Molecular epidemiology of an enterovirus A71 outbreak associated with severe neurological disease, Spain, 2016
González-Sanz, Rubén (Centro Nacional de Microbiología (Espanya))
Casas-Alba, Didac (Institut de Recerca Sant Joan de Déu)
Launes, Cristian (Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública)
Muñoz-Almagro, Carmen (Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública)
Ruiz-García, María Montserrat (Hospital General Universitario de Elche)
Alonso, Mercedes (Hospital Infantil Universitario Niño Jesús (Madrid))
González-Abad, María José (Hospital Infantil Universitario Niño Jesús (Madrid))
Megías, Gregoria (Complejo Hospitalario de Burgos)
Rabella, Núria (Institut d'Investigació Biomèdica Sant Pau)
del Cuerpo Casas, Margarita (Institut d'Investigació Biomèdica Sant Pau)
Gozalo-Margüello, Mónica (Hospital Universitario Marqués de Valdecilla (Santander, Cantabria))
González-Praetorius, Alejandro (Hospital Universitario de Guadalajara)
Martínez-Sapiña, Ana (Hospital Universitario Miguel Servet (Saragossa))
Goyanes-Galán, María José (Hospital General Universitario Gregorio Marañón)
Romero, María Pilar (Hospital Universitario La Paz (Madrid))
Calvo, Cristina (Hospital Universitario La Paz (Madrid))
Antón, Andrés (Hospital Universitari Vall d'Hebron)
Imaz, Manuel (Hospital de Basurto (Bilbao, Biscaia))
Aranzamendi Zaldumbide, Maitane (Hospital Universitario de Cruces (Barakaldo, País Basc))
Hernández Rodríguez, Águeda. (Institut Germans Trias i Pujol. Hospital Universitari Germans Trias i Pujol)
Moreno-Docón, Antonio (Hospital Universitario Virgen de la Arrixaca (Múrcia))
Rey-Cao, Sonia (Complexo Hospitalario Universitario de Vigo)
Navascués, Ana (Complejo Hospitalario de Navarra)
Otero, Almudena (Translational Research Network in Paediatric Infectious Diseases (RITIP). IdiPaz)
Cabrerizo, María (Translational Research Network in Paediatric Infectious Diseases (RITIP). IdiPaz)
Universitat Autònoma de Barcelona

Data:	2019
Resum:	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.
Nota:	Altres ajuts: We wish to thank I Bustillo, H del Pozo and P Higueras for their technical assistance. We also sincerely wish to thank all technical staff from microbiology departments and medical staff from paediatrics departments from all participating hospitals. Some of the samples are included in an ongoing project (PI15CIII-00020) which was supported by a grant by the Health Research System (AES).
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	Encephalitis ; Enterovirus ; Epidemiology ; Outbreaks ; Surveillance
Publicat a:	Eurosurveillance, Vol. 24 Núm. 7 (14 2019) , p. 1800089, ISSN 1560-7917

DOI: 10.2807/1560-7917.ES.2019.24.7.1800089
PMID: 30782267

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