Surveillance and laboratory detection for non-polio enteroviruses in the European Union/European Economic Area, 2016

Abstract

Enteroviruses (EVs) cause severe outbreaks of respiratory and neurological disease as illustrated by EV-D68 and EV-A71 outbreaks, respectively. We have mapped European laboratory capacity for identification and characterisation of non-polio EVs to improve preparedness to respond to (re)-emerging EVs linked to severe disease. An online questionnaire on non-polio EV surveillance and laboratory detection was submitted to all 30 European Union (EU)/European Economic Area (EEA) countries. Twenty-nine countries responded; 26 conducted laboratory-based non-polio EV surveillance, and 24 included neurological infections in their surveillance. Eleven countries have established specific surveillance for EV-D68 via sentinel influenza surveillance (n = 7), typing EV-positive respiratory samples (n = 10) and/or acute flaccid paralysis surveillance (n = 5). Of 26 countries performing non-polio EV characterisation/typing, 10 further characterised culture-positive EV isolates, whereas the remainder typed PCR-positive but culture-negative samples. Although 19 countries have introduced sequence-based EV typing, seven still rely entirely on virus isolation. Based on 2015 data, six countries typed over 300 specimens mostly by sequencing, whereas 11 countries characterised under 50 EV-positive samples. EV surveillance activity varied between EU/EEA countries, and did not always specifically target patients with neurological and/or respiratory infections. Introduction of sequence-based typing methods is needed throughout the EU/EEA to enhance laboratory capacity for the detection of EVs.

Keywords: Europe; laboratory methods; laboratory surveillance; molecular typing; respiratory infections; viral encephalitis; viral infections; viral meningitis.

Figure 1

Non-polio enterovirus surveillance systems currently in use in the European Union/European Economic Area countries for enteroviruses, 2016 (n=29 countries)

Figure 2

Specific reporting and surveillance systems in use for enterovirus-D68 in the European Union/European Economic Area, 2016 (n=29 countries)

Figure 3

Specific reporting and surveillance systems in use for hand, foot and mouth disease in the European Union/European Economic Area, 2016 (n=29 countries)

Figure 4

Number of non-polio enterovirus-positive samples typed in European Union/European Economic Area, 2015 (n=29 countries)

Figure 5

RT-PCR used for primary enterovirus detection in the European Union/European Economic Area, 2016 (n = 29 countries)

Figure 6

Use of commercial methods in enterovirus diagnostics in the European Union/European Economic Area, 2016 (n = 29 countries)

Figure 7

Use of IgG and/or IgM serology in the European Union/European Economic Area, 2016 (n = 29 countries)

Figure 8

Methods used for enterovirus typing/characterisation in the European Union/European Economic Area, 2016 (n = 29 countries)

Figure 9

Comparison of primer and probe sequences used in non-polio enterovirus detection RT-PCRs to consensus sequences in various European Union/European Economic Area, 2016 (n=11 countries)