Detection of Enterovirus D68 in wastewater samples from the United Kingdom during outbreaks reported globally between 2015 and 2018

Detection of enterovirus D68 (EV-D68) in wastewater samples from the UK between December 2014 and December 2018 showed a marked seasonal distribution with a high proportion of samples containing EV-D68 during periods when identification of this virus in clinical samples was most common. This includes a recent upsurge of EV-D68 detection in respiratory samples from the United Kingdom between August and December 2018 associated with cases of acute flaccid myelitis, following similar reports in the USA. Phylogenetic analysis of EV-D68 sewage strains demonstrated that strains belonging to distinct genetic clades followed the same temporal distribution as that observed for EV-D68 clinical strains in the UK and that they showed very close genetic relationship with EV-D68 strains circulating elsewhere in the world during the same periods. The results demonstrated a clear association between detecting EV-D68 in wastewater and finding it in clinical samples which was somehow unexpected given that EV-D68 is rarely detected in stool samples. We conclude that the use of environmental surveillance is a valuable tool to detect and monitor outbreaks due to EV-68 infection.