Retrospective point-prevalence study of Enterovirus D68 (EV-D68) detection in the symptomatic paediatric population presenting to the Children’s Hospital Emergency Department, RBHSC, Northern Ireland

Enterovirus D68 (EV-D68) detection has recently been associated with severe neurological symptoms in adults and children in European countries. The spectrum of disease by EV-D68 ranges from asymptomatic to acute respiratory symptoms, hospitalisation, and sporadically to neurological symptoms, including acute flaccid paralysis (AFP) and acute flaccid myelitis (AFM), and death. This has led to increased vigilance for detection of enterovirus D68, especially in cases that present with the more severe clinical syndromes. In normal cases, enterovirus is transmitted by faecal-oral routes and/or respiratory routes, however in the case of EV-D68 it is almost exclusively passed through respiratory transmission. An infection of EV-D68 is generally distinguished by its rapid onset of disease. The incubation period of the disease between 3 to 5 days, which is unlike the other enteroviruses which usually have an incubation period of around 10 days. This study describes a retrospective analysis of 150 non-invasive respiratory specimens (nose/throat or throat swabs) collected from paediatric outpatients presenting to Childrens Hospital Emergency Department with respiratory and/or CNS symptoms including fever and seizure. Specimens have been collected from November 2017- November 2018. All specimens tested by four RT-PCR assays for Pan-Enterovirus, EV-D68 specific, human Rhinovirus and RNaseP (quality control). Results on prevalence of EV-D68, as single or co-infection, are presented. Results indicate low prevalence of EV-D68 in the Northern Ireland symptomatic paediatric population. As EV-D68 is an emerging infection it is critical to remain vigilant particularly in the case of neurological presentation.