Key result
Enterovirus positivity among hospitalized patients in Israel was 7.1% in CSF and 19.3% in stool samples, with rates declining significantly during the SARS-CoV-2 pandemic (p=0.006).
Why the study?
Enteroviruses cause illnesses ranging from mild to severe, including neurological complications, prompting evaluation of their molecular epidemiology, clinical impact, and seasonality.
Observational
No
Enterovirus epidemiology in Israel showed dynamic changes including shifts in seasonality, genotype variability, and a significant decline during the SARS-CoV-2 pandemic.
Enteroviral CSF positivity may flag ICU-level severity; hypothesis-generating for subtype surveillance and leaves practice implications open.
Enteroviruses (EVs) cause a spectrum of illnesses ranging from mild to severe, including neurological complications. In this study, the molecular epidemiology, clinical impact, and seasonality of EVs were evaluated among hospitalized patients in a large tertiary medical center in Israel from 2016 to 2024. A total of 11,246 cerebrospinal fluid (CSF) samples and 5,744 stool samples were tested for EV RNA using RT‐PCR, with 7.1% ( n = 798) and 19.3% ( n = 1,110) testing positive, respectively. Positive samples were sequenced for genotype identification based on partial VP1 sequences with 70% genotype identification. The most commonly detected subtypes in CSF samples were: E‐18 (16.4%), E‐5 (80/567, 14.1%), E‐6 (67/567, 11.8%), E‐30 (64/567, 11.3%), CVB5 (37/567, 6.5%), E‐4 (29/567, 5.1%), and CVB2 (28/567, 4.9%). These subtypes were also detected in stool samples during similar time periods. Seasonal analyses showed the expected summer peaks with unexpected off‐season outbreaks in 2016, 2017, and 2022–2024. Additionally, EV positivity rates declined significantly during the SARS‐CoV‐2 pandemic ( p = 0.006) followed by a resurgence in 2022–2023. Phylogenic analysis revealed genomic shifts in CVB2, E‐5, E‐6, E‐18, and E‐30, whereas CVB5 and E‐4 showed no significant variations. CVB2 infections were particularly associated with severe illness in infants, with 10.6% of all sequenced cases requiring ICU admission. These findings demonstrate dynamic changes in EV epidemiology in Israel, including shifts in seasonality, genotype variability, and the impact of SARS‐CoV‐2 on EV circulation, highlighting the importance of continued molecular surveillance for identifying emerging strains and better understand trends relevant to public health.
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Fratty et al. (2026) conducted an observational in Enterovirus infection. Enterovirus infection was evaluated on Enterovirus RNA positivity (p=0.006). Enterovirus positivity among hospitalized patients in Israel was 7.1% in CSF and 19.3% in stool samples, with rates declining significantly during the SARS-CoV-2 pandemic (p=0.006).
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