Description of non-polio enteroviruses identified in two national surveillance programmes in South Africa

Abstract

Background: Human enteroviruses (EV) consist of 106 serotypes and four species: EV-A, EV-B, EV-C and EV-D. Enteroviruses cause clinical symptoms varying from severe to mild. Knowledge of EV burden in South Africa is limited, and as non-polio EV are important causes of acute flaccid paralysis (AFP) and meningitis, information on the circulating serotypes is vital.Methods: Between 2010 and 2012, a total of 832 stool and viral isolate specimens were obtained from two national surveillance programmes at the National Institute for Communicable Diseases: the Rotavirus Sentinel Surveillance Programme (RSSP) and the AFP surveillance programme. Real-time polymerase chain reaction and Sanger sequencing were performed to detect and serotype EV.Results: Non-polio EV were detected in 446 specimens, of which 308 were sequenced. Stool specimens yielded a greater variety of serotypes than viral cultures. EV-B viruses were predominant (58.44%), whilst EV-C viruses were detected in 31% of the specimens tested. South African prevalence for these viruses was higher than other countries, such as France with less than 2%, and Spain and the United States with less than 10%. The most common serotype detected was Enterovirus 99 (EV-C, 8.63%), which has not been reported in other regions. Conclusion:Direct sequencing from stool specimens yields a broader, more comprehensive description of EV infections compared to sequencing from viral cultures. Disease-associated serotypes were detected, but only in small numbers. This study provides a baseline for EV strain circulation; however, surveillance needs to be expanded to improve EV knowledge in South Africa.

Non-Polio Enteroviruses Isolated by Acute Flaccid Paralysis Surveillance Laboratories in the Russian Federation in 1998–2021: Distinct Epidemiological Features of Types

“…The distribution of EV species in our study ( Figure 4 ) was similar to that observed in many countries of the world in different climatic zones according to the results of AFP surveillance [ 31 , 32 , 34 , 36 , 37 , 38 ], investigation of healthy children [ 38 , 39 , 40 ], surveillance of EVs [ 41 ], and rotavirus surveillance [ 32 ]. After 2010, the proportion of EV-A steadily began to increase among both AFP and EVI isolates ( Figure 4 ).…”

“…During the 24 years of this study, the incidence of NPV isolation ranged from 0.3 to 7.7%, on average 3.6% for any virus and 2.5% for NPEVs. This is significantly lower than the frequency of virus isolation from AFP patients in some countries of Asia and Africa, which could be above 60% [31][32][33], and is comparable or somewhat lower than the frequency determined in some countries of the European Region [34,35]. It is noteworthy that NPEV isolation rates can be used to evaluate the efficiency of surveillance, but the reference regions should be matched in terms of socio-economic and environmental conditions.…”

Molecular characterization & recombination analysis of complete enterovirus-88 isolated from acute flaccid paralysis cases in India

“…This century has so far seen around 30 per cent in addition to EV genus. Other than Bangladesh and India, EV-B88 detection has also been reported from Ghana in association with enteric disease in children 18 , Western Cape province of South Africa in a rotavirus surveillance programme 19 and Thailand (acute gastroenteritis in children) along with some other gastroenteritis virus with a prevalence of 1.5 per cent in the group affected 20 . Not much has been reported on EV-B88, except detections in association with AFP and gastroenteritis.…”

Diversity of enteroviruses in cerebrospinal fluid specimens collected from hospitalised patients in the private and public sector in South Africa

“…In addition, Enterovirus B species is the largest and most prevalent species of the enteroviruses, so the chances of being detected might be higher than with the other Enterovirus species. 18,33,35 Last, detection and typing methods could be biased towards Enterovirus B species. To eliminate Enterovirus B species bias, a cell culture independent detection and typing method was suggested by Nix et al 20 In the past Enterovirus B species bias was noted because viruses from clinical specimens were cell cultured in a Rhabdomyosarcoma cell line, which showed a greater susceptibility to Enterovirus B species in comparison to other Enterovirus species.…”

“…Since Enterovirus B species is the major cause of encephalitis and meningitis cases, it is probably more likely to be detected in cerebrospinal fluid. In addition, Enterovirus B species is the largest and most prevalent species of the enteroviruses, so the chances of being detected might be higher than with the other Enterovirus species 18,33,35 . Last, detection and typing methods could be biased towards Enterovirus B species.…”