Networking of public health and clinical laboratories: a successful strategy to uncover promptly two enterovirus D68 outbreaks in Lombardy region (northern Italy), July 2021-November 2022
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Department of Biomedical Sciences for Health, University of Milan, Italy
Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
Fondazione IRCCS Ca’ Ganda Ospedale Maggiore Policlinico, Milano, Italy
Microbiology and Virology Laboratory, ASST “Papa Giovanni XXIII”, Bergamo, Italy
Laboratorio di Microbiologia e Virologia ASST Cremona, Italy
S.C. Microbiologia Clinica- ASST Grande Ospedale Metropolitano Niguarda, Italy
Department of Medicine and Surgery, University of Insubria, Varese, Italy; Laboratory of Microbiology, ASST Sette Laghi, Varese, Italy
S.C. Microbiologia, ASST Monza, Monza, Italy
Laboratory Medicine Department, Asst Bergamo Est, Bergamo Italy
Direzione Generale Welfare Regione Lombardia, Milano, Italy
Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
Publication date: 2023-04-26
Popul. Med. 2023;5(Supplement):A268
In Lombardy (a region in northern Italy, 10 million inhabitants), a network of public health and clinical laboratories was established to tackle and respond to emerging human infectious diseases. This study aimed at: 1) detecting and investigating the role of EVD68 in respiratory infections in Lombardy from July-2021 to November-2022; 2) describing the epidemiological features of EVD68.

From July-2021 to November-2022, respiratory samples were collected from: i) outpatients with influenza-like illness (ILI) in the framework of influenza surveillance network, ii) inpatients with severe acute respiratory infection (SARI) in 8 hospitals in Lombardy. Samples were tested for EV-RNA by all virological laboratories; the EV-positive sample were promptly tested for EVD68 by 2 second-level laboratories.

347 laboratory-confirmed EV-positive samples were detected: 139 from ILI and 208 from SARIs. EVD68 was identified in 38.6% (n=134) of EV-positive specimens. EVD68-positive individuals had a median age of 3 years (IQR: 4.5 years). EVD68-positive rate among SARI cases was statistically higher than that observed in ILIs (46.2% vs. 27.3%; p<0.0001), with a risk of infection from EVD68 3-fold higher (OR:3.0; 95%CI:1.9-4.8) in SARIs than in ILIs. EVD68 circulated with two consecutive epidemic waves. The first wave –accounting for 25% of EVD68s- started in September-2021, peaked at end of November, ended in March-2022; the second wave –accounting for 72.6% of EVD68s- started in July-2022, reached a peak in the beginning of October-2022 and is still ongoing.

The tight collaboration and close networking of public health and clinical laboratories allowed disclosing in real-time two EVD68 outbreaks in Lombardy over the last year. A greater contribution of EVD68 was observed in SARIs than in ILIs. Collaboration and networking of public health and clinical laboratory through molecular surveillance need to be advocated and endorsed as a successful key strategy to uncover and respond to emerging pathogens.