#13,473
Earlier this week, in EID Journal: Emerging Enteroviruses In China 2010-2016, we looked at a number of Non-polio Enteroviruses (NPEV's) - including CV-A6, EV-71, and EV-D68 - which have sparked epidemics (particularly in children) around the globe.
Enteroviruses encompass a large family of small RNA viruses that include the three Polioviruses, along with myriad non-polio serotypes of Human Rhinovirus, Coxsackievirus, echovirus, and human, porcine, and simian enteroviruses.As the chart below indicates, EV-D68 was the most reported NPEV reported in the United States between 2014-2016, but it was joined by a number of other enteroviruses, including Echovirus 30.
Serious outbreaks tend to be cyclical, and over the past couple of years we've primarily seen EV-D68 and EV-71 reported out of Europe (see ECDC: Rapid Risk Assessment On Recent Enterovirus Outbreaks In Europe), but earlier this month the ECDC reported a jump in Echovirus 30 cases (ramping up in June) which has resulted in an increase in the number of meningitis or meningoencephalitis cases.
Today the ECDC has published a new epidemiological update on this recent increase in Echovirus 30 infections across Northern Europe.
Epidemiological update - Increase in Echovirus 30 detections in Denmark, Germany, the Netherlands, Norway and Sweden, June to July 2018
epidemiological update
31 Aug 2018
In 2018, Norway [1] and the Netherlands [2] published reports from national public health institutes on increased Echovirus 30 (E30) detections associated with an increase in the number of meningitis or meningoencephalitis cases. Since the beginning of 2018, 407 E30 cases have been reported to ECDC in 10 EU/EEA countries based on an Epidemic Intelligence Information System–Vaccine Preventable Diseases (EPIS-VPD) data call.
Since the beginning of 2018, 407 E30 cases have been reported to ECDC in 10 EU/EEA countries based on an Epidemic Intelligence Information System–Vaccine Preventable Diseases (EPIS-VPD) data call: Austria (6), Belgium (5), Denmark (65), Germany (44), Iceland (1), Latvia (1), Netherlands (122), Norway (37), Sweden (32) and United Kingdom (England, Scotland and Wales, 94) (Figure 1).
This is an increase of 148 patients from the previous update on 3 August 2018. The figures are based on available preliminary data from 1 January to 31 July 2018. An update was also received from Croatia, Czech Republic, Finland and Slovenia, who did not detect any E30 detections in 2018. Certain typing results for enteropositive detections were still pending for July specimens in these countries.
Denmark reported that 41 out of their 65 E30 detections (63%) were from cerebrospinal fluid (CSF) specimens, which can be used as a proxy for severe infection. Germany collected specimens only from aseptic meningitis, encephalitis or acute flaccid paralysis cases, therefore their 44 E30 patients all had central nervous system (CNS) symptoms.
A total of 94 out of 132 patients (71%) were reported with central nervous system symptoms from the Netherlands, Norway and the United Kingdom. For 68 patients, further symptom categories were reported and classified as meningitis (n=36, 53%), meningoencephalitis (n=26, 38%) or other CNS symptoms (n=5, 7%; one additional patient reported with sepsis, fever, tachycardia and groaning respiration).
For the other patients, the specific symptoms were unknown. Up until now, age information was available for 361 of the patients and the epidemic has mostly affected individuals under 3 months (n=86, 24%) and 26–45 years of age (n=145, 40%). Based on available preliminary data, the male (n=208) to female (n=148) ratio was 1.4.
E30 is a non-polio enterovirus that causes aseptic meningitis outbreaks worldwide. Such outbreaks have been detected earlier in Europe [3–10] and occur usually at five- to six-year intervals [11]. The exact transmission route of current infections is unknown. However, non-polio enteroviruses usually transmit through faecal-oral or oral-oral routes.
Unfortunately, specific prevention or control measures are not available for E30 and symptomatic treatment should be applied. Good hygienic practices such as frequent hand washing, avoidance of shared utensils, bottles or glasses and disinfection of contaminated surfaces (e.g. with diluted bleach solution) are recommended to prevent the spread of E30 from person to person.
In affected countries, further transmission of E30 cannot be excluded and all EU/EEA Member States should remain vigilant for the continuing E30 epidemic. Where relevant, national public health authorities should consider informing clinicians of increased numbers of aseptic meningitis cases related to E30 infections and the importance of collecting respiratory, stool and CSF specimens even if white blood cell count is normal, as well as adhering to recommendations on detection of non-polio enteroviruses in laboratories [12].
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