Outbreaks & Surveillance

In the United States, people can get infected with non-polio enteroviruses at any time of the year. However, it is more common in the summer and fall. There is no predictable pattern for when these viruses circulate and cause infections and outbreaks.

Outbreaks of Various Non-Polio Enteroviruses

• Coxsackievirus A16 is the most common cause of hand, foot, and mouth disease (HFMD) in the United States.
• Coxsackievirus A6 was the most commonly reported type of enterovirus in this country from 2009 to 2013, mostly due to a large outbreak in 2012 of severe hand, foot, and mouth disease. Some of the infected people developed symptoms that were more severe than usual.
• Coxsackievirus A24 and enterovirus 70 have been associated with outbreaks of conjunctivitis.
• Echoviruses 13, 18, and 30 have caused outbreaks of viral meningitis in the United States.
• Enterovirus 71 has caused large outbreaks of HFMD worldwide, especially in children in Asia. Some infections from this virus have been associated with severe neurologic disease, such as brainstem encephalitis.
• Enterovirus D68 caused a nationwide outbreak in 2014 of severe respiratory illness in the United States.

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Surveillance Systems

Information on cases and outbreaks of enterovirus infection is collected in the United States using two surveillance systems:

• National Respiratory and Enteric Virus Surveillance System (NREVSS): a voluntary, laboratory-based surveillance system that has included enterovirus reporting since July 2007. This system is used to track the number of enterovirus tests that are performed and the proportion that are positive, by specimen type, location, and when they were collected. Serotyping, demographic data, and clinical data are not reported.
• National Enterovirus Surveillance System (NESS): a passive, voluntary, laboratory-based system that collects basic data on specimens positive for enterovirus or human parechovirus, including serotype. NESS has been collecting data since the 1960s.

References

• Midgley CM, Watson JT, Nix WA, Curns AT, Rogers SL, et al. Severe respiratory illness associated with a nationwide outbreak of enterovirus D68 in the USA (2014): a descriptive epidemiological investigation. Lancet Respir Med. 2015 Nov;3(11):879-87.
• Midgley CM, Jackson MA, Selvarangan R, Turabelidze G, Obringer E, Johnson D, et al. Severe respiratory illness associated with enterovirus D68 — Missouri and Illinois, 2014. MMWR. 2014:63(36)798-9.
• Centers for Disease Control and Prevention. Notes from the field: Severe hand, foot, and mouth disease associated with coxsackievirus a6—Alabama, Connecticut, California, and Nevada, November 2011-February 2012. MMWR 2012;61:213-4.
• American Academy of Pediatrics. Section 3: Enterovirus (nonpoliovirus)– clinical manifestations. In Red Book: 2015 Report of the Committee on Infectious Diseases, 30th ed. Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Elk Grove Village, IL: American Academy of Pediatrics; 2015.

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