Molecular epidemiology of an enterovirus A71 outbreak associated with severe neurological disease, Spain, 2016
Author
González-Sanz, Rubén
Casas-Alba, Didac
Launes, Cristian
Ruiz-García, María Montserrat
Alonso, Mercedes
González-Abad, María José
Megías, Gregoria
Rabella, Nuria
Del Cuerpo, Margarita
Gozalo Margüello, Mónica
González-Praetorius, Alejandro
Martínez-Sapiña, Ana
Goyanes-Galán, María José
Romero, María Pilar
Calvo, Cristina
Antón, Andrés
Imaz, Manuel
Aranzamendi, Maitane
Hernández-Rodríguez, Águeda
Moreno-Docón, Antonio
Rey-Cao, Sonia
Navasués, Ana
Otero, Almudena
Cabrerizo, María
Publication date
2019-02ISSN
1560-7917
Abstract
Enterovirus 71 (EV-A71) is a small, non-enveloped, single-stranded RNA virus that belongs to the species Enterovirus A along with 24 other serotypes within the Enterovirus genus [1]. According to the VP1 protein sequence, EV-A71 is classified into six genogroups (A–F) and a number of subgenogroups (B0–B5, C1–C5) [2]. Although EV-A71 infection is often asymptomatic, it can cause disorders with a wide range of clinical manifestations from non-specific febrile illness, aseptic meningitis and mild mucocutaneous symptoms to severe neurological diseases such as brainstem encephalitis and acute flaccid paralysis (AFP) [3,4]. EV-A71 is distributed worldwide. However, the largest outbreaks associated with hand, foot and mouth disease (HFMD) with subsequent neurological and cardiopulmonary complications have been described in the Asia-Pacific region, especially in the past 20 years [2,5-7]. These outbreaks have been connected to the circulation of different subgenogroups (B3, B4, C1, C2 and C4) [8-14]. In Europe, although outbreaks of polio-like disease occurred in Hungary and Bulgaria in the 1970s [15,16], only sporadic cases have been reported from several countries in recent years, mainly caused by the C1 and C2 subgenogroups [2,17]. In 2015, a new recombinant EV-A71 variant was identified that affected at least 19 young children in different areas of Germany [18]. This infection was associated with neurological manifestations (cerebral seizures, myoclonia and ataxia) that required hospitalisation. There were no reports of fatal cases or clinical sequelae after hospital discharge. Moreover, a well-documented case, a 2-year-old girl, required hospitalisation and was diagnosed with brainstem encephalitis and cardiopulmonary complications with an outcome of a probable persistent neurological impairment [19]. In addition, 18 cases of severe neurological disease associated with EV-A71 infection, and phylogenetically closely related to the strains described in Germany, were reported in France between May and October 2016. Patients presented with rhombencephalitis, encephalitis or encephalomyelitis, and one fatal case of acute cardiac failure was reported [20]. The same strain was also involved in a sporadic case of encephalitis in Poland during summer 2016 [21]. In Spain, EV-A71 was circulating at a very low rate until 2015 [22,23]. In the spring of 2016, however, a large outbreak associated with severe neurological diseases was reported in the region of Catalonia [24-26] and further disseminated to the rest of the country. In the present study, we investigated the clinical manifestations of EV-A71 infections and the molecular epidemiology and geographical spread of the strains detected in Spain in 2016, comparing them to strains circulating in Spain and other countries in recent years.
Document Type
Article
Document version
Published version
Language
English
Subject (CDU)
61 - Medical sciences
616.8 - Neurology. Neuropathology. Nervous system
Keywords
Epidemiologia
Neurologia
Virus
Meningitis
Encefalomielitis
Epidemiología
Neurología
Virus
Meningitis
Encefalomielitis
Epidemiology
Neurology
Virus
Meningitis
Encephalomyelitis
Pages
9
Publisher
European Centre for Disease Prevention and Control (ECDC)
Collection
24; 7
Is part of
Eurosurveillance
Citation
González-Sanz, Rubén; Casas-Alba, Didac; Launes, Cristian [et al.]. Molecular epidemiology of an enterovirus A71 outbreak associated with severe neurological disease, Spain, 2016. Eurosurveillance, 2019, 24(7), 1800089. Disponible en: <https://www.eurosurveillance.org/content/10.2807/1560-7917.ES.2019.24.7.1800089>. Fecha de acceso: 14 may. 2021. DOI: 10.2807/1560-7917.ES.2019.24.7.1800089
This item appears in the following Collection(s)
- Ciències de la Salut [740]
Rights
This is an open-access article distributed under the terms of the Creative Commons Attribution (CC BY 4.0) Licence. You may share and adapt the material, but must give appropriate credit to the source, provide a link to the licence, and indicate if changes were made. This article is copyright of the authors or their affiliated institutions, 2019.
Except where otherwise noted, this item's license is described as https://creativecommons.org/licenses/by/4.0/