title: Human enterovirus D68 in clinical and sewage samples in Israel.
abstract: Since mid-August 2014, North America experienced a wide outbreak of Enterovirus D68 (EV-D68) associated with severe respiratory illness in children. Several other countries also reported cases of EV-D68 in 2014.
  
  
  
  The aim of this study was to determine whether EV-D68 circulated in Israel in 2014, caused severe respiratory illness in children and was the causative agent of Acute Flaccid Paralysis.
  
  
  
  Archived clinical respiratory samples from a cohort of 710 hospitalized pediatric patient's (<10years old) with respiratory illness were screened for clade B specific EV-D68 by real-time PCR. The patients were seen at four medical centers covering the entire country between August and November 2014. We also evaluated 49 patient stool samples from 26 AFP cases during 2014 for presence of EV-D68. In addition, RNA from sewage samples collected throughout Israel during the same study period was also tested for EV-D68. Partial VP1 sequencing was performed on all positive samples.
  
  
  
  Of the 710 clinical samples evaluated, 7 (1%) were positive for EV-D68. Two patients were from the central part of Israel, while the rest was from the southern part. The majority of the patients did not have any underlying disease. Not only that, but, none of the 26 suspected AFP cases had EV-D68 nucleic acid in their stool samples. EV-D68 RNA was detected in 9 out of 93 sewage samples, mainly from Southern Israel. Sequence analysis of EV-D68 VP1 gene from both sewage and clinical samples indicated that the Israeli EV-D68 RNA belonged to Clade B which was genetically similar to 2014 circulating European and North American EV-D68 virus.
  
  
  
  EV-D68 circulated in Israel during the 2014 summer-fall season and caused hospitalization of a small percent of the patients with respiratory illness.
authors.affiliation: Central Virology Laboratory, Public Health Services, Ministry of Health and Chaim Sheba Medical Center, Tel-Hashomer, Israel; Israel Center for Disease Control, Tel-Hashomer, Israel. Electronic address: merav.weil@sheba.health.gov.il.
authors.forename: Merav
authors.initials: M
authors.lastname: Weil
authors.affiliation: Central Virology Laboratory, Public Health Services, Ministry of Health and Chaim Sheba Medical Center, Tel-Hashomer, Israel; Tel Aviv University, Tel-Aviv, Israel.
authors.forename: Michal
authors.initials: M
authors.lastname: Mandelboim
authors.affiliation: Central Virology Laboratory, Public Health Services, Ministry of Health and Chaim Sheba Medical Center, Tel-Hashomer, Israel; Tel Aviv University, Tel-Aviv, Israel.
authors.forename: Ella
authors.initials: E
authors.lastname: Mendelson
authors.affiliation: Central Virology Laboratory, Public Health Services, Ministry of Health and Chaim Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: Yossi
authors.initials: Y
authors.lastname: Manor
authors.affiliation: Central Virology Laboratory, Public Health Services, Ministry of Health and Chaim Sheba Medical Center, Tel-Hashomer, Israel; Tel Aviv University, Tel-Aviv, Israel.
authors.forename: Lester
authors.initials: L
authors.lastname: Shulman
authors.affiliation: Central Virology Laboratory, Public Health Services, Ministry of Health and Chaim Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: Daniela
authors.initials: D
authors.lastname: Ram
authors.affiliation: Chaim Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: Galia
authors.initials: G
authors.lastname: Barkai
authors.affiliation: Virology Laboratory, Soroka University Medical Center, Beer-Sheva, Israel.
authors.forename: Yonat
authors.initials: Y
authors.lastname: Shemer
authors.affiliation: Clinical Virology Unit, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
authors.forename: Dana
authors.initials: D
authors.lastname: Wolf
authors.affiliation: Virology Laboratory, Rambam Health Care Campus, Haifa, Israel.
authors.forename: Zipi
authors.initials: Z
authors.lastname: Kra-Oz
authors.affiliation: Central Virology Laboratory, Public Health Services, Ministry of Health and Chaim Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: Leah
authors.initials: L
authors.lastname: Weiss
authors.affiliation: Central Virology Laboratory, Public Health Services, Ministry of Health and Chaim Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: Rakefet
authors.initials: R
authors.lastname: Pando
authors.affiliation: Central Virology Laboratory, Public Health Services, Ministry of Health and Chaim Sheba Medical Center, Tel-Hashomer, Israel; Tel Aviv University, Tel-Aviv, Israel.
authors.forename: Musa
authors.initials: M
authors.lastname: Hindiyeh
authors.affiliation: Central Virology Laboratory, Public Health Services, Ministry of Health and Chaim Sheba Medical Center, Tel-Hashomer, Israel.
authors.forename: Danit
authors.initials: D
authors.lastname: Sofer
mesh_terms: D012634:Bodily Secretions / Q000821:virology; D002648:Child; D002675:Child, Preschool; D004770:Enterovirus / Q000145:classification / Q000302:isolation & purification*; D004769:Enterovirus Infections / Q000453:epidemiology* / Q000821:virology*; D005243:Feces / Q000821:virology; D005260:Female; D006801:Humans; D007223:Infant; D007557:Israel / Q000453:epidemiology; D008297:Male; D060888:Real-Time Polymerase Chain Reaction; D012141:Respiratory Tract Infections / Q000453:epidemiology* / Q000821:virology*; D012189:Retrospective Studies; D017422:Sequence Analysis, DNA; D012722:Sewage / Q000821:virology*; D015678:Viral Structural Proteins / Q000235:genetics
chemical_list: D012722:Sewage; D015678:Viral Structural Proteins
keywords: Enterovirus D68; Respiratory illness; VP1 sequencing