Molecular Characterization of Enteroviruses Isolated from Acute Flaccid Paralysis Cases in Poland, 1999–2014

Abstract

Enteroviruses (EVs) are among viral pathogens that can cause acute flaccid paralysis (AFP). This study represents an overview of EVs isolated through AFP surveillance in Poland between 1999 and 2014. The presence of enteroviruses was studied in stool samples that were collected from 747 AFP cases and their asymptomatic contacts. Fifty five (6.12%) cases of AFP were associated with enterovirus isolation. Out of the 55 positive cases, 40 were associated with detection of enterovirus in patient, and 15 with detection of EV in healthy contact, without positive detection in paralytic patient. Polioviruses were isolated from 35 AFP cases. The results of this study showed that about 43.6% of positive AFP cases were found in association with the isolation of non-polio enteroviruses (NPEV). A total of 12 different types of the species B were detected (CVA9, CVB1, CVB3, CVB4, CVB5, E3, E4, E9, E11, E13, E30), and one additional isolate represented the species enterovirus A (EV71). Among the 12 serotypes of species B, CVB3 and CVB5 were more frequently detected than others, representing 40% of the characterized isolates, followed by CVB4 (16%), E4 (8%), and E11(8%). Phylogenetic analysis revealed that strains from Poland had the closest genetic relationship with isolates previously identified in Europe (France, Finland, Denmark, Moldova) but also in other parts of the world (Tunisia, China, USA), suggesting wide distribution of these lineages. The paper provides information about NPEV circulation in Poland in the past 16 years, about its association with the AFP and it indicates the need for monitoring NPEV circulation even after the eradication of poliomyelitis.

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

“…We separated the final 96 studies into the three neurological complications of interest: AFP, [24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] encephalitis, and meningitis. 26,48,56,58, The "encephalitis" category also encompassed cases of rhombencephalitis, meningoencephalitis, and studies that did not distinguish between meningitis and encephalitis.…”

“…The majority of studies were from the Western Pacific Region (30/96, 31.25%) or the European Region (29/96, 30.2%).A comparison of descriptive data for the three conditions is shown in TableS4. For AFP, 10 studies24,31,[34][35][36][38][39][40][41][42] used the WHO criteria as a method of diagnosis, one study33 used separate criteria designated by a neurologist, and the remaining eight studies[25][26][27][28][29][30]32,37 did not report the criteria for diagnosis. Methods of diagnosis for cases of encephalitis and meningitis were not consistently reported; thus, these data were not collated.…”

Genetic Characterization of Human Enteroviruses Associated with Hand, Foot and Mouth Diseases in Poland, 2013–2016

“…Whereas EV71 has been occasionally detected in clinical samples (Wieczorek and Krzysztoszek, 2016). To better understand the molecular characteristics of enteroviruses circulating in Poland, particularly the diversity of those viruses associated with HFMD, we examined clinical material from HFMD cases, that occurred during the period 2013-2016, in three regions of Poland.…”

Cases of Acute Flaccid Paralysis Associated with Coxsackievirus A2: Findings of a 20-Year Surveillance in the Russian Federation

“…Thus, the frequency of NPEV isolation from stool samples allows the assessment of the quality of surveillance for poliomyelitis and AFP. The frequency fluctuates in different countries depending on climatic and socio-economic conditions [14][15][16][17]. According to our data, in the Russian Federation, the proportion of AFP cases positive for NPEV was 3.2% in the period 2000-2019 (238 out of 7414).…”

“…The proportion of AFP cases from which non-polio enteroviruses (NPEV) were isolated varies from country to country: 4.3% in Tunisia [14], 6.12% in Poland [15], 19.4% in Italy [16], and 20.8% in the Philippines [17]. The etiological role of NPEV is not always obvious, since the WHO-recommended AFP case investigation algorithm consists of examining stool samples [18], and the isolation of ubiquitously present NPEV from a non-sterile specimen may be an accidental finding.…”