Outbreaks & Surveillance

In the United States, people can get infected with non-polio enteroviruses at any time of the year. However, non-polio enterovirus infections are more common in the summer and fall.

Outbreaks of Various Non-Polio Enteroviruses

• Coxsackievirus A16 is the most common cause of hand, foot, and mouth disease (HFMD) in the United States.

A report published in MMWR describes cases of neurologic disease associated with enterovirus A71 among children in Colorado in 2018.
Read the report.

• 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 outbreaks have been documented in 2014, 2016, and 2018, causing respiratory illness in the United States.

Surveillance Systems

Two surveillance systems collect information on cases and outbreaks associated with enterovirus infection in the United States:

• National Respiratory and Enteric Virus Surveillance System (NREVSS): a voluntary, laboratory-based surveillance system that has included enterovirus reporting since July 2007. This system tracks the number of enterovirus tests 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

• Kujawski SA, Midgley CM, Rha B, et al. Enterovirus D68–Associated Acute Respiratory Illness — New Vaccine Surveillance Network, United States, July–October, 2017 and 2018. MMWR Morb Mortal Wkly Rep 2019;68:277–280.
• Messacar K, Burakoff A, Nix WA, et al. Notes from the Field: Enterovirus A71 Neurologic Disease in Children — Colorado, 2018. MMWR Morb Mortal Wkly Rep 2018;67:1017–1018.
• 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.
• Prill MM, Dahl RM, Midgley CM, Chern SW, Lu X, et al. Severe Respiratory Illness Associated With Rhinovirus During the Enterovirus D68 Outbreak in the United States, August 2014-November 2014. Clin Infect Dis. 2018 May 2;66(10):1528-1534
• 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 manifestatio In Red Book: 2018 Report of the Committee on Infectious Diseases, 31st ed. Kimberlin DW, Brady MT, Jackson MA, Long SS, eds. Elk Grove Village, IL: American Academy of Pediatrics; 2018.