Abstract
Background: Human enteroviruses (EVs) have been linked with severe disease and syndromes as varied as acute respiratory illness, myocarditis, and flaccid paralysis. With global polio eradication on sight the focus of clinical investigations has expanded to the identification of other EV serotypes associated with severe neurological conditions such as EV-D68, responsible for large outbreaks in 2014 and 2016 that spread worldwide and were related with severe respiratory disease leading to acute myelitis in some cases. New EV serotypes with epidemic potential continue to emerge such as EV-C104, EV-C105, EV-C109, and EV-C117 identified in respiratory samples in recent years.Methods: We used a next generation sequencing (NGS) approach to detect multiple EV serotypes directly in a sewage concentrate from Glasgow (Scotland, United Kingdom) generating whole-capsid nucleotide sequences that were compared to sequences of cell culture isolates from this sewage sample and clinical EV isolates from GenBank.Results: Thirteen different serotypes belonging to all four A, B, C, and D EV species were identified in the sewage concentrate. EV strains closely related to EV-D68 epidemic isolates of B3 lineage reported in the United States and Europe in 2016 and to EV-C109 respiratory isolates found in Denmark and Netherlands in 2015 were identified.Conclusion: Environmental surveillance (ES) can effectively detect EV circulation in human populations. The use of NGS for ES can help overcoming the limitations of traditional cell culture and sequencing methods, which are selective and biased, and can contribute to the early detection and assessment of spread of emerging EV pathogens.
Highlights
Human enteroviruses (EVs) are common human pathogens that have been associated with severe disease including syndromes such as acute respiratory disease, meningitis, myocarditis, hepatitis, and flaccid paralysis, the most notorious being paralytic poliomyelitis caused by poliovirus (PV) (Tapparel et al, 2013)
The most prevalent strains belonged to species B serotypes but EV strains from species A (CV-A4, CV-A6, and CV-A16), C (CV-A1, CV-A22, and EVC109), and D (EV-D68) serotypes were found
We have identified and characterized multiple EV strains in a sewage sample from Scotland using next generation sequencing (NGS) analysis of PanEV-specific RT-PCR products obtained directly from the sewage concentrate, including EV strains from EV-C109 and EV-D68 serotypes typically found in respiratory samples
Summary
Human enteroviruses (EVs) are common human pathogens that have been associated with severe disease including syndromes such as acute respiratory disease, meningitis, myocarditis, hepatitis, and flaccid paralysis, the most notorious being paralytic poliomyelitis caused by poliovirus (PV) (Tapparel et al, 2013). Related EV-D68 strains were found during the same period in Canada, Europe, and Asia with more than 2,000 cases reported in 20 countries (Holm-Hansen et al, 2016) These outbreaks were temporally and geographically associated with clusters of increased AFM, in the United States. With global polio eradication on sight the focus of clinical investigations has expanded to the identification of other EV serotypes associated with severe neurological conditions such as EV-D68, responsible for large outbreaks in 2014 and 2016 that spread worldwide and were related with severe respiratory disease leading to acute myelitis in some cases. New EV serotypes with epidemic potential continue to emerge such as EV-C104, EVC105, EV-C109, and EV-C117 identified in respiratory samples in recent years
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