Epidemiology of human enterovirus 71 infections in France, 2000–2009

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Abstract

Background

Human enterovirus 71 (EV-71) emerged as a significant pathogen able to cause large outbreaks involving severe neurological cases and children fatalities in Asia.

Objectives

To describe epidemiology of EV-71 infections in France.

Study design

Fifty-nine patients admitted in 12 different hospitals from 1994 to 2009 were included. The entire VP1 coding gene of 58 EV-71 strains was sequenced and phylogenetic analyses were performed to assign strains to genogroups/subgenogroups and to compare French isolates to European and worldwide isolates.

Results

The median age of the patients was 1.04 years (9 days to 7 years). Among 46 documented EV-71 infections, 39 were self-limited. Seven children developed severe sepsis-like, respiratory or neurological complications. Among them, 2 children died from acute respiratory distress syndrome. All the EV-71 strains belonged to genogroup C: 31 isolates belonged to subgenogroup C1, 26 to subgenogroup C2 and 1 to subgenogroup C4. All the strains were genetically related to other European strains isolated at the same period of time. Although C1 isolates were predominant between 1994 and 2005, C2 strains have been predominant since 2007. No association was found between any genotype and the age or the clinical symptoms.

Conclusions

The C4 subgenogroup, which was associated with large outbreaks in China, did not spread in France. It is important to monitor more carefully the EV-71 strains circulating in France to detect the introduction of new genetic variants that could be associated with major outbreaks.

Section snippets

Background

Although mainly associated with asymptomatic infections and benign conditions (fever, hand, foot and mouth disease (HFMD), aseptic meningitis, bronchiolitis), human enterovirus 71 (EV-71) is also responsible for severe and sometimes fatal neurological complications such as brain-stem encephalitis and poliomyelitis-like paralysis.1 During the last twelve years, EV-71 infections have emerged as a significant public health threat in the Asia-Pacific region, where large outbreaks associated with

Objectives

The aim of this study was to describe clinical and epidemiological features as well as molecular data on a series of EV-71 cases hospitalized in France between 1994 and 2009.

Patients and EV-71 strains

Fifty-nine patients, for whom an EV-71 infection had been laboratory-confirmed, were included in this study. They were admitted to 12 different hospitals in France between 1994 and 2009 (Table 1). EV-71 strains were isolated from various clinical specimens using either MRC-5 (human lung embryonic fibroblasts) or RD (rhabdomyosarcoma) cell lines. All the EV-71 strains, except 9 collected and typed at the University Hospital of Clermont-Ferrand, were typed at the National Reference Center for

Demographic and clinical data

Most of the patients included in this study (n = 57/59) were admitted to hospital from 2000 to 2009. They represented 70.4% of the total number of patients diagnosed with an EV-71 infection in a hospital setting over that period in France (Table 3).

The median age of the patients was of 1.04 years old (9 days to 7 years) (Table 1). Infants (0–3 months) and young children (4 months to 3 years) accounted for 25.4% (15/59) and 61% (36/59) of the patients included, respectively. The M/F sex ratio was

Discussion

This is the first study describing the epidemiology of EV-71 infections in France over a 10-year period.

In France, only hospitalized cases of EV-71 infection are laboratory-confirmed and, since 2000, voluntarily reported through a laboratory network to the National Institute for Public Health. Based on that sentinel surveillance system, EV-71 infections reported during the last 10 years were mainly sporadic, as observed in other European countries.10, 11, 12, 13 Our study included 59

Conflict of interest

The authors declare that they have no conflict of interest.

Acknowledgments

We thank all the virologists of the EV surveillance network for transmitting the clinical and epidemiological data for the patients included in this study: Dr Ducancelle (Angers), Dr Billion (Aubenas), Dr Legrand-Quillien (Brest), Dr Petitjean-Lecherbonnier (Caen), Dr Pothier (Dijon), Dr Morel-Baccard (Grenoble), Dr Venard (Nancy), Dr Coste-Burel (Nantes), Dr Agius (Poitiers), Dr Marmonnier (Le Mans). We thank Monique Ballandras and Delphine Falcon from the National Reference Center for

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