Enterovirus Surveillance (EVSurv) in Germany

Keeren, Kathrin; Böttcher, Sindy; Diedrich, Sabine

doi:10.3390/microorganisms9102005

Cited by 14 publications

(18 citation statements)

References 99 publications

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“…We followed the same analysis path as for the astroviruses, however we did not apply the genome correction step due to overall low coverage. In general, we observed the expected seasonality (Keeren et al, 2021) with highest signals in northern hemisphere summer months (Fig. 4E).…”

Section: Resultssupporting

confidence: 53%

Comprehensive profiling of wastewater viromes by genomic sequencing

Wyler

Lauber

Manukyan

et al. 2022

Preprint

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Genomic material in wastewater provides a rich source of data for detection and surveillance of microbes. Used for decades to monitor poliovirus and other pathogens, the SARS-CoV-2 pandemic and the falling costs of high-throughput sequencing have substantially boosted the interest in and the usage of wastewater monitoring. We have longitudinally collected over 100 samples from a wastewater treatment plant in Berlin/Germany, from March 2021 to July 2022, in order to investigate three aspects. First, we conducted a full metagenomic analysis and exemplified the depth of the data by temporal tracking strains and to a certain extent also variants of human astroviruses and enteroviruses. Second, targeting respiratory pathogens, a broad enrichment panel enabled us to detect waves of RSV, influenza, or common cold coronaviruses in high agreement with clinical data. Third, by applying a profile Hidden Markov Model-based search for novel viruses, we identified more than 100 thousand novel transcript assemblies likely not belonging to known virus species, thus substantially expanding our knowledge of virus diversity. Taken together, we present a longitudinal and deep investigation of the viral genomic information in wastewater that underlines the value of sewage surveillance for both public health purposes and planetary virome research.

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Section: Resultssupporting

confidence: 53%

Comprehensive profiling of wastewater viromes by genomic sequencing

Wyler

Lauber

Manukyan

et al. 2022

Preprint

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“…EV surveillance differs substantially between individual European countries but typically focuses on enteroviruses detected from patients with severe infections presenting with neurological symptoms [21]. Since the noti cation of EV is non-mandatory in most countries in the EU, including Germany, their surveillance relies on voluntary reporting of clinicians, hospitals or laboratories [5,21]. Efforts to harmonize and collate surveillance data on the European level have recently been established through the European Non-Poliovirus Enterovirus Network (ENPEN) [21][22][23].…”

Section: Discussionmentioning

confidence: 99%

“…The national AFP surveillance in Germany was established in 1998 as a way of demonstrating polio-free status. However, the results of the surveillance proved to be insu cient according to AFP sensitivity criteria [5]. In Germany only 50 to 60% of the expected AFP cases were reported from the clinics (approx.…”

Section: Introductionmentioning

confidence: 99%

Evaluation of 17 years of MERIN (Meningitis and Encephalitis register in Lower Saxony, Germany) surveillance system: participants acceptability survey, completeness and timeliness of data

Luczynska

Beyrer

Holle

et al. 2023

Preprint

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Background A Meningitis and Encephalitis Surveillance (MERIN) was implemented in 2003 in Lower Saxony, Germany as an alternative to acute flaccid paralyses surveillance, as the latter did not reach WHO sensitivity criteria. The system provides information on circulating enterovirus (EV) serotypes by focussing on patients with suspected aseptic meningitis, encephalitis or acute flaccid paralysis and contributes to the national surveillance in documenting polio free status. MERIN is based on voluntary participation of hospitals. Therefore, our evaluation focusses on acceptability of the system’s objectives and performance, and identifying areas for improvement. Methods To assess acceptability, 32 contributing hospitals were invited to an online-based survey (11/2021 to 01/2022) to rate the MERIN objectives, laboratory’s performance, their workload, modes of processes and communication. Ideas for improvement were collected in open fields. In addition, data completeness and timeliness of laboratory diagnostics were assessed. Results We received 30 questionnaires, 25 from pediatric and 5 from neurological departments, of 21 hospitals (66% response rate). High levels of satisfaction with the communication (≥ 96%), timeliness (≥ 81%), and distribution of the results (≥ 85%) were reported, 97% of participants judged the required workload as adequate. The median proportion of eligible patients included in MERIN was 75%. Participants gave rapid and reliable diagnostic testing the highest priority (96%), while monitoring of Germany’s polio-free status was rated the lowest (61%). Providing medical reports digitally as well regular as updates about circulating EV serotypes were identified as areas for improvement. Data completeness of selected variables ranged from 78.3 to 99.9%. Median time between sample collection and arrival at laboratory was 2 days [IQR 1–3], EV diagnostics via PCR took one day [IQR 0–6] and EV isolation on cell culture 11 days [IQR 10–13]. Conclusion MERIN is a highly accepted surveillance system. Its quality was enhanced further by addressing the suggested improvements such as regular reports on circulating EV serotypes and facilitating digital access to laboratory results. Our results emphasise the importance of recognizing and considering participants’ motivations and expectations, and addressing their priorities, even if this is not the surveillance system’s main focus. This approach can be applied to surveillance systems of other non-mandatory notifiable diseases.

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“…As is the case for infections with other EV genotypes [ 36 ], E30 was detected mainly in children: 50% of the patients were under three years old, with a high incidence (16% of the total) in babies from 0 to 3 months. This could be because babies and very young children are more prone to infection as they have not yet acquired immunity, and medical attention is sought quickly for symptoms, such as fever or irritability in this population.…”

Section: Discussionmentioning

confidence: 99%

Epidemiology of Echovirus 30 Infections Detected in a University Hospital in Catalonia, Spain, in 1995–2020

et al. 2022

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There is a growing interest in echovirus 30 (E30), an enterovirus responsible for neurological disease and hospitalization. There are multiple studies of outbreaks, but few that study the epidemiology over long periods of time. Our study aims to describe the clinical, epidemiological and microbiological characteristics of a series of E30 infections detected over 26 years. Data were retrospectively collected from a database of all enterovirus infections identified in our laboratory. They were detected by viral isolation or nucleic acid detection in patients presenting with respiratory or neurological infections, rash, sepsis-like syndrome, or gastroenteritis. Enterovirus genotyping was performed by amplification of the VP1 gene using RT-nested PCR, followed by sequencing and BLAST analysis. Of the 2402 enterovirus infections detected, 1619 were linked to at least one genotype and 173 were caused by E30. Clinical information was available for 158 (91.3%) patients. E30 was associated with neurological infection in 107 (67.8%) cases and it was detected almost every year. Phylogenetic analysis was performed with 67 sequences. We observed that E30 strains circulating in Catalonia from 1996 to 2016 belong to two lineages (E and F), although the majority cluster was in F. In 2018, lineage I emerged as the dominant lineage.

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Enterovirus Surveillance (EVSurv) in Germany

Cited by 14 publications

References 99 publications

Comprehensive profiling of wastewater viromes by genomic sequencing

Comprehensive profiling of wastewater viromes by genomic sequencing

Evaluation of 17 years of MERIN (Meningitis and Encephalitis register in Lower Saxony, Germany) surveillance system: participants acceptability survey, completeness and timeliness of data

Epidemiology of Echovirus 30 Infections Detected in a University Hospital in Catalonia, Spain, in 1995–2020

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