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Abstract

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.

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This work is licensed under a Creative Commons Attribution 4.0 International License.
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2019-02-14
2024-11-21
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2019.24.7.1800089
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Molecular epidemiology of an enterovirus A71 outbreak associated with severe neurological disease, Spain, 2016
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Rub%C3%A9n+Gonz%C3%A1lez-Sanz&option1=author&noRedirect=true" class="nonDisambigAuthorLink">González-Sanz Rubén</a>, <a href="/search?value1=Didac+Casas-Alba&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Casas-Alba Didac</a>, <a href="/search?value1=Cristian+Launes&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Launes Cristian</a>, <a href="/search?value1=Carmen+Mu%C3%B1oz-Almagro&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Muñoz-Almagro Carmen</a>, <a href="/search?value1=Mar%C3%ADa+Montserrat+Ruiz-Garc%C3%ADa&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Ruiz-García María Montserrat</a>, <a href="/search?value1=Mercedes+Alonso&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Alonso Mercedes</a>, <a href="/search?value1=Mar%C3%ADa+Jos%C3%A9++Gonz%C3%A1lez-Abad&option1=author&noRedirect=true" class="nonDisambigAuthorLink">González-Abad María José </a>, <a href="/search?value1=Gregoria+Meg%C3%ADas&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Megías Gregoria</a>, <a href="/search?value1=Nuria+Rabella&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Rabella Nuria</a>, <a href="/search?value1=Margarita+del+Cuerpo&option1=author&noRedirect=true" class="nonDisambigAuthorLink">del Cuerpo Margarita</a>, <a href="/search?value1=M%C3%B3nica+Gozalo-Marg%C3%BCello&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Gozalo-Margüello Mónica</a>, <a href="/search?value1=Alejandro+Gonz%C3%A1lez-Praetorius&option1=author&noRedirect=true" class="nonDisambigAuthorLink">González-Praetorius Alejandro</a>, <a href="/search?value1=Ana+Mart%C3%ADnez-Sapi%C3%B1a&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Martínez-Sapiña Ana</a>, <a href="/search?value1=Mar%C3%ADa+Jos%C3%A9+Goyanes-Gal%C3%A1n&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Goyanes-Galán María José</a>, <a href="/search?value1=Mar%C3%ADa+Pilar+Romero&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Romero María Pilar</a>, <a href="/search?value1=Cristina+Calvo&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Calvo Cristina</a>, <a href="/search?value1=Andr%C3%A9s+Ant%C3%B3n&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Antón Andrés</a>, <a href="/search?value1=Manuel+Imaz&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Imaz Manuel</a>, <a href="/search?value1=Maitane+Aranzamendi&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Aranzamendi Maitane</a>, <a href="/search?value1=%C3%81gueda+Hern%C3%A1ndez-Rodr%C3%ADguez&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Hernández-Rodríguez Águeda</a>, <a href="/search?value1=Antonio+Moreno-Doc%C3%B3n&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Moreno-Docón Antonio</a>, <a href="/search?value1=Sonia++Rey-Cao&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Rey-Cao Sonia </a>, <a href="/search?value1=Ana+Navascu%C3%A9s&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Navascués Ana</a>, <a href="/search?value1=Almudena+Otero&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Otero Almudena</a>, <a href="/search?value1=Mar%C3%ADa+Cabrerizo&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Cabrerizo María</a></span>. Molecular epidemiology of an enterovirus A71 outbreak associated with severe neurological disease, Spain, 2016. <a href="/content/ecdc">Euro Surveill.</a> 2019;24(7):pii=1800089. <a href="https://doi.org/10.2807/1560-7917.ES.2019.24.7.1800089" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2019.24.7.1800089</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 27 Feb 2018;&nbsp;&nbsp; <span class="generated">Accepted</span>: 09 Jul 2018 </span> </p>
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