Abstract
We report on the increased circulation of enterovirus A71 in Germany in 2019. Strains were mainly identified in hospitalised patients with suspected aseptic meningitis/encephalitis. Molecular analysis showed co-circulation of EV-A71 sub-genogroups C1 and C4, a signal for physicians and public health authorities to include/intensify EV diagnostic in patients showing signs of aseptic meningitis, encephalitis or acute flaccid paralysis/myelitis.
Highlights
We report on an increase of EV-A71 C1-like strains in Germany in 2019 and first detections of EV-A71 C4 strains in patients with neurological disease and HFMD
Stool or cerebrospinal fluid samples of hospitalised patients with signs of aseptic meningitis/encephalitis and/or acute flaccid paralysis are analysed within a quality-controlled laboratory network (LaNED)
Our findings suggest an increased circulation of EV-A71 strains in Germany already in the first 7 months of the year
Summary
Our findings suggest an increased circulation of EV-A71 strains in Germany already in the first 7 months of the year. Considering the fact that the EV season is still ongoing, the data available suggest that 2019 will become an epidemic year similar to 2016, 2013 and 2010. In Germany, the predominant EV-A71 sub-genogroup C2 was replaced by C1-like strains in 2016. Emergence of EV-A71 sub-genogroup C4 strains in Germany was detected between 2011 and 2013 [2], with France [10], Russia [11] and Denmark [12] reporting such detection around the same time. Since non-polio EV infections are not mandatorily notifiable at federal level in Germany, no data on severe cases or deaths are available. We were informed of an additional fatal case where EV-A71 was detected in a German child hospitalised in Austria in July 2019
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