title: Enterovirus infections in England and Wales, 2000-2011: the impact of increased molecular diagnostics.
abstract: There have recently been significant changes in diagnostic practices for detecting enterovirus (EV) infections across England and Wales. Reports of laboratory-confirmed EV infections submitted by National Health Service (NHS) hospital laboratories to Public Health England (PHE) over a 12-year period (2000-2011) were analysed. Additionally, the PHE Virus Reference Department (VRD) electronic database containing molecular typing data from 2004 onwards was interrogated. Of the 13,901 reports, there was a decline from a peak of 2254 in 2001 to 589 in 2006, and then an increase year-on-year to 1634 in 2011. This increase coincided with increasing PCR-based laboratory diagnosis, which accounted for 36% of reported cases in 2000 and 92% in 2011. The estimated annual incidence in 2011 was 3.9/100,000 overall and 238/100,000 in those aged <3 months, who accounted for almost one-quarter of reported cases (n = 2993, 23%). During 2004-2011, 2770 strains were submitted for molecular typing to the VRD, who found no evidence for a predominance of any particular strain. Thus, the recent increase in reported cases closely reflects the increase in PCR testing by NHS hospitals, but is associated with a lower proportion of samples being submitted for molecular typing. The high EV rate in young infants merits further investigation to inform evidence-based management guidance.
authors.affiliation: Paediatric Infectious Diseases Research Group, St George's University of London, London, UK.
authors.forename: S
authors.initials: S
authors.lastname: Kadambari
authors.forename: A
authors.initials: A
authors.lastname: Bukasa
authors.forename: I O
authors.initials: IO
authors.lastname: Okike
authors.forename: R
authors.initials: R
authors.lastname: Pebody
authors.forename: D
authors.initials: D
authors.lastname: Brown
authors.forename: C
authors.initials: C
authors.lastname: Gallimore
authors.forename: J
authors.initials: J
authors.lastname: Xerry
authors.forename: M
authors.initials: M
authors.lastname: Sharland
authors.forename: S N
authors.initials: SN
authors.lastname: Ladhani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D004739:England / Q000453:epidemiology; D004769:Enterovirus Infections / Q000175:diagnosis* / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D025202:Molecular Diagnostic Techniques / Q000379:methods* / Q000706:statistics & numerical data*; D017720:Molecular Epidemiology / Q000379:methods; D058889:Molecular Typing / Q000379:methods* / Q000706:statistics & numerical data* / Q000639:trends; D014852:Wales / Q000453:epidemiology; D055815:Young Adult
keywords: Cell culture; PCR; enterovirus; genotyping; surveillance