BACKGROUND: Enterovirus D68 (EV-D68) causes respiratory disease ranging from mild to severe and in rare cases a paralytic syndrome, called acute flaccid myelitis (AFM). Since the global EV-D68 outbreak in 2014, the virus has mainly circulated in biennial epidemic cycles with peaks detected during even years. However, following the COVID-19 pandemic, the seasonal pattern of EV-D68 has been characterized by large yearly upsurges. Here, we describe the circulation of EV-D68 in Europe in 2023 and track its genetic evolution. STUDY DESIGN: Data was compiled from members of the European Non-Polio Network (ENPEN). This included monthly data on the total number of EV samples tested, EV positive samples, EV-D68 positive samples and cases, and other EV positive samples detected in 2023. Information on sample types and surveillance system was recorded. Sequence data from the VP1 gene was used for phylogenetic and amino acid sequence analysis. RESULTS: EV was detected in 13,585 out of 203,622 diagnostic samples tested (6.7 %), of which 402 (3.0 %) were determined as EV-D68, representing 386 cases. EV-D68 infections peaked in October 2023 (136/386; 35.2 %). 267/386 (69.2 %) of EV-D68 cases were captured through clinical EV surveillance, almost all of which (202/204 of positive samples with sample type information) were detected in respiratory specimens. Phylogenetic analysis performed on 99 VP1 sequences revealed a distinct B3-derived lineage with a previously undescribed residue change, D554E, in Europe. CONCLUSIONS: The study documents sustained circulation of EV-D68 in Europe in 2023, the evolution of B3-derived lineages, and appearance of previously undescribed amino acid substitutions in Europe. This stresses the need for continuous EV-D68 surveillance and harmonization of EV-D68 detection practices towards better data comparability across countries.
- MeSH
- COVID-19 epidemiology MeSH
- Enterovirus Infections * epidemiology virology MeSH
- Phylogeny MeSH
- Humans MeSH
- Enterovirus D, Human * genetics classification isolation & purification MeSH
- Evolution, Molecular MeSH
- Amino Acid Substitution MeSH
- Capsid Proteins * genetics MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Europe MeSH
- Keywords
- Gaza,
- MeSH
- Humans MeSH
- West Asian People MeSH
- Sewage * microbiology MeSH
- Poliovirus Vaccines MeSH
- Poliovirus * isolation & purification MeSH
- Check Tag
- Humans MeSH
Enterovirus D68 (EV-D68) infections are associated with severe respiratory disease and acute flaccid myelitis (AFM). The European Non-Polio Enterovirus Network (ENPEN) aimed to investigate the epidemiological and genetic characteristics of EV-D68 infections and its clinical impact during the fall-winter season of 2021-2022. From 19 European countries, 58 institutes reported 10 481 (6.8%) EV-positive samples of which 1004 (9.6%) were identified as EV-D68 (including 852 respiratory samples). Clinical data were reported for 969 cases; 78.9% of infections were reported in children (0-5 years); and 37.9% of cases were hospitalized. Acute respiratory distress was commonly noted (93.1%) followed by fever (49.4%). Neurological problems were observed in 6.4% of cases including 6 diagnosed with AFM. Phylodynamic/Nextstrain and phylogenetic analyses based on 694 sequences showed the emergence of 2 novel B3-derived lineages, with no regional clustering. In conclusion, we describe a large-scale European EV-D68 upsurge with severe clinical impact and the emergence of B3-derived lineages.
- MeSH
- Child MeSH
- Adult MeSH
- Enterovirus Infections * epidemiology virology MeSH
- Phylogeny * MeSH
- Respiratory Tract Infections virology epidemiology MeSH
- Infant MeSH
- Middle Aged MeSH
- Humans MeSH
- Enterovirus D, Human * genetics classification isolation & purification MeSH
- Adolescent MeSH
- Young Adult MeSH
- Myelitis epidemiology virology MeSH
- Neuromuscular Diseases epidemiology virology MeSH
- Infant, Newborn MeSH
- Child, Preschool MeSH
- Aged MeSH
- Central Nervous System Viral Diseases epidemiology virology MeSH
- Check Tag
- Child MeSH
- Adult MeSH
- Infant MeSH
- Middle Aged MeSH
- Humans MeSH
- Adolescent MeSH
- Young Adult MeSH
- Male MeSH
- Infant, Newborn MeSH
- Child, Preschool MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Geographicals
- Europe MeSH
Non-polio enteroviruses (NPEV) cause significant disease worldwide. Population-based sero-surveillance, by measuring antibodies against specific NPEV types, provides additional information on past circulation and the prediction for future upsurges. Virus neutralisation assays (VNA), the current method of choice for measuring NPEV type specific antibodies, are not entirely standardised. Via the European Non-Polio Enterovirus Network, we organised a VNA quality assessment in which twelve laboratories participated. We provided five echovirus (E) types (E1, E18, E30 G2, E30 G6 and E6) and intravenous immunoglobulins (IVIG) as a sample for the NPEV VNA quality assessment. Differences in VNA protocols and neutralising Ab (nAb) titres were found between the participating laboratories with geometric coefficients of variation ranging from 10.3-62.9 %. Mixed-effects regression analysis indicated a small but significant effect of type of cell line used. Harmonisation of cell line passage number, however, did not improve variation between laboratories. Calibration by making use of a reference sample, reduced variation between laboratories but differences in nAb titres remained higher than two log2 dilution steps. In conclusion, sero-surveillance data from different laboratories should be compared with caution and standardised protocols are needed.
- MeSH
- Echovirus Infections virology epidemiology immunology MeSH
- Enterovirus Infections virology immunology MeSH
- Enterovirus B, Human * immunology MeSH
- Humans MeSH
- Neutralization Tests * methods standards MeSH
- Antibodies, Neutralizing * blood immunology MeSH
- Antibodies, Viral * blood immunology MeSH
- Seroepidemiologic Studies MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Geographicals
- Europe MeSH
NRL pro enteroviry (NRL/ENT) v SZÚ vyšetřuje v rámci environmentální surveillance odpadní vody z čističek 15 měst a 5 uprchlických táborů. V roce 2023 bylo vyšetřeno 239 vzorků odpadních vod. 179 vzorků bylo pozitivních. Pozitivní vzorky byly určeny jako non-polio-enteroviry (NPEV).
The National Reference Laboratory for Enteroviruses (NRL/ENT) at the National Institute of Public Health investigates sewage from sewage treatment plants in 15 cities and 5 refugee camps as part of environmental surveillance. In 2023, 239 sewage samples were tested. 179 samples were positive. The positive samples were determined to be non-polio-enteroviruses (NPEV).
- MeSH
- Child MeSH
- Endemic Diseases prevention & control MeSH
- Infection Control methods organization & administration statistics & numerical data MeSH
- Immunization Programs MeSH
- Poliomyelitis * prevention & control MeSH
- Poliovirus Vaccines therapeutic use MeSH
- Poliovirus isolation & purification pathogenicity MeSH
- Disease Eradication * methods MeSH
- Check Tag
- Child MeSH
- Geographicals
- Pakistan MeSH
Global Polio Laboratory Network (GPLN) potvrdila ve své zprávě z 22. června 2022 izolaci polioviru odvozeného z vakcíny typu 2 (VDPV2) ze vzorků životního prostředí v Londýně, Spojené království (UK), které byly vyšetřeny v rámci probíhající surveillance onemocnění. Je důležité poznamenat, že virus byl izolován pouze ze vzorků životního prostředí – nebyly zjištěny žádné související případy akutní chabé parézy. Proočkovanost kombinovanou vakcínou DTaP/IPV/Hib/HepB, která chrání před několika nemocemi včetně obrny, v Londýně naznačuje, že v poslední době došlo k poklesu proočkovanosti na hodnotu 86,6 %.
The Global Polio Laboratory Network (GPLN) has confirmed in its report of 22 June 2022 the isolation of vaccine-derived poliovirus type 2 (VDPV2) from environmental samples in London, United Kingdom (UK), that were tested as part of disease surveillance. It is important to note that the virus was isolated from environmental samples only – no associated cases of acute flaccid paresis were reported. In London, the uptake of the combined DTaP/IPV/Hib/HepB vaccine, which protects against several diseases including polio, indicates that there has been a recent decline in vaccine coverage to 86.6%.
NRL pro enteroviry v rámci environmentální surveillance vyšetřuje odpadní vody z čističek 9 měst, 2 pobytových středisek a 3 zařízení pro zajištění cizinců. V roce 2021 bylo vyšetřeno 159 vzorků odpadních vod. 73 vzorků bylo uzavřeno jako negativní, 86 jako pozitivní. Pozitivní vzorky byly určeny jako non-polio-enteroviry (NPEV), viabilních z nich bylo 27 vzorků. Současně bylo všech otestováno 159 vzorků z odpadních vod na přítomnost RNA SARS-CoV-2, z nichž 25 bylo pozitivních.
Within environmental surveillance, the National Reference Laboratory for Enteroviruses screens wastewater from sewage treatment plants in nine cities, two accommodation centres, and three detention facilities for foreigners. In 2021, 159 sewage samples were analysed. Seventy-three samples turned out negative and 86 were positive. The detected viruses were identified as non-polio-enteroviruses (NPEV), remaining viable in 27 samples. The 159 sewage samples were tested for the presence of RNA SARS-CoV-2, of which 25 turned out positive.
Coxsackievirus A6 (CV-A6) has recently overtaken enterovirus A71 and CV-A16 as the primary causative agent of hand, foot, and mouth disease worldwide. Virions of CV-A6 were not identified in previous structural studies, and it was speculated that the virus is unique among enteroviruses in using altered particles with expanded capsids to infect cells. In contrast, the virions of other enteroviruses are required for infection. Here we used cryo-electron microscopy (cryo-EM) to determine the structures of the CV-A6 virion, altered particle, and empty capsid. We show that the CV-A6 virion has features characteristic of virions of other enteroviruses, including a compact capsid, VP4 attached to the inner capsid surface, and fatty acid-like molecules occupying the hydrophobic pockets in VP1 subunits. Furthermore, we found that in a purified sample of CV-A6, the ratio of infectious units to virions is 1 to 500. Therefore, it is likely that virions of CV-A6 initiate infection, like those of other enteroviruses. Our results provide evidence that future vaccines against CV-A6 should target its virions instead of the antigenically distinct altered particles. Furthermore, the structure of the virion provides the basis for the rational development of capsid-binding inhibitors that block the genome release of CV-A6.
