TY - JOUR
T1 - Molecular epidemiology of an enterovirus A71 outbreak associated with severe neurological disease, Spain, 2016
AU - González-Sanz, Rubén
AU - Casas-Alba, Didac
AU - Launes, Cristian
AU - Muñoz-Almagro, Carmen
AU - Montserrat Ruiz-García, María
AU - Alonso, Mercedes
AU - González-Abad, María José
AU - Megías, Gregoria
AU - Rabella, Nuria
AU - del Cuerpo, Margarita
AU - Gozalo-Margüello, Mónica
AU - González-Praetorius, Alejandro
AU - Martínez-Sapiña, Ana
AU - Goyanes-Galán, María José
AU - Pilar Romero, María
AU - Calvo, Cristina
AU - Antón, Andrés
AU - Imaz, Manuel
AU - Aranzamendi, Maitane
AU - Hernández-Rodríguez, Águeda
AU - Moreno-Docón, Antonio
AU - Rey-Cao, Sonia
AU - Navascués, Ana
AU - Otero, Almudena
AU - Cabrerizo, María
PY - 2019/2/14
Y1 - 2019/2/14
N2 - © 2019, European Centre for Disease Prevention and Control (ECDC). All rights reserved. Introduction: Enterovirus 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. Aim: Our objective was to investigate the epidemiology and clinical characteristics of the outbreak. Methods: We 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. Results: Most 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. Conclusion: An 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.
AB - © 2019, European Centre for Disease Prevention and Control (ECDC). All rights reserved. Introduction: Enterovirus 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. Aim: Our objective was to investigate the epidemiology and clinical characteristics of the outbreak. Methods: We 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. Results: Most 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. Conclusion: An 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.
U2 - https://doi.org/10.2807/1560-7917.ES.2019.24.7.1800089
DO - https://doi.org/10.2807/1560-7917.ES.2019.24.7.1800089
M3 - Article
C2 - 30782267
VL - 24
M1 - 1800089
ER -