Epidemiological and clinical insights into enterovirus circulation in Europe, 2018 - 2023: a multi-center retrospective surveillance study.

Authors

Sten de Schrijver, Emiel Vanhulle, Anne Ingenbleek, Leonidas Alexakis, Caroline Klint Johannesen, Eeva K Broberg, Heli Harvala, Thea K Fischer, Kimberley S M Benschop, ENPEN study collaborators

Published in

The Journal of infectious diseases. Apr 04, 2025. Epub Apr 04, 2025.

Abstract

Enteroviruses (EV) cause yearly outbreaks with severe infections, particularly in young children. This study investigates EV circulation, age-distribution, and clinical presentations in Europe from 2018-2023.
Aggregated data were requested from ECDC National Focal Points for Surveillance and European Non-Polio Enterovirus Network. Data included detection month, specimen type, age-group, and clinical presentation for the ten most commonly reported EV types per year.
Twenty-eight institutions from 16 countries reported 563,654 EV-tests during the study-period with 33,265 (5.9%) EV-positive. Forty-two types were identified (n=11,605 cases) with echovirus (E)30, coxsackievirus (CV)A6, EV-D68, E9, E11, CVB5, E18, CVB4, EV-A71, and E6 most frequently reported. E30 detection declined after 2018/2019, while CVA6, CVB5, E9, E11, and EV-D68 were prevalent both before and after the COVID-19 pandemic, and CVB4 and E18 were prevalent after the pandemic. Over the study period, a shift in seasons (summer to fall) and specimen positivity (feces to respiratory) was observed. Neurological signs predominated among EV-A71, CVB4, CVB5, E6, E9, E11, E18, and E30 (30-72%). CVB4, CVB5, E9, E11, and E18 were also frequently reported among neonates (18-32%). CVA6 was frequently associated with HFMD, and EV-D68 with respiratory infections. Paralysis was reported among 22 infections, associated with ten non-polio types.
This study emphasizes the widespread circulation and severe nature of EV infections in Europe, particularly among neonates, as well as the (re-)emergence of specific types post-pandemic. Our findings highlight the need for continuous EV-surveillance to monitor variation in circulation, age, and clinical presentations, including paralysis among non-polio EV infections.

PMID:
40184501
Bibliographic data and abstract were imported from PubMed on 05 Apr 2025.

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