Rapid risk assessment: Enterovirus 68 detected in the USA, Canada and Europe – Second update, 25 November 2014

Risk assessment
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European Centre for Disease Prevention and Control. Enterovirus D68 detections in the USA, Canada and Europe – Second update 25 November 2014. Stockholm: ECDC; 2014.

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​In November, France and the United Kingdom both reported sporadic cases of neurological disease involving enterovirus 68 (EV-D68) detection. As a result, ECDC has updated its rapid risk assessment on EV-D68, first triggered by reports from North America. To date, European acute flaccid paralysis (AFP)/enhanced enterovirus surveillance has not detected unusual clusters or unexpected trends.

Executive summary

In November, France and the United Kingdom both reported sporadic cases of neurological disease involving enterovirus 68 (EV-D68) detection. As a result, ECDC has updated its rapid risk assessment on EV-D68, first triggered by reports from North America. To date, European acute flaccid paralysis (AFP)/enhanced enterovirus surveillance has not detected unusual clusters or unexpected trends. In 2014, EV-D68 has been detected in at least fifteen EU/EEA countries but no epidemic clusters of severe disease have been reported. 

To date, EU/EEA countries have not reported any unusual increase in numbers of undiagnosed acute respiratory infections, clusters of neurological disease or an increase in hospital admissions.

North America

Since mid-August 2014 and as of 20 November 2014, local health authorities in 47 States and the District of Columbia in the US have notified the US Centers for Disease Control and Prevention (CDC) of 1 121 laboratory-confirmed EV-D68 infections. Some regions in Canada have also been detecting respiratory illness associated with EV-D68 infection. Since September 2014 and, as of 4 November 2014, 214 cases of EV-D68 had been confirmed by the Public Health Agency of Canada (PHAC).
 
As yet, an epidemiological link has not been established between EV-D68 and the neurological illness clusters reported in the US, but the virus has been circulating independently at several locations. The increased detection of severe EV-D68 cases may relate to the fact that the severe cases are more likely to be investigated.
 
ECDC is closely monitoring the situation and will continue to inform Member States if additional EV-68 cases are confirmed in the USA, Canada and EU/EEA Member States.

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