Epidemiological and Clinical Insights into Enterovirus Circulation in Europe, 2018–2023: A Multicenter Retrospective Surveillance Study - Report - MDSpire

Epidemiological and Clinical Insights into Enterovirus Circulation in Europe, 2018–2023: A Multicenter Retrospective Surveillance Study

  • By

  • Sten de Schrijver

  • Emiel Vanhulle

  • Anne Ingenbleek

  • Leonidas Alexakis

  • Caroline Klint Johannesen

  • Eeva K Broberg

  • Heli Harvala

  • Thea K Fischer

  • Kimberley S M Benschop

  • on behalf of

  • ENPEN Study Collaborators

  • Jan Albert

  • Nancy Allen

  • Laurent Andreoletti

  • Sowsan Atabani

  • Christelle Auvray

  • Aldert Bart

  • Carla Berengua

  • Natasa Berginc

  • Maxime Bisseux

  • Hanneke Boon

  • Ana Bordes-Benitez

  • Andrew Bosworth

  • Sindy Böttcher

  • Maria Cabrerizo

  • Annapaola Callegaro

  • Cristina Calvo

  • Benjamin Canning

  • Marianne Coste-Burel

  • Karen Couderé

  • Jean-Marie Delarbre

  • Sabine Diedrich

  • Susanne Dudman

  • Robert Dyrdak

  • Julien Exinger

  • Eric Farfour

  • Maria Dolores Fernandez-Garcia

  • Jacky Flipse

  • Vincent Foulongne

  • Kristina Træholt Franck

  • Floriane Gallais

  • Magali Garcia

  • Irina Georgieva

  • Géraldine Gonfrier

  • Clémence Guillaume

  • Almudena Gutierrez-Arroyo

  • Cécile Henquell

  • Marijke Hooghiemstra

  • Elisabeth 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 Lemée

  • 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 Megias

  • Sofie Elisabeth Midgley

  • Audrey Mirand

  • Richard Molenkamp

  • Milagrosa Montes

  • Antonio Moreno-Docón

  • Carmen Munoz-Almagro

  • Jean-Benjamin Murat

  • Jean-Luc Murk

  • Ana Navascues-Ortega

  • Maria Carmen Nieto-Toboso

  • Laetitia 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 Rogez

  • Maud Salmona

  • Kenda Saloum

  • Erik Schaftenaar

  • Cécile Schanen

  • Manuel Schibler

  • Isabelle Schuffenecker

  • Karl Stefic

  • Petri Susi

  • Caroline M A Swanink

  • Charlotte Tellini

  • Anne Lise Toyer

  • Sara Colonia Uceda Renteria

  • Juan Valencia-Ramos

  • Freek B van Loenen

  • Inge van Loo

  • Véronique Venard

  • Jaco J Verweij

  • Karin J von Eije

  • Tytti Vuorinen

  • Elke Wollants

  • Laura Zanetti

  • April 4, 2025

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Clinical and Epidemiological Analysis of Enterovirus Activity in Europe, 2018–2023

Overview

This retrospective multicenter study analyzed enterovirus (EV) circulation and clinical presentations across 16 European countries from 2018 to 2023. Among 563,654 tests, 5.9% were EV positive, with 42 types identified; echovirus 30, coxsackievirus A6, and EV-D68 were most frequent. Post-COVID-19 pandemic shifts included changes in prevalent types, seasonality, specimen positivity, and clinical manifestations, highlighting ongoing EV circulation and severity.

Background

Enteroviruses are RNA viruses transmitted primarily via fecal-oral and respiratory routes, causing a spectrum of illnesses including hand, foot, and mouth disease, respiratory infections, meningitis, and paralysis, especially in neonates and young children. Surveillance of nonpolio EVs in Europe has been inconsistent, prompting the establishment of the European Non-Polio Enterovirus Network (ENPEN) to standardize data collection. This study aimed to investigate epidemiological and clinical patterns of EV infections, including seasonal trends, specimen types, age distribution, and clinical presentations, over a six-year period.

Data Highlights

ParameterValue
Total samples tested563,654
EV positive samples33,265 (5.9%)
EV types identified42 types (11,605 cases typed)
Most frequent EV typesEchovirus 30, Coxsackievirus A6, EV-D68, E9, E11, CVB5, E18, CVB4, EV-A71, E6
Neurological signs prevalence30%–72% among EV-A71, CVB4, CVB5, E6, E9, E11, E18, E30
Paralysis cases22 infections associated with 10 nonpolio EV types

Key Findings

  • Echovirus 30 declined after 2018/2019, while CVA6, CVB5, E9, E11, and EV-D68 remained prevalent before and after the COVID-19 pandemic.
  • Post-pandemic emergence of CVB4 and E18 was observed, indicating shifts in circulating EV types.
  • Seasonal shift from summer to fall and specimen positivity shift from fecal to respiratory samples were noted.
  • Neurological symptoms predominated in infections with EV-A71, CVB4, CVB5, E6, E9, E11, E18, and E30, with 30%–72% of cases affected.
  • Neonates were frequently affected by CVB4, CVB5, E9, E11, and E18, with 18%–32% of cases in this age group.
  • Hand, foot, and mouth disease was commonly associated with CVA6, and respiratory infections with EV-D68.

Clinical Implications

The study underscores the importance of continuous, standardized surveillance of enteroviruses across Europe to detect shifts in circulating types and clinical presentations. Awareness of the neurological and severe manifestations, including paralysis associated with nonpolio EVs, is critical for timely diagnosis and management, especially in neonates and young children. Clinicians should consider EV infection in differential diagnoses of neurological and respiratory illnesses during seasonal peaks.

Conclusion

Enteroviruses continue to circulate widely in Europe with evolving epidemiological patterns and clinical severity, particularly following the COVID-19 pandemic. Sustained surveillance and clinical vigilance are essential to monitor and respond to the dynamic landscape of EV infections.

References

  1. European Centre for Disease Prevention and Control/ENPEN/2024 -- Clinical and Epidemiological Analysis of Enterovirus Activity in Europe from 2018 to 2023

Original Source(s)

Epidemiological and Clinical Insights into Enterovirus Circulation in Europe, 2018–2023: A Multicenter Retrospective Surveillance Study

  • by Sten de Schrijver, Emiel Vanhulle, Anne Ingenbleek, Leonidas Alexakis, Caroline Klint Johannesen, Eeva K Broberg, Heli Harvala, Thea K Fischer, Kimberley S M Benschop, on behalf of, ENPEN Study Collaborators, Jan Albert, Nancy Allen, Laurent Andreoletti, Sowsan Atabani, Christelle Auvray, Aldert Bart, Carla Berengua, Natasa Berginc, Maxime Bisseux, Hanneke Boon, Ana Bordes-Benitez, Andrew Bosworth, Sindy Böttcher, Maria Cabrerizo, Annapaola Callegaro, Cristina Calvo, Benjamin Canning, Marianne Coste-Burel, Karen Couderé, Jean-Marie Delarbre, Sabine Diedrich, Susanne Dudman, Robert Dyrdak, Julien Exinger, Eric Farfour, Maria Dolores Fernandez-Garcia, Jacky Flipse, Vincent Foulongne, Kristina Træholt Franck, Floriane Gallais, Magali Garcia, Irina Georgieva, Géraldine Gonfrier, Clémence Guillaume, Almudena Gutierrez-Arroyo, Cécile Henquell, Marijke Hooghiemstra, Elisabeth 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 Lemée, 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 Megias, Sofie Elisabeth Midgley, Audrey Mirand, Richard Molenkamp, Milagrosa Montes, Antonio Moreno-Docón, Carmen Munoz-Almagro, Jean-Benjamin Murat, Jean-Luc Murk, Ana Navascues-Ortega, Maria Carmen Nieto-Toboso, Laetitia 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 Rogez, Maud Salmona, Kenda Saloum, Erik Schaftenaar, Cécile Schanen, Manuel Schibler, Isabelle Schuffenecker, Karl Stefic, Petri Susi, Caroline M A Swanink, Charlotte Tellini, Anne Lise Toyer, Sara Colonia Uceda Renteria, Juan Valencia-Ramos, Freek B van Loenen, Inge van Loo, Véronique Venard, Jaco J Verweij, Karin J von Eije, Tytti Vuorinen, Elke Wollants, Laura Zanetti

  • April 4, 2025

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