In late September, the Centers for Disease Control and Prevention (CDC) in the USA published a report on clusters of acute respiratory illness associated with Human Enterovirus 68 (HEV68) in Asia, Europe and the United States.¹  HEV68 is a unique enterovirus that shares epidemiological and biological features with human rhinoviruses (HRV).²

First isolated in California in 1962 from four children with bronchiolitis and pneumonia,³ HEV68 has been rarely reported since and the full spectrum of illness that it can cause is unknown. The six clusters of respiratory illness associated with HEV68 described in the report occurred in Asia, Europe and the United States from  2008 to 2010.

 HEV68 infection described in the clusters was associated with respiratory illness ranging from relatively mild illness that did not require hospitalisation to severe illness requiring intensive care and mechanical ventilation. Three cases, two in the Philippines and one in Japan, were fatal. In these six clusters, HEV68 disproportionately occurred among children.

The CDC learned of the clusters of HEV68 from public health agencies requesting consultation or diagnostic assistance and from reports presented at scientific conferences. In each cluster, HEV68 was diagnosed by reverse transcription-polymerase chain reaction (RT-PCR) testing targeting the 5'-nontranslated region, followed by partial sequencing of the structural protein genes, VP4-VP2, VP1, or both, to give definitive, enterovirus type-specific information.

This report highlights HEV68 as an increasingly recognised cause of respiratory illness. Clinicians should be aware of HEV68 as one of many causes of viral respiratory disease and should report clusters of unexplained respiratory illness to the appropriate public health agency.

 The full report is available here.  

References

1. Centers for Disease Prevention and Control. Clusters of acute respiratory illness associated with Human Enterovirus 68-Asia, Europe and United States, 2008-2010. MMWR 2011;38:1302-1304. Available here. 
2. Oberste MS, Maher K, Schnurr D, et al. Enterovirus 68 is associated with respiratory illness and shares biological features with both the enteroviruses and the rhinoviruses. J Gen Virol 2004;85:2577 - 84
3. Schieble JH, Fox VL, Lennette EH. A probable new human picornavirus associated with respiratory disease. Am J Epidemiology 1967;85:297 -310.