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Molecular epidemiology of an enterovirus A71 outbreak associated with severe neurological disease, Spain, 2016
- Rubén González-Sanz1 , Didac Casas-Alba2 , Cristian Launes2,20 , Carmen Muñoz-Almagro2,19,20 , María Montserrat Ruiz-García3 , Mercedes Alonso4 , María José González-Abad4 , Gregoria Megías5 , Nuria Rabella6 , Margarita del Cuerpo6 , Mónica Gozalo-Margüello7 , Alejandro González-Praetorius8 , Ana Martínez-Sapiña9 , María José Goyanes-Galán10 , María Pilar Romero11,21 , Cristina Calvo11,21 , Andrés Antón12 , Manuel Imaz13 , Maitane Aranzamendi14 , Águeda Hernández-Rodríguez15 , Antonio Moreno-Docón16 , Sonia Rey-Cao17 , Ana Navascués18 , Almudena Otero1,21 , María Cabrerizo1,20,21
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View Affiliations Hide AffiliationsAffiliations: 1 Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain 2 Institut de Recerca Sant Joan de Déu, Barcelona, Spain 3 Hospital General de Elche, Alicante, Spain 4 Hospital Infantil Universitario Niño Jesús, Madrid, Spain 5 Complejo Hospitalario de Burgos, Burgos, Spain 6 Hospital Santa Creu i Sant Pau, Barcelona, Spain 7 Hospital Universitario Marqués de Valdecilla, Santander, Spain 8 Hospital Universitario de Guadalajara, Guadalajara, Spain 9 Hospital Miguel Servet, Zaragoza, Spain 10 Hospital Gregorio Marañón, Madrid, Spain 11 Hospital Universitario La Paz, Fundación IdiPaz, Madrid, Spain 12 Hospital Universitari Vall d´Hebron, Barcelona, Spain 13 Hospital de Basurto, Bilbao, Spain 14 Hospital de Cruces, Bilbao, Spain 15 Microbiology Service, University Hospital “Germans Trias i Pujol”, Department of Genetics and Microbiology, Autonomous University of Barcelona, Badalona, Spain 16 Hospital Universitario Virgen de la Arrixaca, Murcia, Spain 17 Hospital General de Vigo, Vigo, Spain 18 Complejo Hospitalario de Navarra, Pamplona, Spain 19 Universitat Internacional de Catalunya, Barcelona, Spain 20 CIBER de epidemiología y Salud Pública, CIBERESP, Madrid, Spain 21 Translational Research Network in Paediatric Infectious Diseases (RITIP), IdiPaz, Madrid, SpainRubén González-Sanzruben.gs isciii.es
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Citation style for this article: González-Sanz Rubén, Casas-Alba Didac, Launes Cristian, Muñoz-Almagro Carmen, Ruiz-García María Montserrat, Alonso Mercedes, González-Abad María José , Megías Gregoria, Rabella Nuria, del Cuerpo Margarita, Gozalo-Margüello Mónica, González-Praetorius Alejandro, Martínez-Sapiña Ana, Goyanes-Galán María José, Romero María Pilar, Calvo Cristina, Antón Andrés, Imaz Manuel, Aranzamendi Maitane, Hernández-Rodríguez Águeda, Moreno-Docón Antonio, Rey-Cao Sonia , Navascués Ana, Otero Almudena, Cabrerizo María. Molecular epidemiology of an enterovirus A71 outbreak associated with severe neurological disease, Spain, 2016. Euro Surveill. 2019;24(7):pii=1800089. https://doi.org/10.2807/1560-7917.ES.2019.24.7.1800089 Received: 27 Feb 2018; Accepted: 09 Jul 2018
Abstract
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.
Our objective was to investigate the epidemiology and clinical characteristics of the outbreak.
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.
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.
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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