Potencial risks of outbreaks of various clinical forms of enteroviral infection

   Enterovirus infection is widespread both in Russia and in neighboring and non-neighboring countries.

   The relevance of its study is due to its global spread, the risk of introducing new pathogen isolates into the Russian Federation due to high migration and tourism activity, as well as the pathogen's high contagiousness and resistance in the environment, the diversity of transmission mechanisms and routes, the lack of specific prevention, outbreaks with varying degrees of severity, and the impact on all segments of the population, especially children and newborns (the mortality rate in this group reaches 30–50 %).

   The aim of the study was to analyze the factors contributing to the emergence and spread of enterovirus infection outbreaks and to identify the clinical forms of the disease most susceptible to outbreak development.

   Materials and methods. Using information from statistical forms available on the official websites of US and European health organizations and the WHO, we examined the pathogenetic aspects of enterovirus infection, epidemiological risks, and age-related characteristics.

   Results and discussion. Diagnosis is challenging due to the diversity of clinical forms: the rate of misdiagnosis reaches 67 %. The study highlights the need to improve early recognition of the disease and illuminates the complex interaction of epidemiological and clinical factors contributing to outbreaks.

   Conclusions. The high genetic variability of enteroviruses causes a wide range of clinical manifestations, from asymptomatic carriage to severe forms such as serous meningitis. PCR is the preferred method for genotype identification and genome sequencing. Molecular epidemiological monitoring is carried out by Rospotrebnadzor. Improving health literacy among tourists visiting regions with warm climates is important. Optimizing epidemiological surveillance includes creating a unified disease monitoring system, identifying risk zones, and analyzing dominant serotypes.

1. Baggen J., Thibaut H. J., Strating J. R., van Kuppeveld F. J. M. Enterovirus replication and pathogenesis. Nat Rev Microbiol. 2020; 18 (11): 653–667. DOI: 10.1038/s41579-020-00438-7

2. Alimov A. V., Feldblum I. V., Akimkin V. G. et al. Epidemiological surveillance and control of enterovirus (non-polio) infection: current issues and solutions. Yekaterinburg: Yunika, 2021. 181 p. (In Russ.).

3. Arkhipkina S. A., Grishinina S. A. Clinical and epidemiological analysis of cases of enterovirus infection. Clinician. 2020; 14 (3–4): 52–56. (In Russ.). DOI: 10.17650/1818-8338-2020-14-3-4-K616

4. Zhang Y., Tan X., Wang H. Y., Yan D., Zhu S., Wang D. et al. Molecular epidemiology of enteroviruses associated with hand, foot, and mouth disease. Front Microbiol. 2021; 12:678363. DOI: 10.3389/fmicb.2021.678363

5. Zayats N. A., Zhitenova E. V., Serova Y. S. Dynamics of enterovirus infection morbidity. Bulletin of Medical Internet Conferences. 2019; 9: 529–530. (In Russ.).

6. Kovalev E. V., Tverdokhlebova T. I., Simovanyan E. N. Molecular epidemiological and clinical aspects of enterovirus infection. Med. Herald of the South of Russia. 2023; 14 (1): 83–92. (In Russ.). DOI: 10.21886/2219-8075-2023-14-1-83-92

7. Messacar K., Schreiner T. L., Van Haren K., Yang M., Glaser C. A., Tyler K. L. Acute flaccid myelitis : clinical review. Lancet Infect Dis. 2022; 22 (4): e96–e107. DOI: 10.1016/S1473–3099(21)00593-9

8. Lu G., Yan W., Wang Y., Shi L., Zhu S., Zhang Y. Genetic evolution of enteroviruses. Viruses. 2021; 13 (6): 1085. DOI: 10.3390/v13061085

9. Khetsuriani N., Lamonte-Fowlkes A., Oberst S., Pallansch M. A. Enterovirus surveillance: global trends. Clin Infect Dis. 2020; 71 (Suppl 4): S 258–S 265. DOI: 10.1093/cid/ciaa1436

10. Holm-Hansen C.C., Midgley S. E., Fischer T. K. Global emergence of enterovirus D 68. Euro Surveill. 2021; 26 (42): 2002255. DOI: 10.2807/1560–7917.ES.2021.26.42.2002255

11. Bian L., Gao F., Mao Q., Sun S., Wu X., Liu S., Liang Z. Coxsackievirus A6 epidemiology and clinical features. Emerg Microbes Infect. 2021; 10 (1): 135–145. DOI: 10.1080/22221751.2021.1872362

12. Zhao T. S., Du J., Chen L., Liu X., Wang X., Zhang H. Epidemiological characteristics of HFMD outbreaks. BMC Infect Dis. 2022; 22: 345. DOI: 10.1186/s12879-022-07347-8

13. Petrova E. I., Minakova Y. V., Portnyagina E. V. et al. Enterovirus infections: a textbook for students. Tomsk: SibGMU, 2023. 76 p. (In Russ.).

14. Lukyanenko N. V. et al. Epidemiological features of enterovirus infection. Medical Review. 2019; 2 (2): 49–52. (In Russ.).

15. Brotons P., Jordan I., Bassat Q., Henares D., de Sevilla M. F., Fumado V. Rhinovirus / enterovirus detection and SARS-CoV-2 persistence. Viruses. 2021; 13 (8): 1598. DOI: 10.3390/v13081598

16. Xing W., Liao Q., Viboud C., Zhang J., Sun J., Wu J. T. Epidemiological characteristics of HFMD. Lancet Infect Dis. 2020; 20 (4): e102–e113. DOI: 10.1016/S1473-3099(19)30719-6

17. Harvala H., Broberg E., Benschop K., Berginc N., Ladhani S., Susi P. Updated recommendations for enterovirus diagnostics. J Clin Virol. 2022; 150–151: 105155. DOI: 10.1016/j.jcv.2022.105155

18. Yeung W. C.G., Rawlinson W. D., Craig M. E. Enterovirus infection and type 1 diabetes. BMJ. 2020; 368: l6794. DOI: 10.1136/bmj.l6794

19. Wang K., Ye F., Chen Y., Zhou X., Wang H., Li X. Clinical and neurological features of enterovirus A71 and D 68 infections. Front Neurol. 2021; 12: 706964. DOI: 10.3389/fneur.2021.706964

20. World Health Organization. Enterovirus surveillance reports. Weekly Epidemiological Record. 2022–2024.

21. Centers for Disease Control and Prevention (CDC). Non-polio enterovirus reports. MMWR. 2021–2024.

22. Midgley S. E., Benschop K., Dyrdak R., Mirand A., Bailly J. L., Bierbaum S. Enterovirus D 68 outbreak and neurological complications. Euro Surveill. 2020; 25 (45): 2001915. DOI: 10.2807/1560–7917.ES.2020.25.45.2001915

23. Puenpa J., Wanlapakorn N., Vongpunsawad S., Poovorawan Y. Enterovirus-associated HFMD epidemiology. Microorganisms. 2021; 9 (7): 1504. DOI: 10.3390/microorganisms9071504

24. Sejvar J. J., Lopez A. S., Cortese M. M., Leshem E., Pastula D. M., Miller L. Acute flaccid myelitis surveillance updates. Clin Infect Dis. 2021; 72 (10): 1802–1808. DOI: 10.1093/cid/ciaa1515

25. Walker P. J., Siddell S. G., Lefkowitz E. J., Mushegian A. R., Dempsey D. M., Dutilh B. E. Virus taxonomy update. Arch Virol. 2019; 164 (9): 2417–2429. DOI: 10.1007/s00705-019-04306-w

26. Bian L., Wang Y., Yao X., Mao Q., Xu M., Liang Z. Global burden of HFMD. Infect Dis Poverty. 2020; 9: 75. DOI: 10.1186/s40249-020-00682-3

27. Liu W., Wu S., Xiong Y., Li T., Wen Z., Yan M. Epidemiology of enterovirus A71 infections. Viruses. 2021;13(4):562. DOI: 10.3390/v13040562

28. Huang J., Liao Q., Ooi M. H., Cowling B. J., Chang Z., Wu P. Enterovirus outbreaks and molecular surveillance. Front Public Health. 2022; 10: 823105. DOI: 10.3389/fpubh.2022.823105

29. Novikova N. A., Golitsyna L. N., Selivanova S. G., Zverev V. V., Ponomareva N. V., Leonov A. V. et al. Morbidity, etiological structure, and prevention issues of enterovirus (non-polio) infection. Information Bulletin of the Reference Center for Monitoring Enterovirus Infections. 2023: 3–12. (In Russ.).

30. FBUZ «Center for Hygienic Education of the Population» Rospotrebnadzor. https://cgon.rospotrebnadzor.ru 2025. 93–99 р. (In Russ.).