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. 2019 Feb;24(7):1800089.
doi: 10.2807/1560-7917.ES.2019.24.7.1800089.

Molecular epidemiology of an enterovirus A71 outbreak associated with severe neurological disease, Spain, 2016

Rubén González-Sanz  1 , Didac Casas-Alba  2 , Cristian Launes  2   3 , Carmen Muñoz-Almagro  4   2   3 , María Montserrat Ruiz-García  5 , Mercedes Alonso  6 , María José González-Abad  6 , Gregoria Megías  7 , Nuria Rabella  8 , Margarita Del Cuerpo  8 , Mónica Gozalo-Margüello  9 , Alejandro González-Praetorius  10 , Ana Martínez-Sapiña  11 , María José Goyanes-Galán  12 , María Pilar Romero  13   14 , Cristina Calvo  13   14 , Andrés Antón  15 , Manuel Imaz  16 , Maitane Aranzamendi  17 , Águeda Hernández-Rodríguez  18 , Antonio Moreno-Docón  19 , Sonia Rey-Cao  20 , Ana Navascués  21 , Almudena Otero  1   14 , María Cabrerizo  1   3   14
Affiliations

Molecular epidemiology of an enterovirus A71 outbreak associated with severe neurological disease, Spain, 2016

Rubén González-Sanz et al. Euro Surveill. 2019 Feb.

Abstract

IntroductionEnterovirus A71 (EV-A71) is an emerging pathogen that causes a wide range of disorders including severe neurological manifestations. In the past 20 years, this virus has been associated with large outbreaks of hand, foot and mouth disease with neurological complications in the Asia-Pacific region, while in Europe mainly sporadic cases have been reported. In spring 2016, however, an EV-A71 outbreak associated with severe neurological cases was reported in Catalonia and spread further to other Spanish regions.AimOur objective was to investigate the epidemiology and clinical characteristics of the outbreak.MethodsWe carried out a retrospective study which included 233 EV-A71-positive samples collected during 2016 from hospitalised patients. We analysed the clinical manifestations associated with EV-A71 infections and performed phylogenetic analyses of the 3'-VP1 and 3Dpol regions from all Spanish strains and a set of EV-A71 from other countries.ResultsMost EV-A71 infections were reported in children (mean age: 2.6 years) and the highest incidence was between May and July 2016 (83%). Most isolates (218/233) were classified as subgenogroup C1 and 217 of them were grouped in one cluster phylogenetically related to a new recombinant variant strain associated with severe neurological diseases in Germany and France in 2015 and 2016. Moreover, we found a clear association of EV-A71-C1 infection with severe neurological disorders, brainstem encephalitis being the most commonly reported.ConclusionAn emerging recombinant variant of EV-A71-C1 was responsible for the large outbreak in 2016 in Spain that was associated with many severe neurological cases.

Keywords: encephalitis; enterovirus; epidemiology; outbreaks; surveillance.

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Conflict of interest statement

Conflict of interest: None declared.

Figures

Figure 1
Figure 1
Phylogenetic analysis of 3´-VP1 sequences of enterovirus-A71, Spain, 2016 (n = 233) and representatives of different genogroups worldwide
Figure 2
Figure 2
Phylogenetic analysis of 3Dpol sequences of enterovirus-A71, Spain, 2016 (n = 187) and representatives of different members of Enterovirus A species
Figure 3
Figure 3
Geographical distribution of enterovirus-A71 cases, Spain, 2016 (n = 233)
Figure 4
Figure 4
Temporal distribution of enterovirus-A71 cases, by epidemiological week, Spain, 2016 (n = 233)
See this image and copyright information in PMC

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