By Ethan Covey
An ongoing outbreak of enterovirus D68 has been tied to sewage water in Leicester, U.K., according to research presented at the 32nd European Congress of Clinical Microbiology & Infectious Diseases (ECCMID) in Lisbon, Portugal (Poster L0032).
“Enterovirus (EV) D68 and EV A71 are notable for their role in causing epidemics of hand-foot-and-mouth (HFMD) diseases in children,” said Nahed Elhefnawy, MD, a microbiology registrar at the University Hospitals of Leicester NHS Trust in the United Kingdom. “They also have been correlated with serious neurological diseases that lead to paralysis with spinal cord lesions, consistent with acute flaccid myelitis (AFM).”
“Every year, clusters of respiratory infections caused by EV D68 are identified in children, with outbreaks attending to occur biannually,” Dr. Elhefnawy added. “Since the easing of COVID-19 lockdown restrictions, there has been an upsurge in the number of EV D68 cases reported across Europe, though no cases of AFM have been reported so far.”
In Leicester, an outbreak of EV D68 has caused 71 infections in patients aged one month through 79 years. The initial case was detected in September 2021, and cases peaked in November 2021.
The patients have been predominantly male, and 29.6% have been children less than 1 year old. Most presented with mild respiratory symptoms, resulting in an average hospital stay of 3.5 days. However, five patients required ICU support, and two died.
Isolates from 69 cases were analyzed and compared with 4182 archived sequences. This showed that the sequences from the outbreak were most closely aligned with UK sewage samples collected during 2021, and were separate from human clinical samples collected during 2018-2019 from Nottingham, United Kingdom, Germany, France, Japan and the United States.
The lack of linkage to samples from non-UK sites likely reflects the fact that little international travel was occurring during the COVID-pandemic, the study authors hypothesized.
Early identification of cases is essential to preventing future outbreaks, Dr. Elhefnawy noted.
“The potential of EV to cause widespread illness emphasizes the usefulness of the early diagnosis of infection, and the effective role of control measures in viral transmission,” she said.
