The unremitting threat: enterovirus D68, acute flaccid myelitis, and epidemiological surveillance
e202504019
Keywords:
Vigilancia Epidemiológica, Mielitis flácida aguda, enterovirus D68, Vacunas, PandemiasAbstract
The authors read with interest the article by Nguyen-Tran et al., published in Lancet Microbe, on the epidemiological surveillance of enterovirus D68 (EV-D68), an airborne ribonucleic acid (RNA) virus that causes severe respiratory symptoms. Laboratory studies in animal models indicate that this virus can also infect motor neurons in the spinal cord, leading to a poliovirus-like paralysis known as acute flaccid myelitis (AFM). Although treatments such as monoclonal antibodies and potential vaccines are being investigated in early stages, there are currently no approved therapies or vaccines to combat EV-D68 infection.
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Nguyen-Tran H, Park SW, Messacar K, Dominguez SR, Vogt MR, Permar S, Permaul P, Hernandez M, Douek DC, McDermott AB, Metcalf CJE, Grenfell B, Spaulding AB. Enterovirus D68: a test case for the use of immunological surveillance to develop tools to mitigate the pandemic potential of emerging pathogens. Lancet Microbe. 2022 Feb; 3(2): e83-e85. doi: https://dx.doi.org/10.1016/S2666-5247(21)00312-8. Epub 2022 Jan 7. PMID: 35036969; PMCID: PMC8741221.
Messacar K, Schreiner TL, Maloney JA, Wallace A, Ludke J, Oberste MS et al. A cluster of acute flaccid paralysis and cranial nerve dysfunction temporally associated with an outbreak of enterovirus D68 in children in Colorado, USA. Lancet (2015) 385 (9978):1662-1671. doi: https://dx.doi.org/10.1016/S0140-6736(14)62457-0
Skowronski DM, Chambers C, Sabaiduc S, Murti M, Gustafson R, Pollock S, Hoyano D, Rempel S, Allison S, De Serres G, Dickinson JA, Tellier R, Fonseca K, Drews SJ, Martineau C, Reyes-Domingo F, Wong T, Tang P, Krajden M. Systematic community- and hospital-based surveillance for enterovirus-D68 in three Canadian provinces, August to December 2014. Euro Surveill. 2015;20(43). doi: https://dx.doi.org/10.2807/1560-7917.ES.2015.20.43.30047
Whitehouse ER, Lopez A, English R, Getachew H, Ng TFF, Emery B, Rogers S, Kidd S. Surveillance for Acute Flaccid Myelitis-United States, 2018-2022. MMWR Morb Mortal Wkly Rep. 2024 Feb 1;73(4):70-76. doi: https://dx.doi.org/10.15585/mmwr.mm7304a1. PMID: 38300829; PMCID: PMC10843070.
Barnadas C, Midgley SE, Skov MN, Jensen L, Poulsen MW, Fischer TK. An enhanced Enterovirus surveillance system allows identification and characterization of rare and emerging respiratory enteroviruses in Denmark, 2015-16. J Clin Virol. 2017 Aug; 93:40-44. doi: https://dx.doi.org/10.1016/j.jcv.2017.05.017
González-Sanz R, Taravillo I, Reina J, Navascues A, Moreno-Docón A, Aranzamendi M, Romero MP, Del Cuerpo M, Pérez MC, Pérez S, Otero A, Cabrerizo M. Enterovirus D68-associated respiratory and neurological illness in Spain, 2014-2018. Emerging Microbes & Infections 8:1438-1444 (2019). doi: https://dx.doi.org/10.1080/22221751.2019.1668243
Raboni SM, Giamberardino HI, Debur MC, Santos JS. Enterovirus D68-associated respiratory infection in southern Brazil, 2018-A population-based laboratory surveillance. J Clin Virol. 2020 Aug; 129:104503. doi: https://dx.doi.org/10.1016/j.jcv.2020.104503. Epub 2020 Jun 11.
Ruggieri V et al. Enterovirus D68 infection in a cluster of children with acute flaccid myelitis. Buenos Aires, Argentina, 2016 Eur J Paediatr Neurol (2017).
Levy A et al. Enterovirus D68 disease and molecular epidemiology in Australia. J Clin Virol (2015).
Benschop KS, Albert J, Anton A, Andrés C, Aranzamendi M, Armannsdóttir B, Bailly JL, Baldanti F, Baldvinsdóttir GE, Beard S, Berginc N, Böttcher S, Blomqvist S, Bubba L, Calvo C, Cabrerizo M, Cavallero A, Celma C, Ceriotti F, Costa I, Cottrell S, Del Cuerpo M, Dean J, Dembinski JL, Diedrich S, Diez-Domingo J, Dorenberg D, Duizer E, Dyrdak R, Fanti D, Farkas A, Feeney S, Flipse J, De Gascun C, Galli C, Georgieva I, Gifford L, Guiomar R, Hönemann M, Ikonen N, Jeannoël M, Josset L, Keeren K, López-Labrador FX, Maier M, McKenna J, Meijer A, Mengual-Chuliá B, Midgley SE, Mirand A, Montes M, Moore C, Morley U, Murk JL, Nikolaeva-Glomb L, Numanovic S, Oggioni M, Palminha P, Pariani E, Pellegrinelli L, Piralla A, Pietsch C, Piñeiro L, Rabella N, Rainetova P, Uceda Renteria SC, Romero MP, Reynders M, Roorda L, Savolainen-Kopra C, Schuffenecker I, Soynova A, Swanink CM, Ursic T, Verweij JJ, Vila J, Vuorinen T, Simmonds P, Fischer TK, Harvala H. Re-emergence of enterovirus D68 in Europe after easing the COVID-19 lockdown, September 2021. Euro Surveill. 2021Nov;26(45):2100998. doi: https://dx.doi.org/10.2807/1560-7917.ES.2021.26.45.2100998
Fall A, Abdullah O, Han L, Norton JM, Gallagher N, Forman M, Morris CP, Klein E, Mostafa HH. Enterovirus D68: Genomic and Clinical Comparison of 2 Seasons of Increased Viral Circulation and Discrepant Incidence of Acute Flaccid Myelitis-Maryland, USA. Open Forum Infectious Diseases, Volume 11, Issue 11, November 2024, ofae656. https://dx.doi.org/10.1093/ofid/ofae656
Chow EJ, Uyeki TM, Chu HY. The effects of the COVID-19 pandemic on community respiratory virus activity. Nat Rev Microbiol 2023;21:195–210. PMID:36253478. https://dx.doi.org/10.1038/s41579-022-00807-9
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Copyright (c) 2025 Teresa Cristina Guijarro Castro, María Cabrerizo Sanz, Josefa Masa Calles

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