{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,25]],"date-time":"2026-06-25T17:46:48Z","timestamp":1782409608232,"version":"3.54.5"},"reference-count":35,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T00:00:00Z","timestamp":1777593600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100013302","name":"King Abdullah International Medical Research Center","doi-asserted-by":"publisher","award":["NRC23R\/560\/08"],"award-info":[{"award-number":["NRC23R\/560\/08"]}],"id":[{"id":"10.13039\/501100013302","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Reviews in Medical Virology"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Enterovirus D68 (EV\u2010D68) has been implicated in clusters of acute flaccid myelitis (AFM) and severe respiratory illness; however, the magnitude and consistency of association across settings and over time remain uncertain. We quantified the association between EV\u2010D68 detection and acute neurologic outcomes (particularly AFM) and explored design\u2010 and time\u2010related heterogeneity. Following PRISMA 2020 and MOOSE guidance, we systematically identified observational studies reporting associations between EV\u2010D68 detection and neurologic outcomes. Random effects meta\u2010analysis was performed using REML with Knapp\u2010Hartung adjustment; heterogeneity was summarised with\n                    <jats:italic>\u03c4<\/jats:italic>\n                    <jats:sup>2<\/jats:sup>\n                    and I\n                    <jats:sup>2<\/jats:sup>\n                    . Prespecified moderators were examined with meta\u2010regression. Small\u2010study effects were evaluated using contour\u2010enhanced funnel plots, Egger and Peters tests, and PET\u2010PEESE bias\u2010adjusted models. PROSPERO registration: 1152300. Across 98 studies, the pooled odds ratio (OR) was 1.39 (95% CI 1.14\u20131.69), with high heterogeneity (I\n                    <jats:sup>2<\/jats:sup>\n                    \u00a0=\u00a098.9%; prediction interval 0.24\u20138.15). By design, respiratory surveillance studies showed stronger association (OR 1.59, 95% CI 1.35\u20131.86,\n                    <jats:italic>k<\/jats:italic>\n                    \u00a0=\u00a078) whereas AFM case\u2010control studies did not (OR 0.86, 95% CI 0.40\u20131.86,\n                    <jats:italic>k<\/jats:italic>\n                    \u00a0=\u00a020). In multivariable meta\u2010regression, study design and calendar year explained about 47% of inter\u2010study variance. Predicted ORs declined from 2014 to 2022 across regions. Funnel asymmetry and small\u2010study effects were suggested; PET\u2010PEESE bias\u2010adjusted estimates remained above the null. The EV\u2010D68 outcome association is context\u2010dependent and time\u2010varying. Surveillance datasets enriched during outbreak waves drive the pooled signal, while AFM case\u2010control designs yield attenuated estimates after adjustment. Standardising diagnostics and integrating design\u2010specific surveillance will improve risk estimation and AFM preparedness.\n                  <\/jats:p>","DOI":"10.1002\/rmv.70147","type":"journal-article","created":{"date-parts":[[2026,5,1]],"date-time":"2026-05-01T18:18:51Z","timestamp":1777659531000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Enterovirus D68 and Acute Neurologic Outcomes: A Systematic Review and Meta\u2010Analysis (2010\u20132025)"],"prefix":"10.1002","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2088-0629","authenticated-orcid":false,"given":"Asif","family":"Naeem","sequence":"first","affiliation":[{"name":"King Abdullah International Medical Research Center (KAIMRC)  Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muhammad Masroor","family":"Alam","sequence":"additional","affiliation":[{"name":"World Health Organization  Islamabad Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Musaed","family":"Alharbi","sequence":"additional","affiliation":[{"name":"King Abdullah International Medical Research Center (KAIMRC)  Riyadh Saudi Arabia"},{"name":"Department of Pediatric Infectious Diseases King Abdullah Specialist Children Hospital Ministry of National Guard\u2010Health Affairs (NGHA)  Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maymunah","family":"Hakami","sequence":"additional","affiliation":[{"name":"King Abdullah International Medical Research Center (KAIMRC)  Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1077-0872","authenticated-orcid":false,"given":"Nabeel","family":"Alzahrani","sequence":"additional","affiliation":[{"name":"King Abdullah International Medical Research Center (KAIMRC)  Riyadh Saudi Arabia"},{"name":"Department of Clinical Laboratory Sciences College of Applied Medical Sciences King Saud Bin Abdulaziz University for Health Sciences  Riyadh Saudi Arabia"},{"name":"Division of Microbiology Department of Pathology and Laboratory Medicine Ministry of the National Guard Health Affairs  Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seena","family":"Thomas","sequence":"additional","affiliation":[{"name":"King Abdullah International Medical Research Center (KAIMRC)  Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sameera","family":"Aljohani","sequence":"additional","affiliation":[{"name":"King Abdullah International Medical Research Center (KAIMRC)  Riyadh Saudi Arabia"},{"name":"Department of Clinical Laboratory Sciences College of Applied Medical Sciences King Saud Bin Abdulaziz University for Health Sciences  Riyadh Saudi Arabia"},{"name":"Division of Microbiology Department of Pathology and Laboratory Medicine Ministry of the National Guard Health Affairs  Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Bosaeed","sequence":"additional","affiliation":[{"name":"King Abdullah International Medical Research Center (KAIMRC)  Riyadh Saudi Arabia"},{"name":"Department of Pediatric Infectious Diseases King Abdullah Specialist Children Hospital Ministry of National Guard\u2010Health Affairs (NGHA)  Riyadh Saudi Arabia"},{"name":"College of Medicine King Saud Bin Abdulaziz University for Health Sciences  Riyadh Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,1]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.15585\/mmwr.mm7304a1"},{"key":"e_1_2_11_3_1","unstructured":"Centers for Disease Control and Prevention (CDC). \u201cClinical Overview of Enterovirus D68 (EV\u2010D68) \u201d [Internet]. (April 2024): [cited 2025 Sep 16] https:\/\/www.cdc.gov\/non\u2010polio\u2010enterovirus\/hcp\/clinical\u2010overview\/index.html."},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2025.9131"},{"key":"e_1_2_11_5_1","unstructured":"European Centre for Disease Prevention and Control (ECDC). \u201cFactsheet for Health Professionals on Human Non\u2010polio Enteroviruses \u201d [Internet]. 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