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Update on Enterovirus Infections as of June 20, 2017

An increase in diagnoses of enterovirus (EV) infections is observed every year in France during the summer and fall. The summer peak is usually observed in late June and early July. The most frequently reported and diagnosed symptoms are neurological, primarily consisting of meningitis that requires only symptomatic treatment and resolves rapidly without sequelae. They primarily affect children under 15 years of age. The virus is transmitted through person-to-person contact or via contaminated objects or food, with the virus being shed from the nasopharynx or in stool.In France, surveillance of EV infections has been conducted since 2000 by a network of volunteer laboratories (Enterovirus Surveillance Network (RSE), coordinated by the National Reference Center (CNR) and Santé publique France). This surveillance primarily targets EV-related neuro-meningitis infections. Furthermore, since 2012, the CNR has implemented enhanced hospital-based surveillance of severe EV infections (particularly neonatal and respiratory) and community-based surveillance of hand, foot, and mouth disease. In addition, surveillance of emergency department visits for a diagnosis of EV meningitis is conducted by Santé publique France’s Oscour® network.Analysis of surveillance data suggests that during the summer of 2017, the number of EV infections may be higher than that observed over the past two years, although no increase in the number of severe clinical forms—particularly neurological ones—has been reported to date. The emergency departments included in Oscour® began to observe a gradual increase in the number of emergency department visits for viral meningitis starting in week 16 (April 17–23, 2017), which increased markedly in the following weeks, peaking in week 26 (June 26–July 2, 2017) and then declining rapidly. During the month of June, the weekly number of cases was higher than that observed during the same period in the two previous years, suggesting a potentially more severe EV meningitis epidemic this year. Data from the RSE show the same trends. As of June 20, 2017, 432 cases of infection with positive EV detection in cerebrospinal fluid had been reported by RSE laboratories. EV infections are most often mild, with a significant number of asymptomatic cases. However, any febrile symptoms associated with neurological symptoms should raise suspicion of an EV infection and require medical consultation. Among patients’ close contacts, stricter adherence to household and/or public hygiene rules (particularly handwashing) is imperative to limit the transmission of these viruses, especially to immunocompromised individuals or pregnant women.