Non-Polio enterovirus infections epidemiology and demographics

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Sujaya Chattopadhyay, M.D.[2]

Overview

The long-term circulation dynamics are characterised by distinct epidemic and endemic patterns.Epidemics in temperate regions exhibit a characteristic seasonal variation, with peaks in summer and early autumn. This is less apparent in tropical regions. Climate, socio-economic factors and homotypic immunity likely contribute to the geographic distribution of different types. Enterovirus A sequences dominate in East and Southeast Asia while Enterovirus B is most common in Western Asia, Europe, Africa, South America, Southern Asia, and Oceania. Enteroviruses C and D are relatively rare.

Epidemiology[1]

The long-term circulation dynamics is characterised by distinct epidemic and endemic patterns[2].

  • New types or strains can start off with a cryptic, endemic phase before assuming epidemic proportions (e.g. EV-A71[3], EV-D68[4])
  • Bottlenecks from epidemic epidemiological cycles can limit diversity in certain areas, leading to a self-limiting pattern[5].
  • Epidemics in temperate regions exhibit a characteristic seasonal variation, with peaks in summer and early autumn. This is less apparent in the tropical regions[6].
  • Differences in geography can also change the timing of epidemic cycles, making them longer or even variable.
  • The cause for the cyclical patterns is likely multifactorial, being a combination of weather, geographic barriers, hygiene, viral evolution, herd immunity, changes in the susceptible population and host factors.
  • Homotypic immunity is probably the most important factor dictating transmission dynamics[6].
  • The relative species prevalence also changes throughout the year[7].

Demographics[1]

Climate, socio-economic factors and homotypic immunity likely contribute to the geographic distribution of different types[8].

Enterovirus A

Sequences dominate in East (71%) and South-east Asia (73.4%), with the most common EV-A71, EV-A6, EV-A16, EV-A10 occurring in that order. Very low levels are detected in Africa, North America and Western Asia.

Enterovirus B

Most common in Western Asia(81.4%), Europe(63.1%), Africa(63%), South America(61.3%), Southern Asia(61%), Oceania (55.1%).

Enterovirus C

  • A significant proportion exists in Africa(22.1%) and South America (21.2%); rarer in rest of the world
  • CV-A 24 is the most commonly sequenced EV-C type, with higher proportion in South America

Enterovirus D

  • Relatively rare worldwide; represent 76.7% of sequences in North America.

References

  1. 1.0 1.1 Brown DM, Zhang Y, Scheuermann RH (2020). "Epidemiology and Sequence-Based Evolutionary Analysis of Circulating Non-Polio Enteroviruses". Microorganisms. 8 (12). doi:10.3390/microorganisms8121856. PMC 7759938 Check |pmc= value (help). PMID 33255654 Check |pmid= value (help).
  2. Khetsuriani N, Lamonte-Fowlkes A, Oberst S, Pallansch MA, Centers for Disease Control and Prevention (2006). "Enterovirus surveillance--United States, 1970-2005". MMWR Surveill Summ. 55 (8): 1–20. PMID 16971890.
  3. Tee KK, Lam TT, Chan YF, Bible JM, Kamarulzaman A, Tong CY; et al. (2010). "Evolutionary genetics of human enterovirus 71: origin, population dynamics, natural selection, and seasonal periodicity of the VP1 gene". J Virol. 84 (7): 3339–50. doi:10.1128/JVI.01019-09. PMC 2838098. PMID 20089660.
  4. Tokarz R, Firth C, Madhi SA, Howie SRC, Wu W, Sall AA; et al. (2012). "Worldwide emergence of multiple clades of enterovirus 68". J Gen Virol. 93 (Pt 9): 1952–1958. doi:10.1099/vir.0.043935-0. PMC 3542132. PMID 22694903.
  5. Yarmolskaya MS, Shumilina EY, Ivanova OE, Drexler JF, Lukashev AN (2015). "Molecular epidemiology of echoviruses 11 and 30 in Russia: different properties of genotypes within an enterovirus serotype". Infect Genet Evol. 30: 244–248. doi:10.1016/j.meegid.2014.12.033. PMID 25562123.
  6. 6.0 6.1 Pons-Salort M, Oberste MS, Pallansch MA, Abedi GR, Takahashi S, Grenfell BT; et al. (2018). "The seasonality of nonpolio enteroviruses in the United States: Patterns and drivers". Proc Natl Acad Sci U S A. 115 (12): 3078–3083. doi:10.1073/pnas.1721159115. PMC 5866597. PMID 29507246.
  7. Brinkman NE, Fout GS, Keely SP (2017). "Retrospective Surveillance of Wastewater To Examine Seasonal Dynamics of Enterovirus Infections". mSphere. 2 (3). doi:10.1128/mSphere.00099-17. PMC 5471348. PMID 28630939.
  8. Bo YC, Song C, Wang JF, Li XW (2014). "Using an autologistic regression model to identify spatial risk factors and spatial risk patterns of hand, foot and mouth disease (HFMD) in Mainland China". BMC Public Health. 14: 358. doi:10.1186/1471-2458-14-358. PMC 4022446. PMID 24731248.


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