Enterovirus infections in England and Wales, 2000–2011: the impact of increased molecular diagnostics

Abstract

There have recently been significant changes in diagnostic practices for detecting enterovirus (EV) infections across England and Wales. Reports of laboratory-confirmed EV infections submitted by National Health Service (NHS) hospital laboratories to Public Health England (PHE) over a 12-year period (2000-2011) were analysed. Additionally, the PHE Virus Reference Department (VRD) electronic database containing molecular typing data from 2004 onwards was interrogated. Of the 13,901 reports, there was a decline from a peak of 2254 in 2001 to 589 in 2006, and then an increase year-on-year to 1634 in 2011. This increase coincided with increasing PCR-based laboratory diagnosis, which accounted for 36% of reported cases in 2000 and 92% in 2011. The estimated annual incidence in 2011 was 3.9/100,000 overall and 238/100,000 in those aged <3 months, who accounted for almost one-quarter of reported cases (n = 2993, 23%). During 2004-2011, 2770 strains were submitted for molecular typing to the VRD, who found no evidence for a predominance of any particular strain. Thus, the recent increase in reported cases closely reflects the increase in PCR testing by NHS hospitals, but is associated with a lower proportion of samples being submitted for molecular typing. The high EV rate in young infants merits further investigation to inform evidence-based management guidance.

Enterovirus and parechovirus meningitis in infants younger than 90 days old in the UK and Republic of Ireland: a British Paediatric Surveillance Unit study

“…The strength of this study lies in the prospective national surveillance that captured all cases across the UK and Ireland over a relative short time period. A limitation of our study is the low proportion of EV/HPeV strains submitted for typing to the PHE reference laborator;31 we were, therefore, unable to assess correlations between serotype and poor outcomes, which were rare. Additionally, as there were no evidence-based guidelines available during the surveillance period, clinical investigations and management as well as outpatient follow-up of infants was haphazard, with fewer than half the infants reviewed after hospital discharge.…”

Severe Enterovirus Infections in Hospitalized Children in the South of England

“…29 A recently published study providing laboratory data from the national reference laboratory in England and Wales from the period 2000 to 2011 reported similar proportions, with echoviruses accounting for 55%, coxsackie A viruses for 5%, and coxsackie B viruses for 23% of the enterovirus strains for which typing result were available. 16 Comparing our data to those national data it appears that cases with coxsackie A virus infection were relatively overrepresented in our cohort, although the significance of this remains uncertain. However, our data show that this was not due to a single coxsackie A virus serotype with particular virulence.…”

“…3 , 14 , 15 A recently published report describing epidemiological data of disease-causing enterovirus serotypes in England provided data on the predominant circulating serotypes, but only contained a very limited amount of clinical data, and therefore lacked the ability to identify potential associations between causative serotypes and clinical manifestations as well as disease severity. 16 …”

Emerging Infections and Pertinent Infections Related to Travel for Patients with Primary Immunodeficiencies

“…The mode of transmission is mainly through fecal-oral and respiratory routes. Infection occurs all around the year in tropical and subtropical regions, while in temperate climates the peak incidence of infection is during summer and fall months [ 226 ]. NPEVs are associated with diverse clinical manifestations ranging from mild febrile illness to severe, potentially fatal conditions.…”