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J Clin Virol. 2018 Apr;101:11-17. doi: 10.1016/j.jcv.2018.01.008. Epub 2018 Feb 6.

Recommendations for enterovirus diagnostics and characterisation within and beyond Europe.

Author information

1
University College London Hospital, London, UK. Electronic address: heli.harvala@nhs.net.
2
European Centre for Disease Prevention and Control, Stockholm, Sweden.
3
National Institute for Public Health and the Environment, Bilthoven, Netherlands.
4
National Laboratory of Health, Environment and Food, Ljubljana, Slovenia.
5
National Infections Service, Public Health England, London, UK.
6
Institute of Biomedicine, University of Turku, Turku, Finland.
7
Rigshospitalet, Copenhagen, Denmark.
8
Regional Virus Laboratory, Belfast, Northern Ireland, UK.
9
National Infections Service, Public Health England, London, UK; London School of Hygiene & Tropical Medicine, London, UK; NIHR Health Protection Research Unit in Gastrointestinal Infections, UK.
10
University Medical Centre Leiden, Leiden, Netherlands.
11
Royal Infirmary Edinburgh, Edinburgh, UK.
12
Rega Institute for Medical Research, University of Leuven, Belgium.
13
Folkhalsomyndigheten, Stockholm, Sweden.
14
Department of Clinical Microbiology, Karolinska University Hospital, Sweden; Department of Microbiology, Karolinska Institutet, Stockholm, Sweden.
15
Slagelse Hospital, Slagelse, Denmark.
16
Royal Oldham Hospital, Manchester, UK.
17
Public Health Wales, Cardiff, UK.
18
The West Friesland Hospital, Hoorn, Netherlands.
19
Foundation IRSCCS Polyclinic San Matteo, Pavia, Italy.
20
Ghent University Hospital, Ghent, Belgium.
21
University Medical Center Groningen, Groningen, Netherlands.
22
Hospital Universitari Vall d'Hebron, Barcelona, Spain.
23
Center for Public Health Research, Valencia, Spain; Instituto de Salud Carlos III, Madrid, Spain.
24
University of Milan, Milan, Italy.
25
Robert Koch-Institut, Berlin, Germany.
26
University of Leipzig, Leipzig, Germany.
27
Universtiy of Crete, Heraklion, Greece.
28
National Institute for Health and Welfare, Helsinki, Finland.
29
St. Olavs Hospital, Trondheim, Norway.
30
University of Valencia, Valencia, Spain.
31
National Enterovirus Laboratory, Clermont-Ferrand, France.
32
Foundation IRSCCS Polyclinic San Matteo, Pavia, Italy; University of Pavia, Pavia, Italy.
33
The National Institute for Biological Standards and Control, Hertfordshire, UK.
34
Norwegian Institute of Public Health, Oslo, Norway.
35
National Enterovirus Laboratory, Lyon, France.
36
John Radcliffe Hospital, Oxford, UK.
37
Institute of Infection and Global Health, University of Liverpool, Liverpool, UK.
38
Cyprus Institute of Neurology and Genetics, Nicosia, Cyprus.
39
National Virus Reference Laboratory, University College of Dublin, Ireland.
40
University of Dusseldorf, Dusseldorf, Germany.
41
Imperial College London, London, UK.
42
AGES, Wien, Austria.
43
Instituto de Salud Carlos III, Madrid, Spain.
44
St Thomas' Hospital, London, UK.
45
Academic Medical Center, Amsterdam, Netherlands.
46
Hamad General Hospital, Doha, Qatar.
47
Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK.
48
Statens Serum Institute, Copenhagen, Denmark.
49
Nuttfield Department for Medicine, University of Oxford, Oxford, UK.
50
Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK; Department of Medical Microbiology, University of Groningen, Groningen, Netherlands.

Abstract

Enteroviruses (EV) can cause severe neurological and respiratory infections, and occasionally lead to devastating outbreaks as previously demonstrated with EV-A71 and EV-D68 in Europe. However, these infections are still often underdiagnosed and EV typing data is not currently collected at European level. In order to improve EV diagnostics, collate data on severe EV infections and monitor the circulation of EV types, we have established European non-polio enterovirus network (ENPEN). First task of this cross-border network has been to ensure prompt and adequate diagnosis of these infections in Europe, and hence we present recommendations for non-polio EV detection and typing based on the consensus view of this multidisciplinary team including experts from over 20 European countries. We recommend that respiratory and stool samples in addition to cerebrospinal fluid (CSF) and blood samples are submitted for EV testing from patients with suspected neurological infections. This is vital since viruses like EV-D68 are rarely detectable in CSF or stool samples. Furthermore, reverse transcriptase PCR (RT-PCR) targeting the 5'noncoding regions (5'NCR) should be used for diagnosis of EVs due to their sensitivity, specificity and short turnaround time. Sequencing of the VP1 capsid protein gene is recommended for EV typing; EV typing cannot be based on the 5'NCR sequences due to frequent recombination events and should not rely on virus isolation. Effective and standardized laboratory diagnostics and characterisation of circulating virus strains are the first step towards effective and continuous surveillance activities, which in turn will be used to provide better estimation on EV disease burden.

KEYWORDS:

Detection; Diagnostics; EV typing; Enterovirus; European non-polio enterovirus network (ENPEN); Neurological infection

PMID:
29414181
DOI:
10.1016/j.jcv.2018.01.008
[Indexed for MEDLINE]
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