Reliance on laboratory-confirmed cases, which might potentially underestimate the true burden of EV-D68

The gap

Evidence profile

Sourced from the limitations section and discussion and future work of the source papers, classified as general, drawn from work published between 2024 and 2026, spanning 3 journals. Those papers have been cited 53 times in total.

Supporting evidence — 3 representative gaps

• Circulation Patterns, Genetic Diversity, and Public Health Implications of Enterovirus D68, Europe, 2014–2024 (2026) · Emerging infectious diseases · cited 4× · doi

  reliance on laboratory-confirmed cases, which might potentially underestimate the true burden of EV-D68, because milder cases frequently go undiagnosed - surveillance data might not be uniformly collected across Europe - the limited number of fully genetically characterized cases might fail to capture the full diversity of circulating strains, at least during the 2024 season

  generallimitations section
  Keywords: reliance laboratory-confirmed cases potentially underestimate true burden ev-d68
• Molecular surveillance and genomic characterization of enterovirus D68 in southern Portugal, 2024–2025 (2026) · Archives of Virology · doi

  The present study reports the detection and genomic charac- terization of EV-D68 in respiratory samples collected in Page 5 of 11 189 southern Portugal, contributing to the limited data available on EV-D68 in Portugal. EV-D68, a re-emerging respiratory pathogen increas- ingly linked to severe respiratory disease and neurological complications [1, 33], has shown genetic diversification and widespread circulation across Europe [10, 13], yet its presence in Portugal remains poorly documented.

  generaldiscussionevidence 5/5
  Keywords: respiratory portugal present reports detection genomic charac terization samples collected page southern contributing limited available
• Epidemiology of Enterovirus Genotypes in Association with Human Diseases (2024) · Viruses · cited 49× · doi

  The burden of EV infections varies across different regions. In the USA, severe res- piratory illness caused by EV-D68 were the primary concern from 2013 to 2023. In Europe,  neurological diseases linked to EV-B infections were common in most EV-infected cases,  while EV-A infections associated with HFMD were frequently reported in Asia. Currently,  most  countries  lack  standardized  EV  surveillance  systems  to  monitor  various  diseases  caused  by  EVs. As  a  result,  it  is  challenging  to  accurately  assess  the  true  impact  of  EV  infections and to provide early warnings of potential outbreaks. Therefore, establishing a  standardized EV surveillance system is essential, particularly for Asian countries with fre- quent EV outbreaks. Furthermore, detailed clinical information and EV genotyping data  from the patients must be thoroughly recorded. This information would help to identify  the spectrum of the diseases associated with different EV genotypes. Further analysis of  EV genotypes in combination with clinical features will establish the link between specific  genotypes and related diseases. This comprehensive approach to EV surveillance will sig- nificantly improve our understanding of the global burden of EV infections and can pro- vide an early warning of the potential outbreaks and guidelines for effective prevention  and control.  Author  Contributions:  K.K.,  P.K.,  and  N.M.  contributed  to  the  manuscript’s  conceptualization,  grant  acquisition,  and  revision.  Z.X.  drafted  the  original  manuscript. All  authors  have  read  and  agreed to the published version of the manuscript.  Funding: This work was supported by the Center of Excellence in Emerging and Re-emerging Di- arrheal Viruses [Grant No. RG2567], the Faculty of Medicine, Chiang Mai University, Thailand and  Youjiang Medical University for Nationalities, China.  Institutional Review Board Statement: Not applicable.  Informed Consent Statement: Not applicable.  Data Availability Statement: Not applicable.  Conflicts of Interest: The authors declare no conflict of interest.

  generalfuture workevidence 5/5
  Keywords: infections diseases surveillance outbreaks genotypes manuscript statement applicable burden erent caused associated countries standardized early

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