World-Wide Prevalence and Genotype Distribution of Enteroviruses

Abstract

Enteroviruses (EVs) are highly prevalent viruses world-wide, causing a wide range of diseases in both children and adults. Insight in the global prevalence of EVs is important to define their clinical significance and total disease burden, and assists in making therapeutic decisions. While many studies have been conducted to describe epidemiology of EVs in specific (sub)populations and patient cohorts, little effort has been made to aggregate the available evidence. In the current study, we conducted a search in the PubMed and Embase (Ovid) databases to identify articles reporting EV prevalence and type distribution. We summarized the findings of 153 included studies. We found that EVs are highly prevalent viruses in all continents. Enterovirus B was the most detected species worldwide, while the other species showed continent-specific differences, with Enterovirus C more detected in Africa and Enterovirus A more detected in Asia. Echovirus 30 was by far the most detected type, especially in studies conducted in Europe. EV types in species Enterovirus B-including echovirus 30-were often detected in patient groups with neurological infections and in cerebrospinal fluid, while Enterovirus C types were often found in stool samples.

Keywords: enterovirus; epidemiology; genotype; prevalence.

Figure 1

Flow diagram displaying the number of studies identified, screened assessed for eligibility and included [17].

Figure 2

Pie charts showing the characteristics of the included studies; (A) Continent where the study was conducted (B) Duration of the inclusion period (C) Year in which the final inclusion/sample collection took place (D) The sample type collected (E) The symptoms of the included study participants (F) The age of the included participants. The ‘>18’ category includes studies in both children and adults and in exclusively adults. CSF; cerebrospinal fluid.

Figure 3

Weighted median prevalence of EVs by (A) Continent, (B) Sample type, (C) Symptoms of the participants and (D) Age of the participants. N-America; North America, S-America; South America, GI; gastrointestinal, Resp; respiratory, CNS; central nervous system, CSF; cerebrospinal fluid.

Figure 4

Pie charts displaying the species distribution reported in (A) all studies describing EV type distribution and in studies conducted in (B) Africa, (C) Asia and (D) Europe. Uncorrected pies display the distribution as reported by the studies. Corrected pie charts display the distribution corrected for the number of types in the species (20 in Enterovirus A, 59 in Enterovirus B, 23 in Enterovirus C and 4 in Enterovirus D).

Figure 4

Pie charts displaying the species distribution reported in (A) all studies describing EV type distribution and in studies conducted in (B) Africa, (C) Asia and (D) Europe. Uncorrected pies display the distribution as reported by the studies. Corrected pie charts display the distribution corrected for the number of types in the species (20 in Enterovirus A, 59 in Enterovirus B, 23 in Enterovirus C and 4 in Enterovirus D).

Figure 5

EV type distribution reported by all studies describing EV type distribution. The proportion of each reported type among the total number of reported typed strains is shown, colored by (A) continent, (B) symptoms and (C) sample types. GI; gastrointestinal, CNS; central nervous system, CSF; cerebrospinal fluid.