Enterovirus D68 and Acute Neurologic Outcomes: A Systematic Review and Meta‐Analysis (2010–2025)

= 98.9%; prediction interval 0.24-8.15). By design, respiratory surveillance studies showed stronger association (OR 1.59, 95% CI 1.35-1.86, k = 78) whereas AFM case-control studies did not (OR 0.86, 95% CI 0.40-1.86, k = 20). In multivariable meta-regression, study design and calendar year explained about 47% of inter-study variance. Predicted ORs declined from 2014 to 2022 across regions. Funnel asymmetry and small-study effects were suggested; PET-PEESE bias-adjusted estimates remained above the null. The EV-D68 outcome association is context-dependent and time-varying. Surveillance datasets enriched during outbreak waves drive the pooled signal, while AFM case-control designs yield attenuated estimates after adjustment. Standardising diagnostics and integrating design-specific surveillance will improve risk estimation and AFM preparedness.