Recommendations for enterovirus diagnostics and characterisation within and beyond Europe

Area of Science:

• Virology
• Infectious Diseases
• Public Health

Background:

• Enteroviruses (EV) cause severe neurological and respiratory infections, leading to outbreaks in Europe.
• Current EV diagnostics are often inadequate, and typing data is not systematically collected at a European level.
• Underdiagnosis hinders effective surveillance and understanding of EV disease burden.

Purpose of the Study:

• To establish the European non-polio enterovirus network (ENPEN) for improved EV diagnostics and surveillance.
• To provide consensus-based recommendations for non-polio EV detection and typing in Europe.
• To facilitate better estimation of EV disease burden through standardized laboratory practices.

Main Methods:

• Development of consensus recommendations by a multidisciplinary team of experts from over 20 European countries.
• Recommendation for submission of respiratory, stool, cerebrospinal fluid (CSF), and blood samples for EV testing.
• Advocacy for the use of reverse transcriptase PCR (RT-PCR) targeting the 5'noncoding regions (5'NCR) for EV diagnosis.
• Recommendation for VP1 capsid protein gene sequencing for accurate EV typing, avoiding 5'NCR sequencing and virus isolation.

Main Results:

• Establishment of the European non-polio enterovirus network (ENPEN).
• Consensus recommendations for EV detection and typing across Europe.
• Identification of optimal sample types (respiratory, stool, CSF, blood) and diagnostic methods (RT-PCR, VP1 sequencing).

Conclusions:

• Standardized laboratory diagnostics and strain characterization are essential first steps for effective EV surveillance.
• Improved diagnostics and data collection will enhance the understanding of EV disease burden in Europe.
• ENPEN aims to improve prompt and adequate diagnosis of enterovirus infections throughout Europe.