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Enterovirus-D68-Neglected Pathogen in Acute Respiratory Infections: Insights from Croatia.
Zeljka Hruskar1, Lucija Skara Abramovic1, Ivana Ferencak1
1Microbiology Department, Croatian Institute of Public Health, 10000 Zagreb, Croatia.
Pathogens (Basel, Switzerland)
|January 28, 2026
Summary
Enterovirus-D68 (EV-D68) was confirmed in Croatia, with circulating lineages matching those in Europe. Increased surveillance is crucial for understanding EV-D68 epidemiology due to likely underreporting.
Area of Science:
- Virology
- Epidemiology
- Genomics
Background:
- Enterovirus-D68 (EV-D68) outbreaks increased globally in 2014, but remained underreported in Croatia due to limited surveillance.
- Following European outbreaks in 2022, systematic characterization of EV-D68 in Croatian respiratory samples was initiated.
Purpose of the Study:
- To confirm the presence of EV-D68 in Croatia.
- To identify circulating EV-D68 lineages through phylogenetic analysis.
- To assess the epidemiological trends of EV-D68 in the region.
Main Methods:
- Respiratory samples from patients with acute respiratory infection were tested for EV and EV-D68 using real-time RT-qPCR.
- EV-D68 positive samples were sequenced to obtain VP1 gene sequences for phylogenetic analysis.
Main Results:
- EV was detected in 2048 samples between March 2022 and December 2024.
- EV-D68 was identified in 13.1% of EV-positive samples in 2022, decreasing in 2023, and rising to 19.6% in 2024.
- Phylogenetic analysis revealed two clades, A2 and B3, with B3 dominant in 2022 and A2 newly introduced in 2024.
Conclusions:
- EV-D68 presence and circulating lineages in Croatia align with European findings.
- The lack of routine testing likely resulted in underestimating EV-D68 prevalence.
- Ongoing surveillance and genomic characterization are essential for clarifying EV-D68 epidemiology in Croatia.
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