Global epidemiology of nonpolio enteroviruses causing severe neurological complications: A systematic review and meta‐analysis

Abstract

Enteroviruses are RNA viruses found as commensals in the human gut and respiratory system, which may cause a wide spectrum of disease. Enteroviruses may cause severe neurologic complications including acute flaccid paralysis (AFP) and encephalitis and are the most commonly diagnosed agents of viral meningitis. Outbreaks of more severe disease are often associated with particular genotypes, such as enterovirus-A71 causing rhombencephalitis and AFP. There are more than 300 described genotypes of human enterovirus, with overlaps in clinical phenotypes between genotypes, and uncertainty about which genotypes are more prevalent in neurological manifestations.A systematic review of observational studies was conducted to evaluate the most prevalent enterovirus genotypes causing AFP, encephalitis, and meningitis. The genotyping methods and sampling sites were compiled as secondary outcomes.Sources included MEDLINE, Embase (publications until January 2019), and references selected from included studies. Meta-analyses using a random effects model were performed to calculate the pooled proportion of enterovirus genotypes in each disease.Ninety-six publications met the eligibility criteria, comprising 3779 AFP cases, 1140 encephalitis cases, and 32 810 meningitis cases. Enterovirus-A71 was most frequently associated with AFP (pooled proportion 0.12, 95% CI, 0.05-0.20) and encephalitis (0.77, 95% CI, 0.61-0.91). Echovirus 30 (0.35, 95% CI, 0.27-0.42) was the most predominant genotype in meningitis cases. Genotypes were most commonly determined using VP1 RT-reverse transcription-polymerase chain reaction, and most samples assessed were cerebrospinal fluid.With the emergence of enteroviruses as an increasing cause of neurological diseases, surveillance and testing need to increase to identify the aetiology of the most common and most severe disorders.

Pediatric Enteroviral Central Nervous System Infections in Bialystok, Poland: Epidemiology, Viral Types, and Drivers of Seasonal Variation

“…Similarly, outbreaks of CVB5 meningitis were reported previously [ 32 , 33 , 34 ]. However, according to a recent review, CVB5 is implicated in only a small proportion of neurological disease caused by enteroviruses globally [ 6 ].…”

“…Non-polio EVs are monitored within the framework of the global WHO polio surveillance network [ 5 ]. Enterovirus A71, echovirus 13, and echovirus 11 were recently reported to be the most common enterovirus types associated with acute flaccid myelitis cases similar to clinical poliomyelitis [ 6 ]. Continuous surveillance of EV circulation shows that different long-term circulation patterns for individual types exist.…”

Distribution of species enterovirus B in patients with central nervous system infections in São Paulo State, Brazil

“…35 Notably, E-18 was for the first time related with AM outbreak in Brazil, such as E-4, E-9 and E-11. The diversity these EV-types associated with AM outbreaks and sporadic cases, also has been reported in other countries, such as E-18 in Taiwan, 36 China, 37 and Germany 38 ; E-4 in India 39 ; E-9 in Spain, Northern Jordan, Kuwait, and China 33,35 ; E-11 in Greece and UK 35 ; and CV-A9 in South Africa, Ontario, and China. 35 We reported for the first time in Brazil the distribution EV types in cases of encephalitis and meningoencephalitis, mainly E-6, E-18, and E-30.…”

“…There opean continents have been also demonstrated the predominance these serotypes. 5,28,[30][31][32][33][34][35] The predominance of echovirus 30 in cases of viral meningitis has not yet been clarified and its virulence needs to be better understood. There is a theory that indicate the existence of another route of transmission of the E-30 beyond the fecal-oral.…”

Recombination Analysis of Non-Poliovirus Members of the Enterovirus C Species: Restriction of Recombination Events to Members of the Same 3DPol Cluster

“…Enteroviruses (EVs) are single stranded positive-sense RNA viruses in the family of Picornaviridae . Upon infection, EVs can cause a wide variety of symptoms and disease outcomes, ranging from mild respiratory or gastro-intestinal symptoms to meningitis, encephalitis, and acute flaccid paralysis [ 1 ]. All currently known EVs belong to one of 15 species ( Enterovirus A - Enterovirus L and Rhinovirus A - Rhinovirus C ), with Enterovirus A – Enterovirus D and all three rhinovirus species known to infect humans [ 2 ].…”