.
authors.forename: Maribel
authors.initials: M
authors.lastname: Gonzalez-Villa
authors.affiliation: Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico.
authors.forename: Alejandro
authors.initials: A
authors.lastname: Alejandre-Garcia
authors.affiliation: Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico.
authors.forename: Justino
authors.initials: J
authors.lastname: Regalado-Pineda
authors.affiliation: Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico.
authors.forename: Patricio
authors.initials: P
authors.lastname: Santillan-Doherty
authors.affiliation: Instituto de Diagnostico y Referencia Epidemiologicos, Manuel Martinez Baez, Mexico City, Mexico.
authors.forename: Irma
authors.initials: I
authors.lastname: Lopez-Martínez
authors.affiliation: Instituto de Diagnostico y Referencia Epidemiologicos, Manuel Martinez Baez, Mexico City, Mexico.|Facultad de Medicina, UNAM, Mexico City, Mexico.
authors.forename: Alberto
authors.initials: A
authors.lastname: Diaz-Quiñonez
authors.affiliation: Instituto Nacional de Enfermedades Respiratorias Ismael Cosio Villegas, Mexico City, Mexico.
authors.forename: Jorge
authors.initials: J
authors.lastname: Salas-Hernandez
mesh_terms: D000293:Adolescent; D001208:Asia / Q000453:epidemiology; D001249:Asthma / Q000150:complications* / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D004196:Disease Outbreaks; D018450:Disease Progression; D030016:Enterovirus D, Human / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D004769:Enterovirus Infections / Q000453:epidemiology* / Q000821:virology*; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008800:Mexico / Q000453:epidemiology; D009305:Nasopharynx / Q000821:virology; D010802:Phylogeny; D010850:Picornaviridae Infections / Q000453:epidemiology / Q000821:virology; D011024:Pneumonia, Viral / Q000150:complications / Q000453:epidemiology* / Q000821:virology; D060888:Real-Time Polymerase Chain Reaction; D012141:Respiratory Tract Infections / Q000150:complications / Q000453:epidemiology* / Q000821:virology*; D012229:Rhinovirus / Q000235:genetics / Q000302:isolation & purification; D012621:Seasons; D014481:United States / Q000453:epidemiology
keywords: Enterovirus D68; epidemiology; outbreak; pediatric; respiratory viruses