{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T14:52:36Z","timestamp":1786978356384,"version":"build-2736575974"},"reference-count":30,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T00:00:00Z","timestamp":1786924800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["32170942"],"award-info":[{"award-number":["32170942"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["32470996"],"award-info":[{"award-number":["32470996"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"award":["32170942"],"award-info":[{"award-number":["32170942"]}],"id":[{"id":"https:\/\/ror.org\/01h0zpd94","id-type":"ROR","asserted-by":"publisher"}]},{"award":["32470996"],"award-info":[{"award-number":["32470996"]}],"id":[{"id":"https:\/\/ror.org\/01h0zpd94","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Nantong Municipal Key Medical Discipline"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>Enterovirus D68 (EV-D68) is a re-emerging pathogen associated with severe acute flaccid myelitis (AFM) and pneumonia, predominantly in children but also capable of causing severe disease in immunocompromised adults. Seroprevalence data are essential for understanding population immunity, age-specific susceptibility, and viral transmission dynamics; yet, such data for the period after the COVID-19 pandemic are scarce. We conducted a cross-sectional serological survey to characterize the neutralizing antibody profile of EV-D68 among children in Xiamen, China, in 2022. A total of 453 children aged 0\u201316 years (217 with acute respiratory tract infection [ARTI] and 236 without) were enrolled. Neutralizing antibody (NtAb) titers against the EV-D68 STL strain were measured using a microneutralization assay, seropositivity was defined as a titer \u22651:16. Multivariable regression and analysis of covariance were used to adjust for age and sex. Overall seroprevalence was 96.0% (435\/453), exceeding 90.0% in every age subgroup (0\u20131 y: 100%; 1\u20133 y: 97.6%; 3\u20135 y: 92.6%; \u22655 y: 96.2%). The geometric mean titer (GMT) was 76.78 (95% CI: 68.32\u201385.24). After adjustment, ARTI status was not significantly associated with seropositivity (adjusted OR = 1.42, 95% CI: 0.46\u20134.41, p = 0.542). In an exploratory comparison, children with ARTI showed nominally higher antibody titers than those without (Mann\u2013Whitney U test, p = 0.003), although the absence of EV-D68-specific PCR testing precludes etiologic attribution of respiratory symptoms to EV-D68 infection. Infants &lt; 1 year showed the highest GMT (86.31), while children aged 1\u20133 years had the lowest GMT (63.52) and the largest low-titer fraction, indicating a susceptibility gap. Our study revealed EV-D68 circulated endemically in this pediatric population, establishing a high population immune baseline (&gt;90.0%) with distinct age-dependent patterns. These findings provide key reference data for ongoing serosurveillance, outbreak risk assessment, and the evaluation of future vaccines or immunoprophylactic strategies should they become available.<\/jats:p>","DOI":"10.3390\/v18080903","type":"journal-article","created":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T13:42:17Z","timestamp":1786974137000},"page":"903","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Seroepidemiology of Enterovirus D68 in Xiamen Children: A Cross-Sectional Study in 2022"],"prefix":"10.3390","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7168-1585","authenticated-orcid":false,"given":"Liting","family":"Wang","sequence":"first","affiliation":[{"name":"Infectious Disease Department, Children\u2019s Hospital of Fudan University, National Children\u2019s Medical Center, Shanghai 201102, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qiguo","family":"Zhu","sequence":"additional","affiliation":[{"name":"Xiamen Children\u2019s Hospital, Xiamen Branch of Children\u2019s Hospital of Fudan University, Xiamen 361006, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yi","family":"Lu","sequence":"additional","affiliation":[{"name":"Xiamen Children\u2019s Hospital, Xiamen Branch of Children\u2019s Hospital of Fudan University, Xiamen 361006, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuanyuan","family":"Wu","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, School of Life Sciences, School of Public Health, Xiamen University, Xiamen 361005, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhifeng","family":"Ke","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, School of Life Sciences, School of Public Health, Xiamen University, Xiamen 361005, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7516-9965","authenticated-orcid":false,"given":"Qingbing","family":"Zheng","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, School of Life Sciences, School of Public Health, Xiamen University, Xiamen 361005, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Longfa","family":"Xu","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, School of Life Sciences, School of Public Health, Xiamen University, Xiamen 361005, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1638-6214","authenticated-orcid":false,"given":"Tong","family":"Cheng","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, School of Life Sciences, School of Public Health, Xiamen University, Xiamen 361005, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rui","family":"Zhu","sequence":"additional","affiliation":[{"name":"State Key Laboratory of Vaccines for Infectious Diseases, Xiang An Biomedicine Laboratory, School of Life Sciences, School of Public Health, Xiamen University, Xiamen 361005, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8759-6921","authenticated-orcid":false,"given":"Jun","family":"Shen","sequence":"additional","affiliation":[{"name":"Infectious Disease Department, Children\u2019s Hospital of Fudan University, National Children\u2019s Medical Center, Shanghai 201102, China"},{"name":"Pediatric Department, Children\u2019s Hospital of Fudan University at Qidong, Nantong 226200, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e64","DOI":"10.1016\/S1473-3099(15)00543-5","article-title":"Global emergence of enterovirus D68: A systematic review","volume":"16","author":"Midgley","year":"2016","journal-title":"Lancet Infect. Dis."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"70","DOI":"10.15585\/mmwr.mm7304a1","article-title":"Surveillance for Acute Flaccid Myelitis\u2014United States, 2018\u20132022","volume":"73","author":"Whitehouse","year":"2024","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1093\/oxfordjournals.aje.a120693","article-title":"A probable new human picornavirus associated with respiratory diseases","volume":"85","author":"Schieble","year":"1967","journal-title":"Am. J. Epidemiol."},{"key":"ref_4","first-page":"798","article-title":"Severe respiratory illness associated with enterovirus D68\u2014Missouri and Illinois, 2014","volume":"63","author":"Midgley","year":"2014","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e0046925","DOI":"10.1128\/jcm.00469-25","article-title":"Enhanced genomic surveillance of enteroviruses reveals a surge in enterovirus D68 cases, the Johns Hopkins health system, Maryland, 2024","volume":"63","author":"Fall","year":"2025","journal-title":"J. Clin. Microbiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2577","DOI":"10.1099\/vir.0.79925-0","article-title":"Enterovirus 68 is associated with respiratory illness and shares biological features with both the enteroviruses and the rhinoviruses","volume":"85","author":"Oberste","year":"2004","journal-title":"J. Gen. Virol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1200","DOI":"10.3201\/eid2506.181759","article-title":"Increase in Enterovirus D68 Infections in Young Children, United Kingdom, 2006\u20132016","volume":"25","author":"Kamau","year":"2019","journal-title":"Emerg. Infect. Dis."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"539","DOI":"10.3201\/eid2803.211467","article-title":"Neutralizing Enterovirus D68 Antibodies in Children after 2014 Outbreak, Kansas City, Missouri, USA","volume":"28","author":"Livingston","year":"2022","journal-title":"Emerg. Infect. Dis."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1800671","DOI":"10.2807\/1560-7917.ES.2019.24.35.1800671","article-title":"Enterovirus D68 serosurvey: Evidence for endemic circulation in the Netherlands, 2006 to 2016","volume":"24","author":"Karelehto","year":"2019","journal-title":"Euro Surveill."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"e76609","DOI":"10.7554\/eLife.76609","article-title":"Changes in transmission of Enterovirus D68 (EV-D68) in England inferred from seroprevalence data","volume":"12","author":"Lambert","year":"2023","journal-title":"Elife"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e29947","DOI":"10.1002\/jmv.29947","article-title":"Seroprevalence of enterovirus D68 in Yamagata, Japan, between 1976 and 2019","volume":"96","author":"Itagaki","year":"2024","journal-title":"J. Med. Virol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2607","DOI":"10.1002\/jmv.27381","article-title":"Seroepidemiology of enterovirus D68 infection in Kuala Lumpur, Malaysia between 2013 and 2015","volume":"94","author":"Chan","year":"2022","journal-title":"J. Med. Virol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"100938","DOI":"10.1016\/j.lanmic.2024.07.001","article-title":"Global age-stratified seroprevalence of enterovirus D68: A systematic literature review","volume":"6","author":"Jorgensen","year":"2025","journal-title":"Lancet Microbe"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"3524","DOI":"10.1002\/jmv.26132","article-title":"Seroepidemiology of enterovirus D68 in a healthy population in Beijing, China, between 2012 and 2017: A retrospective study","volume":"93","author":"Liu","year":"2021","journal-title":"J. Med. Virol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"e32","DOI":"10.1038\/emi.2017.14","article-title":"Seroepidemiology of enterovirus D68 infection in China","volume":"6","author":"Xiang","year":"2017","journal-title":"Emerg. Microbes Infect."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1038\/s41426-018-0103-4","article-title":"A cross-sectional seroepidemiology study of EV-D68 in China","volume":"7","author":"Sun","year":"2018","journal-title":"Emerg. Microbes Infect."},{"key":"ref_17","first-page":"e917","article-title":"Epidemiological and Clinical Insights into the Enterovirus D68 Upsurge in Europe 2021\u20132022 and Emergence of Novel B3-Derived Lineages, ENPEN Multicentre Study","volume":"230","author":"Simoes","year":"2024","journal-title":"J. Infect. Dis."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e70497","DOI":"10.1002\/jmv.70497","article-title":"Global Evolution and Transmission Dynamics of Enterovirus D68","volume":"97","author":"Xiao","year":"2025","journal-title":"J. Med. Virol."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Hodcroft, E.B., Dyrdak, R., Andr\u00e9s, C., Egli, A., Reist, J., Garc\u00eda Mart\u00ednez de Artola, D., Alcoba-Fl\u00f3rez, J., Niesters, H.G.M., Ant\u00f3n, A., and Poelman, R. (2022). Evolution, geographic spreading, and demographic distribution of Enterovirus D68. PLoS Pathog., 18.","DOI":"10.1371\/journal.ppat.1010515"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1038\/s41564-018-0275-7","article-title":"Atomic structures of enterovirus D68 in complex with two monoclonal antibodies define distinct mechanisms of viral neutralization","volume":"4","author":"Zheng","year":"2019","journal-title":"Nat. Microbiol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1159\/000531853","article-title":"Seroprevalence of Enterovirus D68 Infection among Humans: A Systematic Review and Meta-Analysis","volume":"66","author":"Shi","year":"2023","journal-title":"Intervirology"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"956","DOI":"10.1038\/s41598-025-30467-7","article-title":"Subclade B3 and D3 enterovirus D68 among children with severe community-acquired pneumonia in China, 2021 to 2024","volume":"16","author":"Zhou","year":"2025","journal-title":"Sci. Rep."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"127145","DOI":"10.1016\/j.micres.2022.127145","article-title":"Longitudinal survey of humoral and cellular response to SARS-CoV-2 infection in children","volume":"264","author":"Lara","year":"2022","journal-title":"Microbiol. Res."},{"key":"ref_24","first-page":"2315","article-title":"Duration of Enterovirus D68 RNA Shedding in the Upper Respiratory Tract and Transmission among Household Contacts, Colorado, USA","volume":"29","author":"Thompson","year":"2023","journal-title":"Emerg. Infect. Dis."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e70103","DOI":"10.1002\/jmv.70103","article-title":"Performance Evaluation of Molecular Detection of Enteroviruses: Results of 18 Years of Quality Control for Molecular Diagnostics (QCMD) External Quality Assessment Program, 2005\u20132022","volume":"96","author":"Benschop","year":"2024","journal-title":"J. Med. Virol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e0366021","DOI":"10.1128\/mbio.03660-21","article-title":"Cross-Reactive Antibody Responses against Nonpoliovirus Enteroviruses","volume":"13","author":"Rosenfeld","year":"2022","journal-title":"mBio"},{"key":"ref_27","unstructured":"WHO Expert Committee on Biological Standardization (2022). Report on the WHO Collaborative Study to Establish the 1st International Standard for Anti-EV-D68 Serum (Human), World Health Organization. Available online: https:\/\/www.who.int\/publications\/m\/item\/WHO-BS-2022.2418."},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"Gong, L., Wang, Y., Zhang, W., Chen, C., Yang, X., Xu, L., Zhao, C., Jiang, L., Yuan, Z., and Xia, Z. (2020). Acute Flaccid Myelitis in Children in Zhejiang Province, China. Front. Neurol., 11.","DOI":"10.3389\/fneur.2020.00360"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Wang, X., Zhang, P., Li, J., Chu, Y., Li, Z., Yang, Y., Li, F., Cui, S., Huo, D., and Wang, Y. (2020). Enterovirus D68 in a 6-year-old acute flaccid myelitis case in China, 2018: A case report. BMC Infect. Dis., 20.","DOI":"10.1186\/s12879-020-4829-y"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e0192825","DOI":"10.1128\/spectrum.01928-25","article-title":"Environmental surveillance reveals enterovirus diversity in Jinan, China: Detection of types D68, A71, A76, B88, A90, and C99","volume":"14","author":"Wang","year":"2026","journal-title":"Microbiol. Spectr."}],"container-title":["Viruses"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1999-4915\/18\/8\/903\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,17]],"date-time":"2026-08-17T13:46:07Z","timestamp":1786974367000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1999-4915\/18\/8\/903"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,17]]},"references-count":30,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2026,8]]}},"alternative-id":["v18080903"],"URL":"https:\/\/doi.org\/10.3390\/v18080903","relation":{},"ISSN":["1999-4915"],"issn-type":[{"value":"1999-4915","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,17]]}}}