Enterovirus D68 Subclade B3 Strain Circulating and Causing an Outbreak in the United States in 2016

Figures

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  Figure 1. Weekly distribution of RhV/EV-positive nasopharyngeal (NP) specimens detected by the FilmArray Respiratory Panel assay, 2014 through October 2016.

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  Figure 2. (A) Enterovirus D68 detected by an EV-D68-specific rRT-PCR assay in nasopharyngeal (NP) specimens collected from 2013 through October 2016; (B) Map of counties in the Lower Hudson Valley, New York and distribution on the number of patients with enterovirus D68 detected from respiratory samples in 2016. One hundred forty-nine (n = 149) of 160 (93.1%) confirmed cases in 2016 were from this region. The star indicates the site of the Westchester Medical Center. Map was adapted with permission from the New York State Department of Environmental Conservation website (http://www.dec.ny.gov/outdoor/7804.html).

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  Figure 3. (A) Collapsed phylogenetic tree of enterovirus D68 based on nucleotide sequences of 341 complete or nearly complete genomes. Please refer to supplemental Figure S1 for a detailes phylogenetic tree with sequence accession numbers and strain information. Strains of EV-D70 and EV-D90 were used as outgroup; (B) An enlarged phylogenetic tree of EV-D68 subclade B3 strains (n = 50). Strains from China (CHN) and Taiwan (TWN) were shown in red and pink, respectively, whereas strains from the US were shown in green. One strain representing each of other subtypes (clades A, C and D, subclades B1 and B2, and prototype) was included for comparison. The numbers at each branch node are the % of nucleotide sequence identify.

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  Figure 4. Amino acid (aa) polymorphisms of Enterovirus D68 subclade B3 based on the entire polypeptide sequences of approximate 2,190 aa. Twenty-eight amino acid polymorphisms were identified in subclade B3 strains from the US in 2016, as compared to those of subclade B1 strains from US in 2014. Of these, 7 amino acid substitutions that were first described in this report are highlighted in red with corresponding amino acid position numbers. See Fig. 3 for a list of subclade B3 strains included (n = 50). Twenty subclade B1 strains from New York in 2014 were used to generate the graphic presentation for the B1_USA. Amino acid position was based on the EV-D68 subclade B1 strain NY120 (accession #:KP745751).