{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,21]],"date-time":"2026-05-21T13:08:36Z","timestamp":1779368916809,"version":"3.53.0"},"reference-count":47,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,4,4]],"date-time":"2026-04-04T00:00:00Z","timestamp":1775260800000},"content-version":"vor","delay-in-days":3,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["PI22CIII\u201300035"],"award-info":[{"award-number":["PI22CIII\u201300035"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004587","name":"Instituto de Salud Carlos III","doi-asserted-by":"publisher","award":["FI23CIII\/00010"],"award-info":[{"award-number":["FI23CIII\/00010"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Journal of Medical Virology"],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Enterovirus D68 (EV\u2010D68) is a significant cause of respiratory and neurological disease worldwide. In 2024, Spain experienced its largest recorded EV\u2010D68 outbreak, accounting for 37.4% of all typed EV (294\/892). This study describes the epidemiological, clinical, and phylogenetic features of EV\u2010D68 infections. Unexpectedly, EV\u2010D68 infections as it seems were more frequent in adults than in children (57.2% vs. 42.8%,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.05), particularly among individuals &gt;\u200960 years (38.6%). In 84.9% of cases with an EV\u2010D68 infection, EV\u2010D68 was the sole pathogen detected. Respiratory pathologies predominated (91.9%), with bronchospasm\/wheezing episodes and bronchiolitis in children, and pneumonia and exacerbations of chronic obstructive pulmonary disease in older adults (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.05). Older patients showed a more severe clinical profile than pediatric patients, including higher hospitalization rates (79% vs. 59%), longer hospital stays (mean, 10.8 vs. 4.9 days), and more comorbidities (50% vs. 31%) (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.01). Phylogenetic analysis revealed two co\u2010circulating lineages with distinct age\u2010related tropisms: B3.3 mainly affected children (88.5%), whereas the novel A2\/D1.1 infected adults predominantly (79.6%), particularly \u2265\u200960 years (49.5%) (\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.05). This pattern may reflect lineage\u2010specific amino acid substitutions enhancing immune evasion. Neurological disease occurred in only three patients &gt;\u200960 years infected by the A2\/D1.1 lineage, which contained neurovirulent substitutions (I553L, K835E, and T860N). Results support continued genomic and clinical surveillance of EV\u2010D68.\n                  <\/jats:p>","DOI":"10.1002\/jmv.70887","type":"journal-article","created":{"date-parts":[[2026,4,4]],"date-time":"2026-04-04T10:25:22Z","timestamp":1775298322000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Epidemiological and Clinical Characteristics of the Enterovirus D68 Outbreak in Spain in 2024"],"prefix":"10.1002","volume":"98","author":[{"given":"Juan","family":"Camacho","sequence":"first","affiliation":[{"name":"Enterovirus and Viral Gastroenteritis Laboratory, National Centre of Microbiology Instituto de Salud Carlos III Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nerea","family":"Garc\u00eda\u2010Ib\u00e1\u00f1ez","sequence":"additional","affiliation":[{"name":"Enterovirus and Viral Gastroenteritis Laboratory, National Centre of Microbiology Instituto de Salud Carlos III Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Dolores","family":"Fern\u00e1ndez\u2010Garc\u00eda","sequence":"additional","affiliation":[{"name":"Enterovirus and Viral Gastroenteritis Laboratory, National Centre of Microbiology Instituto de Salud Carlos III Madrid Spain"},{"name":"Translational Research Network in Pediatric Infectious Diseases (RITIP) Institute for Health Research IdiPAZ Madrid Spain"},{"name":"CIBERESP, Instituto de Salud Carlos III Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasmin","family":"Biya","sequence":"additional","affiliation":[{"name":"Enterovirus and Viral Gastroenteritis Laboratory, National Centre of Microbiology Instituto de Salud Carlos III Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Estrella","family":"Ruiz de Pedro","sequence":"additional","affiliation":[{"name":"Enterovirus and Viral Gastroenteritis Laboratory, National Centre of Microbiology Instituto de Salud Carlos III Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Almudena","family":"Guti\u00e9rrez","sequence":"additional","affiliation":[{"name":"Hospital U. La Paz Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Carmen","family":"Nieto","sequence":"additional","affiliation":[{"name":"Instituto de Investigaci\u00f3n Sanitaria Biobizkaia Hospital Universitario Basurto Bilbao Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Montserrat","family":"Ruiz\u2010Garc\u00eda","sequence":"additional","affiliation":[{"name":"Hospital General U. de Elche Alicante Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Teresa","family":"Pastor\u2010Fajardo","sequence":"additional","affiliation":[{"name":"Hospital General U. de Elche Alicante Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eduardo","family":"Lagarejos","sequence":"additional","affiliation":[{"name":"Hospital U. de Gran Canaria Dr. Negr\u00edn Las Palmas de Gran Canaria Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"de Leonardo Sim\u00f3n","sequence":"additional","affiliation":[{"name":"Hospital U. de Gran Canaria Dr. Negr\u00edn Las Palmas de Gran Canaria Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Navascu\u00e9s","sequence":"additional","affiliation":[{"name":"Hospital U. de Navarra Pamplona Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonio","family":"Moreno\u2010Doc\u00f3n","sequence":"additional","affiliation":[{"name":"Hospital Cl\u00ednico U. 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