title: The epidemiology of non-polio enteroviruses: recent advances and outstanding questions.
abstract: OBJECTIVE
  There are over 100 serotypes of human enteroviruses, which cause a spectrum of illnesses, including meningitis, encephalitis, paralysis, myocarditis and rash. Increasing incidence of hand-foot-and-mouth disease in the Asia-Pacific region and recent outbreaks of enterovirus-associated disease, such as severe respiratory illness in the United States in 2014, highlight the threat of these viruses to human health.
  
  
  RESULTS
  We describe recent outbreaks of human enteroviruses and summarize knowledge gaps regarding their burden, spectrum of diseases and epidemiology.
  
  
  CONCLUSIONS
  Reported outbreaks of respiratory, neurological, skin and eye diseases associated with human enteroviruses have increased in frequency and size in recent years. Improved molecular diagnostics and genetic sequence analysis are beginning to reveal the complex dynamics of individual serotypes and genotypes, and their contribution to these outbreaks. However, the biological mechanisms underlying their emergence and transmission dynamics remain elusive. They are likely to involve changes in the virus, such as fitness, antigenicity, virulence or tropism, and in the human population, such as levels of sanitation and of homotypic and heterotypic immunity. Improvements in surveillance, serological surveys and detailed genetic and antigenic characterization of viral populations would help to elucidate these mechanisms. This will be important for the design of outbreak control and vaccine development strategies.
authors.affiliation: Department of Infectious Disease Epidemiology, St Mary's Campus, Imperial College London, London, UK.
authors.forename: Margarita
authors.initials: M
authors.lastname: Pons-Salort
authors.forename: Edward P K
authors.initials: EP
authors.lastname: Parker
authors.forename: Nicholas C
authors.initials: NC
authors.lastname: Grassly
mesh_terms: D004196:Disease Outbreaks; D004770:Enterovirus; D004769:Enterovirus Infections; D006232:Hand, Foot and Mouth Disease; D006801:Humans; D014481:United States / Q000453:epidemiology