Epidemiological and Clinical Insights into Enterovirus Circulation in Europe, 2018–2023: A Multicenter Retrospective Surveillance Study
Sten de Schrijver, Emiel Vanhulle, Anne Ingenbleek, Leonidas Alexakis, Caroline Klint Johannesen, Eeva Broberg, Heli Harvala, Thea Kølsen Fischer, Kimberley Benschop, ENPEN Study Collaborators, Jan Albert, Nancy A. Allen, Laurent Andréoletti, Sowsan Atabani, Christelle Auvray, Aldert Bart, Carla Berengua, Nataša Berginc, Maxime Bisseux, Hanneke Boon, Ana Bordes Benítez, Andrew Bosworth, Sindy Böttcher, María Cabrerizo, Annapaola Callegaro, Cristina Calvo, Benjamin Canning, Marianne Coste‐Burel, Karen Couderé, Jean-Marie Delarbre, Sabine Diedrich, Susanne Dudman, Robert Dyrdak, Julien Exinger, Éric Farfour, María Dolores Fernández-García, Jacky Flipse, Vincent Foulongne, Kristina Træholt Franck, Floriane Gallais, Magali Garcia, Irina Georgieva, Géraldine Gonfrier, Clémence Guillaume, Almudena Gutiérrez-Arroyo, Cécile Henquell, M. Hooghiemstra, Elisabeth G. W. Huijskens, Anne J. Jääskeläinen, Marion Jeannoël, Marine Jourdain, Elisabeth Toverud Landaas, Kathrin Keeren, Eduardo Lagarejos, Gisèle Lagathu, Sylvie Larrat, Cristian Launes, Mouna Lazrek, Caroline Lefeuvre, Véronique Lemee, Quentin Lepiller, Marianne Leruez, David Leyssene, Anne Sophie L’Honneur, Bruno Lina, Marie Louchet Ducoroy, Maja M. Lunar, Jean‐Michel Mansuy, Stéphanie Marque Julliet, Gina McAllister, C. Patrick McClure, Antonio Medina-Claros, Gregoria Megías, Sofie Midgley, Audrey Mirand, Richard Molenkamp, Milagrosa Montes, Antonio Moreno‐Docón, Carmen Muñoz‐Almagro, Jean‐Benjamin Murat, Jean‐Luc Murk, Ana Navascués-Ortega, Maria Carmen Nieto-Toboso, Läétitia Ninove, Marije Oosting, Eider Oñate, Jordi Pacaud, Coralie Pallier, Elena Pariani, Laura Pellegrinelli, Mercedes Pérez-Ruiz, Sylvie Pillet, Léa Pilorgé, Luis Piñeiro, Mario Poljak, Birgit Prochazka, Emeline Riverain, Sylvie Ranger‐Rogez, Maud Salmona, Kenda Saloum
Abstract
BACKGROUND: Enteroviruses (EV) cause yearly outbreaks with severe infections, particularly in young children. This study investigates EV circulation, age, and clinical presentations in Europe from 2018 to 2023. METHODS: Aggregated data were requested from the European Centre for Disease Prevention and Control National Focal Points for Surveillance and European Non-Polio Enterovirus Network. Data included detection month, specimen type, age group, and clinical presentation for the 10 most commonly reported EV types per year. RESULTS: Twenty-eight institutions (16 countries) reported 563 654 EV tests during the study period with 33 265 (5.9%) EV positive. Forty-two types were identified (n = 11 605 cases) with echovirus 30 (E30), coxsackievirus A6 (CVA6), EV-D68, E9, E11, CVB5, E18, CVB4, EV-A71, and E6 most frequently reported. E30 declined after 2018/2019, while CVA6, CVB5, E9, E11, and EV-D68 were prevalent both before and after the coronavirus disease 2019 (COVID-19) pandemic, and CVB4 and E18 were prevalent after the pandemic. A shift in seasons (summer to fall) and specimen positivity (feces to respiratory) was observed. Neurological signs predominated among EV-A71, CVB4, CVB5, E6, E9, E11, E18, and E30 (30%-72%). CVB4, CVB5, E9, E11, and E18 were frequently reported among neonates (18%-32%). CVA6 was frequently associated with hand, foot and mouth disease, and EV-D68 with respiratory infections. Paralysis was reported among 22 infections, associated with 10 nonpolio types. CONCLUSIONS: This study emphasizes the widespread circulation and severity of EV infections in Europe, as well as the (re)emergence of specific types postpandemic. Our findings highlight the need for continuous EV surveillance to monitor variation in circulation, age, and clinical presentations, including paralysis among nonpolio EV infections.