Healio: Causes of 2014 EV-D68 outbreak still unknown

By Katherine Bortz

Researchers are still searching for the reasons behind a 2014 outbreak of enterovirus D68, or EV-D68, which affected more than 1,100 people nationwide.

Christopher J. Harrison, MD, professor of pediatrics at the University of Missouri-Kansas City School of Medicine and director of the Infectious Disease Research Laboratory at Children’s Mercy Hospital, and colleagues wrote that in the last 50 years, the United States has seen fewer than 100 sporadic cases and periodic outbreaks caused by EV-D68. However, in 2014, an outbreak affected 1,153 people in 49 states and Washington, D.C. Nationwide, EV-D68 patients mostly had respiratory symptoms consistent with those seen in previous outbreaks, and severe disease occurred primarily in children.

“Instead of having a few scattered cases here and there, there were hundreds,” Harrison told Infectious Diseases in Children. “When that clinical outbreak occurred, the question came up of ‘why now?’ And, ‘why in these kids?’”

“Why this large outbreak was able to occur in a population with a high prevalence of neutralizing antibody against the outbreak isolates remains unclear,” Harrison and colleagues wrote. “One possibility is that respiratory tract mucosal antibody” — probably in the form of secretory immunoglobulin A — “is more relevant than serum antibody for protection against respiratory disease. Also, certain persons could be more susceptible to severe disease because of genetic factors, pre-existing atopy or asthma, or differences in other parts of the immune response, including immunopathologic responses.”

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Learn more about the Division of Infectious Diseases at Children's Mercy