Recommendations for enterovirus diagnostics and characterisation within and beyond Europe
Creators: name: Harvala, Heli
name: Broberg, Eeva
name: Benschop, Kimberley
name: Berginc, Natasa
name: Ladhani, Shamez
name: Susi, Petri
name: Christiansen, Claus
name: McKenna, James
name: Allen, David
name: Makiello, Phoebe
name: McAllister, Georgina
name: Carmen, Mirabelli
name: Zakikhany, Katherina
name: Dyrdak, Robert
name: Nielsen, Xiaohui
name: Madsen, Tina
name: Paul, Joel
name: Moore, Catherine
name: Von Eije, Karin
name: Piralla, Antonio
name: Carlier, Mieke
name: Vanoverschelde, Laura
name: Poelman, Randy
name: Anton, Andrés
name: López-Labrador, F. Xavier
name: Pellegrinelli, Laura
name: Keeren, Kathrin
name: Maier, Melanie
name: Cassidy, Hayley
name: Derdas, Stavros
name: Savolainen-Kopra, Carita
name: Diedrich, Sabine
name: Nordbø, Svein
name: Buesa, Javier
name: Bailly, Jean-Luc
name: Baldanti, Fausto
name: MacAdam, Andrew
name: Mirand, Audrey
name: Dudman, Susanne
name: Schuffenecker, Isabelle
name: Kadambari, Seilesh
name: Neyts, Johan
name: Griffiths, Michael J.
name: Richter, Jan
name: Margaretto, Christina
name: Govind, Sheila
name: Morley, Ursula
name: Adams, Ortwin
name: Krokstad, Sidsel
name: Dean, Jonathan
name: Pons-Salort, Margarita
name: Prochazka, Birgit
name: Cabrerizo, Maria
name: Majumdar, Manasi
name: Nebbia, Gaia
name: Wiewel, Maryse
name: Cottrell, Simon
name: Coyle, Peter
name: Martin, Javier
name: Moore, Catrin
name: Midgley, Sofie
name: Horby, Peter
name: Wolthers, Katja
name: Simmonds, Peter
name: Niesters, Hubert
name: Fischer, Thea K.
Publisher: name: Robert Koch-Institut
Year: 2018
Subjects: subject: Enterovirus
subject: Detection
subject: EV typing
subject: Neurological infection
subject: European non-polio enterovirus network (ENPEN)
subject: Diagnostics
subject: 610 Medizin und Gesundheit

description: 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.