淺談腸病毒D68型

Enterovirus type D68

腸病毒D68型（EV-D68）首見於美國1962年的一波流行中，從四位患有嚴重下呼吸道感染的兒童檢體中被分離出來。相較於其他腸病毒，EV-D68擁有獨特的基因、物理生化及臨床表現。在1962年後40餘年，EV-D68是最罕見被鑑定出來的基因型之一，僅有少部份的群突發被報導出來。從2014年8月開始，一波由美國開始，逐漸擴及加拿大、歐洲及亞洲的全球大流行被注意到。在此波大流行中，超過2,000例被確診為腸病毒D68型感染。兒童是最常見的感染族群，且絕大部分EV-D68感染的兒童均需住院治療，甚至可能需要入住到加護病房。而嚴重的急性下呼吸道感染與急性肢體無力，是最常見的嚴重併發症。東南亞地區從2005年開始，每年也零星有EV-D68感染的病例報告出現。台灣從2014年大流行開始監測以來，每年均有零星個案通報。本文主要是回顧目前有關EV-D68感染的臨床研究，就流行病學、臨床症狀、併發症及死亡率，作一簡單的介紹。目前我們對於EV-D68的了解仍十分匱乏，由於其嚴重的併發症，目前針對兒童發生不明原因的嚴重下呼吸道感染及急性肢體無力個案，衛生主管單位應考慮發展針對EV-D68準確且快速的偵測系統，並建立合適的感染管制政策。

Enterovirus-D68 (EV-D68) was first isolated from 4 children suffered from severe respiratory tract infection and pneumonia in 1962. Compared to other enteroviruses, it has unique genomic and physicochemical properties. In the recent 4 decades, it was one of the most rarely identified genotypes of enteroviruses. In August 2014, a nationwide outbreak of EV-D68 was recognized in the United States. Subsequently, EV-D68 spread to Europe, Canada, and Asia. In this outbreak, more than 2000 cases of EV-D68 infection were identified. Meanwhile, clinical cases of severe lower respiratory tract infection and acute flaccid paralysis also significantly increased. Children were the main affected population and most of them required hospitalization and sometimes intensive care. In Southeast Asia, EV-D68 infection has been recognized since 2005. After the 2014 outbreak, only a few cases were reported annually in Taiwan. In this article, we review published reports and demonstrate the current global epidemiology, clinical features, complications, and mortality of EV-D68 infection. The clinical severity and neurological complications of EV-D68 infection highlight a need for improvement of both diagnostic work-up and infection control of severe pediatric respiratory illnesses of unknown origin.