Enterovirus D68 in Europe, 2025: continent-wide predominance of subclade A2/D and shift from pediatric to adult cases
Background Enterovirus D68 (EV-D68) has predominantly caused infections in children, and detected cases have mainly been infected by subclade B3. In 2025, however, a substantial number of infections in adults was noted. Aim To detail the molecular epidemiology of the 2025 season in Europe. Methods Case and sequencing data was collected from members in the European Non-Polio Enterovirus Network (ENPEN). The participating sites included both clinical and public health laboratories. Results Data was collected from 13 countries at 23 sites. There were 187 clinical cases infected with EV-D68 and 127 detections in wastewater. Age data were available for 76\% (143/187), among which 90 cases were adults. VP1-based genotyping showed subclade A2/D to predominate in all age groups and across all participating countries, as well as in the sewage sampling performed at one site. Two interclade recombinant sequences were detected among 22 whole genome sequences. Conclusion The observed shift towards adult cases and subclade A2/D predominance warrants continued monitoring to determine whether this represents a sustained epidemiological change. The detection of interclade recombinant variants highlights a need to supplement regular VP1-based genotyping with whole-genome sequencing.
Authors
- Guðrún Erna Baldvinsdóttir
- C. Patrick McClure (ORCID: https://orcid.org/0000-0002-1710-1049)
- Kimberley Benschop (ORCID: https://orcid.org/0000-0002-8328-0882)
- Kelly Bicknell (ORCID: https://orcid.org/0000-0002-4709-9162)
- Tina Uršič (ORCID: https://orcid.org/0000-0002-5621-7167)
- Antonio Piralla (ORCID: https://orcid.org/0000-0002-6062-2579)
- Miroslav Petrovec (ORCID: https://orcid.org/0000-0001-8498-7786)
- Emma B. Hodcroft (ORCID: https://orcid.org/0000-0002-0078-2212)
- Concetta Castilletti (ORCID: https://orcid.org/0000-0001-9819-236X)
- Jaco J. Verweij (ORCID: https://orcid.org/0000-0001-8553-931X)
- Elena Pomari (ORCID: https://orcid.org/0000-0002-5182-0231)
- Richard Molenkamp (ORCID: https://orcid.org/0000-0002-9004-3850)
- Davide Oggioni
- Yemisi Adedeji
- Anna Maria Eis‐Hübinger (ORCID: https://orcid.org/0000-0001-9010-8805)
- Marijke Reynders (ORCID: https://orcid.org/0000-0003-2079-1279)
- Brynja Ármannsdóttir (ORCID: https://orcid.org/0000-0003-4647-4415)
- Robert Dyrdak (ORCID: https://orcid.org/0000-0001-8456-4898)
- Elke Wollants (ORCID: https://orcid.org/0000-0002-4057-2236)
- Massimo Oggioni (ORCID: https://orcid.org/0000-0003-2709-6965)
- Natascha de Graaf (ORCID: https://orcid.org/0009-0003-6182-2868)
- Adam Meijer (ORCID: https://orcid.org/0000-0001-8074-7582)
- Morten Rasmussen (ORCID: https://orcid.org/0000-0001-7491-4137)
- Heli Harvala (ORCID: https://orcid.org/0000-0001-9154-4190)
- Sandra Broddesson (ORCID: https://orcid.org/0009-0009-3198-6400)
- Pierluigi Congedo (ORCID: https://orcid.org/0000-0002-6774-8879)
- Lize Cuypers (ORCID: https://orcid.org/0000-0002-9433-8752)
- Elena Pariani (ORCID: https://orcid.org/0000-0001-5681-3455)
- Jean‐Luc Murk (ORCID: https://orcid.org/0000-0003-3661-9035)
- Cristina Andrés (ORCID: https://orcid.org/0000-0002-3200-0895)
- Nataša Berginc (ORCID: https://orcid.org/0009-0007-9949-8230)
- Thea Kølsen Fischer (ORCID: https://orcid.org/0000-0003-4812-980X)
- Lieuwe Roorda
- Maxime Bisseux (ORCID: https://orcid.org/0000-0002-3489-049X)
- Amaresh Pérez-Argüello
- Andrés Antón (ORCID: https://orcid.org/0000-0002-1476-0815)
- Kate E Templeton (ORCID: https://orcid.org/0000-0001-7414-1277)
- Alison B. Tedcastle
- Carmen Muñoz‐Almagro (ORCID: https://orcid.org/0000-0001-5586-404X)
- Karin Jasmijn von Eije (ORCID: https://orcid.org/0000-0003-0627-5673)
- Raquel Guiomar (ORCID: https://orcid.org/0000-0002-4563-6315)
- Kafayat Arowolo (ORCID: https://orcid.org/0000-0001-7972-3284)
- Laura Pellegrinelli (ORCID: https://orcid.org/0000-0003-2344-6032)
- Marion Jeannoël
- Antonino Maria Guglielmo Pitrolo (ORCID: https://orcid.org/0009-0003-3826-8395)
- Nadia Neuner-Jehle (ORCID: https://orcid.org/0009-0001-6829-6448)
- Jorgina Vila (ORCID: https://orcid.org/0000-0001-9715-0627)
- Licínia Gomes (ORCID: https://orcid.org/0009-0009-0214-9646)
- Leo Smeets
- Isabelle Schuffenecker
- Georgina McAllister
- Audrey Mirand (ORCID: https://orcid.org/0000-0002-9638-2415)
- Rebecca Feletti (ORCID: https://orcid.org/0009-0004-6136-5668)
- Lili Andersson-Li
- Alejandra González Sánchez (ORCID: https://orcid.org/0000-0002-1809-3415)
- Aishwarya Arunagirinathan
- Javier Martín
- Joakim Øverb
- Payton Crossley
- Sophie Midgley
- Gerog Navér
Institutions
- Statens Serum Institut (DK)
- University of Copenhagen (DK)
- National Health Service (GB)
- SIB Swiss Institute of Bioinformatics (CH)
- Hospital Sant Joan de Déu Barcelona (ES)
- NHS Lothian (GB)
- Norwegian Institute of Public Health (NO)
- Karolinska University Hospital (SE)
- University of Bonn (DE)
- University of Nottingham (GB)
- University of Ljubljana (SI)
- University of Turku (FI)
- Swiss Tropical and Public Health Institute (CH)
- University of Basel (CH)
- University of Milan (IT)
- Rega Institute for Medical Research (BE)
- University Hospital Bonn (DE)
- Universitair Ziekenhuis Leuven (BE)
- Erasmus MC (NL)
- Turku University Hospital (FI)
- Copenhagen University Hospital (DK)
- Karolinska Institutet (SE)
- Universitat Internacional de Catalunya (ES)
- University of Oxford (GB)
- Portsmouth Hospitals NHS Trust (GB)
- Nordsjællands Hospital (DK)
- Ospedale Sacro Cuore Don Calabria (IT)
- Vall d'Hebron Institut de Recerca (ES)
- National Institute for Public Health and the Environment (NL)
- National University Hospital of Iceland (IS)
- Maasstad Ziekenhuis (NL)
- Vall d'Hebron Hospital Universitari (ES)
- Centre Hospitalier Universitaire de Clermont-Ferrand (FR)
- National Laboratory of Health, Environment and Food (SI)
- Queen's Medical Centre (GB)
- National Institute of Health Dr. Ricardo Jorge (PT)
- Policlinico San Matteo Fondazione (IT)
- Azienda Ospedaliera di Desio e Vimercate (IT)
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (ES)
- Medicines and Healthcare products Regulatory Agency (GB)
- KU Leuven (BE)
Publication Details
- Journal
- medRxiv
- Published
- 2026-10-26
- DOI
- https://doi.org/10.64898/2026.10.23.26366309
- Primary Topic
- Viral Infections and Immunology Research
- Type
- preprint