Enteroviruses

Pathogen
Enteroviruses are a heterogeneous group of RNA viruses in the picornaviridae family. Coxsackie viruses A and B, ECHO viruses, polio viruses and other enteroviruses (e.g. type 68-71) are pathogenic to humans. There are numerous serotypes for all groups.

Prevalence
Enteroviruses are found around the world. Infections with enteroviruses may occur throughout the year, but there is a seasonal accumulation in the summer and autumn months in temperate climate zones.

Route of infection
Enteroviruses are mainly transferred via the faecal-oral route. Droplet infections are also possible. The most common transmission route is directly from person to person or by objects or food contaminated with stool or saliva. In person-to-person transmission, contaminated (dirty) hands play the most important role. Transmission via surface water has also been described. Diaplacental transmission of the viruses with infection of the foetus is also possible.

The virus is mainly excreted during the acute phase of the disease. After this, infected people often excrete the virus with their stool over a period of several weeks.

Transmission of enteroviruses is possible after swimming pools or lakes are contaminated by the faeces of infected people, which is why clustering of aseptic meningitis is often found during the warm summer months.

Incubation period
An average of 7-14 days (2 to 35 days are possible)

Clinical picture

90 to 95 % of all enterovirus infections have an asymptomatic progression.

The clinical pictures caused by enteroviruses range from infections of the upper respiratory tract (summer flu), pneumonia, pleurodynia, herpangina, hand-foot-and-mouth disease, febrile generalised exanthems, conjunctivitis, gastroenteritis, epidemic myalgia (Bornholm disease), hepatitis, myocarditis, pericarditis, meningitis, encephalitis, paralysis and foetal damage up to severe neonatal diseases with pneumonia, myocarditis and meningoencephalitis.

Preventive measures
The risk of infection can be reduced by good hand hygiene. Regular and careful hand disinfection or hand washing with soap play a crucial role, especially after nappy changing or going to the toilet.
Dirty surfaces and objects (including toys and door handles) should be cleaned especially thoroughly. Close contact with people who are infected should be avoided (kissing, embracing, sharing cutlery or cups, etc.).

Diagnostics
In cases of suspected acute enteroviral infection, direct detection should always be attempted by means of PCR from the stool or cerebrospinal fluid.

The detection of antibodies is only of minor importance; the evidence from an individual serum has no diagnostic value due to the epidemic proportions of the disease in the general population. With serology, progress monitoring should always be pursued in order to determine titre dynamics.

Test material

Enterovirus PCR from:

  • Pea-sized stool sample and/or
  • 1 ml of cerebrospinal fluid (in addition to the bacterial diagnosis)

Detection of enteroviral antibodies from:

  • 1 ml of serum

Therapy and prophylaxis
The treatment is symptomatic and depends on the affected organ system. No specific antiviral therapy is currently available.

Immunisation against polio should be in accordance with the recommendation by the Standing Committee on Vaccinations (STIKO).

Reporting obligation
There is no obligation to report Coxsackie viruses, ECHO viruses or enteroviruses pathogenic to humans, except in situations where an outbreak is expected.

PLEASE NOTE: Direct or indirect detection of the polio virus must be reported in accordance with sec. 7 of the German Infection Protection Act (IfSG); a polio virus infection (suspected, illness, death) must be reported in accordance with sec. 6 of the German Infection Protection Act (IfSG).


Sources
www.rki.de/DE/content/InfAZ/E/enteroviren/Kompendium.html
www.lgl.bayern.de/gesundheit/infektionsschutz/infektionskrankheiten_a_z/enterovirus/
www.nlga.niedersachsen.de/portal/live.php?navigation_id=6627&article_ID=19312&_psmand=20

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