Upsurge in Enterovirus infections in Finl…

In Finlandenterovirus cases reported to the Finnish Institute of Health and Welfare were higher than usual.

Most cases have mild symptoms, but at least to Turku, pediatric patients have also required hospitalization due to symptoms of shortness of breath. These patients were found to have enterovirus D68, which usually causes only mild respiratory symptoms, but sometimes also shortness of breath or pneumonia.

Last year, 243 laboratory-confirmed cases of enterovirus were reported to the infectious disease registry. This year, 217 cases have been identified, and this number is expected to increase.

Reminders on Enterovirus D68

The Enterovirus genus includes 12 species identified by letters: 9 enterovirus species (A to H and J) and 3 rhinovirus species (A to C). This classification does not cover the classification based on the pathogenicity of viruses and their ability to infect certain types of cells, at the origin of the coxsakie A, coxsackie B, echovirus and poliovirus groups. Enterovirus D68 (EV-D68) corresponds to one of the five serotypes described within the Enterovirus D species.

EV-D68 was responsible for limited outbreaks of respiratory infections until 2014. From that date, an upsurge in the number of cases was noted in the United States. Many cases of respiratory infections, some of them severe, have since been reported in several European countries. EV-D68 infections occur in an epidemic fashion, most often in late summer and early fall before the usual period of epidemics of respiratory syncytial virus or influenza virus respiratory infections.

Man is the only reservoir of this virus. The respiratory tropism of EV-D68 favors aerosol transmission but faecal-oral transmission is possible because the virus can be detected in stool.

In general, infants, children and adolescents are most affected, but the clinical impact of EV-D68 infections in adults is surely underestimated. EV-D68 is responsible for a wide range of pathologies from simple rhinitis to more severe forms such as pneumonia or acute respiratory distress. The American epidemic in 2014 was marked by a high rate of severe infections with nearly two-thirds of patients admitted to intensive care, 28% having had to benefit from ventilatory assistance. In other studies, the same year, the ICU admission rate was between 6.8 and 27%.

EV-D68 infections are complicated by neurological damage that mainly presents as acute flaccid myelitis (AFM). MFA is characterized by the sudden onset of flaccid and asymmetrical paralysis of the limbs associated with a loss of reflexes and an absence of sensory deficit. Paralysis occurs seven days (1–16 days) after an infectious episode characterized by fever, respiratory and/or digestive symptoms, and myalgia. Neurological sequelae, in particular motor ones, are very frequent.

The search for VEs must be carried out in the face of any severe respiratory infection, in particular in patients admitted to intensive care and any severe neurological impairment should prompt a search for VEs in parallel with other possible etiologic agents.

Diagnosis is based on detection of the EV genome in clinical specimens (nose, throat or blood, stool, cerebrospinal fluid).

There is no standardized treatment for severe respiratory infections or neurological complications associated with EV-D68.

Prevention is based on hygiene measures. It’s necessary :

  • wash hands often with soap and water;
  • avoid touching your eyes, nose and mouth with unwashed hands;
  • avoiding close contact, such as kissing, hugging and sharing cups or cooking utensils, with sick people and when you are sick;
  • cover your mouth with a tissue when you cough or sneeze, or cough into the bend of your elbow;
  • clean and disinfect frequently touched surfaces, such as toys and doorknobs, especially if someone is sick.

Reference : Mirand A et al. Enterovirus D68: a virus with high pathogenic and epidemic potential. Virology. 2018; 22(1) 41-53.

Source: Outbreak News Today

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