Virology Surveillance and Research Section, Department of Microbiological Diagnostics and Virology, Statens Serum Institut, Copenhagen, Denmark.
Virology Surveillance and Research Section, Department of Microbiological Diagnostics and Virology, Statens Serum Institut, Copenhagen, Denmark; Center for Global Health and Department of Infectious Diseases, Clinical Institute, University of Southern Denmark, Odense, Denmark.
Lancet Infect Dis. 2016 May;16(5):e64-e75. doi: 10.1016/S1473-3099(15)00543-5. Epub 2016 Feb 24.
Since its discovery in California in 1962, reports of enterovirus D68 have been infrequent. Before 2014, infections were confirmed in only 699 people worldwide. In August, 2014, two paediatric hospitals in the USA reported increases in the number of patients with severe respiratory illness, with an over-representation in children with asthma. Shortly after, the authorities recognised a nationwide outbreak, which then spread to Canada, Europe, and Asia. In 2014, more than 2000 cases of enterovirus D68 were reported in 20 countries. Concurrently, clusters of children with acute flaccid paralysis of unknown cause were reported in several US states and in Europe. Enterovirus D68 infection was confirmed in some of the paralysed children, but not all. Complications in patients who were severely neurologically affected resemble those caused by poliomyelitis. In this paper we systematically review reports on enterovirus D68 to estimate its global epidemiology and its ability to cause respiratory infections and neurological damage in children. We extracted data from 70 papers to report on prevalence, symptoms, hospitalisation and mortality, and complications of enterovirus D68, both before and during the large outbreak of 2014. The magnitude and severity of the enterovirus D68 outbreak underscores a need for improved diagnostic work-up of paediatric respiratory illness, not only to prevent unnecessary use of antibiotics, but also to ensure better surveillance of diseases. Existing surveillance systems should be assessed in terms of capacity and ability to detect and report any upsurge of respiratory viruses such as enterovirus D68 in a timely manner, and focus should be paid to development of preventive measures against these emerging enteroviruses that have potential for severe disease.
自 1962 年在加利福尼亚州发现以来，肠病毒 D68 的报告并不常见。在 2014 年之前，全世界仅确认了 699 例感染病例。2014 年 8 月，美国的两家儿科医院报告称，严重呼吸道疾病患者数量增加，哮喘儿童的发病率偏高。不久之后，当局确认了全国范围内的疫情爆发，随后蔓延至加拿大、欧洲和亚洲。2014 年，20 个国家报告了超过 2000 例肠病毒 D68 病例。与此同时，美国几个州和欧洲也报告了一些原因不明的急性弛缓性麻痹儿童病例群。一些瘫痪儿童被证实感染了肠病毒 D68，但并非所有儿童。严重神经受影响的患者的并发症与脊髓灰质炎引起的并发症相似。在本文中，我们系统地回顾了肠病毒 D68 的报告，以评估其全球流行病学及其在儿童中引起呼吸道感染和神经损伤的能力。我们从 70 篇论文中提取数据，报告了 2014 年大流行前后肠病毒 D68 的流行情况、症状、住院和死亡率以及并发症。肠病毒 D68 爆发的规模和严重程度突出表明，需要改进儿科呼吸道疾病的诊断工作，不仅要防止不必要地使用抗生素，还要更好地监测疾病。应根据能力和及时发现和报告肠病毒 D68 等呼吸道病毒上升的能力来评估现有监测系统，并应关注开发针对这些具有严重疾病潜力的新兴肠病毒的预防措施。
