What is the clinical evidence from this study?

Study design: Observational. Population: Acute flaccid paralysis (n=747). Intervention: Enterovirus infection. Primary outcome: Enterovirus isolation from AFP cases or their close contacts.

January 1, 2016Polish Journal of Microbiology7 citationsOpen Access

Molecular Characterization of Enteroviruses Isolated from Acute Flaccid Paralysis Cases in Poland, 1999–2014

MWMagdalena Wieczorek AKArleta Krzysztoszek

Key Result

Between 1999 and 2014 in Poland, 6.12% of acute flaccid paralysis cases were associated with enterovirus isolation, with 43.6% of these positive cases linked to non-polio enteroviruses.

Study Design

Type

Observational (n=747)

Structured PICO

Population

747 children under 15 years of age with acute flaccid paralysis and their asymptomatic contacts in Poland, evaluated for enterovirus infection between 1999 and 2014.

Outcome

Presence and molecular characterization of enteroviruses (polio and non-polio) in stool samples

Non-polio enteroviruses, particularly species EV-B, are associated with acute flaccid paralysis cases in Poland, emphasizing the need for ongoing surveillance after polio eradication.

Limitations

Lack of true controls as only contacts of AFP cases were tested, who likely share exposures and viral flora.
Stool is not the optimal specimen for enterovirus disease association studies due to the high proportion of asymptomatic infections.
The cell lines used (RD and L20B) are optimized for poliovirus and less suitable for non-polio enteroviruses, potentially leading to underdetection.
Lack of true controls as only contacts of AFP cases were tested
Stool is not the optimal specimen for enterovirus disease association studies
Cell lines recommended for PV isolation (RD and L20B) are less suitable for isolation of NPEVs

Abstract

Enteroviruses (EVs) are among viral pathogens that can cause acute flaccid paralysis (AFP). This study represents an overview of EVs isolated through AFP surveillance in Poland between 1999 and 2014. The presence of enteroviruses was studied in stool samples that were collected from 747 AFP cases and their asymptomatic contacts. Fifty five (6.12%) cases of AFP were associated with enterovirus isolation. Out of the 55 positive cases, 40 were associated with detection of enterovirus in patient, and 15 with detection of EV in healthy contact, without positive detection in paralytic patient. Polioviruses were isolated from 35 AFP cases. The results of this study showed that about 43.6% of positive AFP cases were found in association with the isolation of non-polio enteroviruses (NPEV). A total of 12 different types of the species B were detected (CVA9, CVB1, CVB3, CVB4, CVB5, E3, E4, E9, E11, E13, E30), and one additional isolate represented the species enterovirus A (EV71). Among the 12 serotypes of species B, CVB3 and CVB5 were more frequently detected than others, representing 40% of the characterized isolates, followed by CVB4 (16%), E4 (8%), and E11(8%). Phylogenetic analysis revealed that strains from Poland had the closest genetic relationship with isolates previously identified in Europe (France, Finland, Denmark, Moldova) but also in other parts of the world (Tunisia, China, USA), suggesting wide distribution of these lineages. The paper provides information about NPEV circulation in Poland in the past 16 years, about its association with the AFP and it indicates the need for monitoring NPEV circulation even after the eradication of poliomyelitis.

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