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

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.

SUBMITTER: Gonzalez-Sanz R

PROVIDER: S-EPMC6381658 | biostudies-literature | 2019 Feb

REPOSITORIES: biostudies-literature

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

González-Sanz Rubén R Casas-Alba Didac D Launes Cristian C Muñoz-Almagro Carmen C Ruiz-García María Montserrat MM Alonso Mercedes M González-Abad María José MJ Megías Gregoria G Rabella Nuria N Del Cuerpo Margarita M Gozalo-Margüello Mónica M González-Praetorius Alejandro A Martínez-Sapiña Ana A Goyanes-Galán María José MJ Romero María Pilar MP Calvo Cristina C Antón Andrés A Imaz Manuel M Aranzamendi Maitane M Hernández-Rodríguez Águeda Á Moreno-Docón Antonio A Rey-Cao Sonia S Navascués Ana A Otero Almudena A Cabrerizo María M

Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin 20190201 7

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 ...[more]

PMID: 30782267

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Project description:BackgroundThe most recent documented Australian outbreak of enterovirus A71 (EV-A71) occurred in Sydney from 2012 to 2013. Over a four-month period more than 100 children presented to four paediatric hospitals with encephalitic presentations including fever and myoclonic jerks. The heterogeneous presentations included typical encephalomyelitis, and cardiopulmonary complications.ObjectivesTo characterise the genomes of enterovirus strains circulating during the 2013 Sydney EV-A71 outbreak and determine their phylogeny, phylogeography and association between genome and clinical phenotype.Study designWe performed an analysis of enterovirus (EV) positive specimens from children presenting to hospitals in the greater Sydney region of Australia during the 2013 outbreak. We amplified near full-length genomes of EV, and used next generation sequencing technology to sequence the virus. We used phylogenetic/phylogeographic analysis to characterize the outbreak viruses.ResultsWe amplified and sequenced 23/63 (37 %) genomes, and identified the majority (61 %) as EV-A71. The EV-A71 sequences showed high level sequence homology to C4a genogroups of EV-A71 circulating in China and Vietnam during 2012-13. Phylogenetic analysis showed EV-A71 strains associated with more severe symptoms, including encephalitis or cardiopulmonary failure, grouped together more closely than those from patients with hand, foot and mouth disease. Amongst the non-EV-A71 sequences were five other EV subtypes (representing enterovirus subtypes A and B), reflecting the diversity of EV co-circulation within the community.ConclusionsThis is the first Australian study investigating the near full-length genome of EV strains identified during a known outbreak of EV-A71. EV-A71 sequences were very similar to strains circulating in Asia during the same time period. Whole genome sequencing offers additional information over routine diagnostic testing such as characterisation of emerging recombinant strains and inform vaccine design.

Dataset Information

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

Publications

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

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