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Abstract

Background

In the Netherlands, echovirus type 6 (E6) is identified through clinical and environmental enterovirus surveillance (CEVS and EEVS).

Aim

We aimed to identify E6 transmission clusters and to assess the role of EEVS in surveillance and early warning of E6.

Methods

We included all E6 strains from CEVS and EEVS from 2007 through 2016. CEVS samples were from patients with enterovirus illness. EEVS samples came from sewage water at pre-specified sampling points. E6 strains were defined by partial VP1 sequence, month and 4-digit postcode. Phylogenetic E6 clusters were detected using pairwise genetic distances. We identified transmission clusters using a combined pairwise distance in time, place and phylogeny dimensions.

Results

E6 was identified in 157 of 3,506 CEVS clinical episodes and 92 of 1,067 EEVS samples. Increased E6 circulation was observed in 2009 and from 2014 onwards. Eight phylogenetic clusters were identified; five included both CEVS and EEVS strains. Among these, identification in EEVS did not consistently precede CEVS. One phylogenetic cluster was dominant until 2014, but genetic diversity increased thereafter. Of 14 identified transmission clusters, six included both EEVS and CEVS; in two of them, EEVS identification preceded CEVS identification. Transmission clusters were consistent with phylogenetic clusters, and with previous outbreak reports.

Conclusion

Algorithms using combined time–place–phylogeny data allowed identification of clusters not detected by any of these variables alone. EEVS identified strains circulating in the population, but EEVS samples did not systematically precede clinical case surveillance, limiting EEVS usefulness for early warning in a context where E6 is endemic.

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This work is licensed under a Creative Commons Attribution 4.0 International License.
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2018-11-08
2024-04-19
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2018.23.45.1800288
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Echovirus type 6 transmission clusters and the role of environmental surveillance in early warning, the Netherlands, 2007 to 2016
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Susana+Monge&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Monge Susana</a>, <a href="/search?value1=Kimberley+Benschop&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Benschop Kimberley</a>, <a href="/search?value1=Loes+Soetens&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Soetens Loes</a>, <a href="/search?value1=Roan+Pijnacker&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Pijnacker Roan</a>, <a href="/search?value1=Susan+Hahn%C3%A9&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Hahné Susan</a>, <a href="/search?value1=Jacco+Wallinga&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Wallinga Jacco</a>, <a href="/search?value1=Erwin+Duizer&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Duizer Erwin</a></span>. Echovirus type 6 transmission clusters and the role of environmental surveillance in early warning, the Netherlands, 2007 to 2016. <a href="/content/ecdc">Euro Surveill.</a> 2018;23(45):pii=1800288. <a href="https://doi.org/10.2807/1560-7917.ES.2018.23.45.1800288" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2018.23.45.1800288</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 01 Jun 2018;&nbsp;&nbsp; <span class="generated">Accepted</span>: 11 Sept 2018 </span> </p>
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    • Echovirus type 6 transmission clusters and the role of environmental surveillance in early warning, the Netherlands, 2007 – 2016: Supplementary material (updated 15 November 2018)

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