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Publication Acute flaccid paralysis (AFP) surveillance: challenges and opportunities from 18 years' experience, Spain, 1998 to 2015(European Centre for Disease Prevention and Control (ECDC), 2018) Masa-Calles, Josefa; Torner, Núria; Lopez-Perea, Noemi; Torres-de Mier, Maria de Viarce; Fernandez Martinez, Beatriz; Cabrerizo, Maria; Gallardo-García, Virtudes; Malo, Carmen; Margolles, Mario; Portell, Margarita; Abadía, Natividad; Blasco, Aniceto; García-Hernández, Sara; Marcos, Henar; Rabella, Núria; Marín, Celia; Fuentes, Amelia; Losada, Isabel; Gutiérrez, Juan García; Nieto, Alba; García Ortúzar, Visitación; Garcia-Cenoz, Manuel; Arteagoitia, José María; Blanco Martínez, Ángela; Rivas, Ana; Castrillejo, DanielAcute flaccid paralysis (AFP) surveillance is key for global polio eradication. It allows detecting poliovirus (PV) reintroductions from endemic countries. This study describes AFP surveillance in Spain from 1998 to 2015. During this time, 678 AFP cases were reported to the Spanish National Surveillance Network. The mean notification rate was 0.58 AFP cases/100,000 population under 15 years old (range: 0.45/100,000-0.78/100,000). Two periods (P) are described: P1 (1998-2006) with the AFP notification rate ranging from 0.66/100,000 to 0.78/100,000, peaking in 2001 (0.84/100,000); and P2 (2007-2015) when the AFP rate ranged from 0.43/100,000 to 0.57/100,000, with the lowest rate in 2009 (0.31/100,000). No poliomyelitis cases were caused by wild PV infections, although two Sabin-like PVs and one imported vaccine-derived PV-2 were detected. Overall, 23 (3.4%) cases met the hot case definition. Most cases were clinically diagnosed with Guillain-Barré syndrome (76.9%; 504/655). The adequate stool collection rate ranged from 33.3% (7/21) to 72.5% (29/40). The annual proportion of AFP cases with non-polio enterovirus findings varied widely across the study period. AFP surveillance with laboratory testing for non-polio enteroviruses must be maintained and enhanced both to monitor polio eradication and to establish sensitive surveillance for prompt detection of other enteroviruses causing serious symptoms.Publication Análisis de un brote de meningitis viral en la provincia de Tucumán, Argentina(Organización Mundial de la Salud (OMS), 2003-04) Freire, María Cecilia; Cisterna, Daniel Marcelo; Rivero, Karina; Palacios, Gustavo Fabián; Casas Flecha, Inmaculada; Tenorio, Antonio; Gómez, José Alberto[ES] Confirmar la existencia de un brote de meningitis viral en 1996 en la provincia de Tucumán, Argentina, y estudiar sus características epidemiológicas. Se analizó información obtenida del Sistema Nacional de Vigilancia Epidemiológica (SINAVE) del Ministerio de Salud de Argentina para el período de 1994 1998, la cual fue provista por la Dirección de Epidemiología de dicho ministerio. Para el cálculo de incidencias se usaron estimaciones poblacionales para los años 1994 1998 realizadas por el Instituto Nacional de Estadística y Censos (INDEC) sobre la base del censo de 1991. El estudio de frecuencias se realizó mediante el análisis de tablas de contingencia de doble entrada, según el método de ji cuadrado con la corrección de Yates. Se consideró significativo el resultado cuando P < 0,05. Se confirmó la presencia de un brote de 189 casos entre el 11 de febrero y el 18 de mayo de 1996. La incidencia de casos en la provincia mostró un aumento entre 1995 y 1996 (de 0,5 a 19,3 casos por 100000 años-persona) y dicha incidencia fue significativamenrte mayor que la observada en el resto del país (19,3 frente a 2,8 casos por 100000 años-persona). El 75,1% de los casos ocurrió en niños menores de 9 años (142/189). Se detectó la presencia de Enterovirus (EV) en 65 de las 111 muestras estudiadas (58,6%). Mediante la reacción en cadena de la polimerasa (RCP) anidada con transcripción inversa se logró detectar EV en 66,3% (53/80) de los casos estudiados por este método, en comparación con solo 29,6% (24/81) de los estudiados mediante aislamiento viral. Se identificó echovirus tipo 4 en 15 (68%) en las 22 muestras tipificadas (5 por aislamiento, 3 por secuenciación y 7 por ambos métodos). Este brote demuestra la capacidad de los EV para diseminarse y producir enfermedad en la población. Durante el brote, por lo menos 56% de los casos fueron hospitalizados. El uso de métodos moleculares permitió el diagnóstico rápido del virus etiológico y posibilitó un mejor control del brote. El reconocimiento temprano de este podría haber evitado la mayoría de las hospitalizaciones y el uso indiscriminado de antibióticos. [EN] To confirm the occurrence of an outbreak of viral meningitis in 1996 in the province of Tucuman, Argentina, and to study the outbreak's epidemiological characteristics. We analyzed information from the National Epidemiological Surveillance System of the Ministry of Health (MOH) of Argentina for 1994-1998 that had been provided by the MOH's Bureau of Epidemiology. We calculated incidence rates using population estimates for the years 1994-1998 developed by the National Statistics and Census Institute, based on the 1991 census. We studied frequencies with contingency tables, using the chi-square method with Yates' correction. Results were considered significant when P < 0.05. We confirmed the occurrence of an outbreak of 189 cases of viral meningitis between 11 February and 18 May 1996. The incidence of cases in Tucuman province increased between 1995 and 1996, from 0.5 to 19.3 cases per 100 000 person-years. That 1996 rate in Tucuman was significantly higher than what was seen in the rest of the country (2.8 cases per 100 000 person-years). Of the 189 cases, 142 of them (75.1%) occurred in children less than 9 years old. Out of 111 samples studied, 65 of them (58.6%) were enterovirus-positive. Through reverse transcription-nested polymerase chain reaction, enteroviruses were found in 66.3% (53/80) of the cases studied by this method, versus in only 29.6% (24/81) of the cases studied through viral isolation. In the 22 samples that were serotyped, echovirus type 4 was identified in 15 of them (68%): 5 by isolation, 3 by sequencing, and 7 by both methods. During the Tucuman outbreak, at least 56% of the cases were hospitalized. This viral meningitis outbreak shows the capacity of enteroviruses to spread and cause disease. The use of molecular methods makes it possible to rapidly diagnose the etiological virus and to better control an outbreak. Recognizing this outbreak in Tucuman sooner could have averted the majority of the hospitalizations and the indiscriminate use of antibiotics.Publication Brotes epidémicos y situaciones de alerta sanitaria de probable etiología vírica en el Centro Nacional de Microbiología durante el período 2012-2013.(Ministerio de Sanidad y Consumo (España), 2016-03-23) Echevarria, Jose Manuel; Avellón, Ana; Cabrerizo, Maria; Casas Flecha, Inmaculada; Echevarria, Juan Emilio; De Ory, Fernando de; Negredo, Anabel; Pozo Sanchez, Francisco; Sánchez-Seco, María Paz; Tarrago Asensio, David; Trallero, GloriaLos Planes Nacionales de erradicación o eliminación de la poliomielitis, el sarampión y la rubéola congénita establecen el papel a jugar por el Centro Nacional de Microbiología (CNM) en la vigilancia de esas enfermedades víricas. Además, el Sistema de Vigilancia de la Gripe en España el Real Decreto 1940/2004 sobre Vigilancia de las Zoonosis y el Plan de Contingencia contra la Rabia lo hacen también en lo relativo a la gripe y a las zoonosis víricas. Los resultados derivados de estas actividades se comunican con mayor o menor amplitud y regularidad.Publication Comparison of epidemiology and clinical characteristics of infections by human parechovirus vs. those by enterovirus during the first month of life(Springer, 2015-11) Cabrerizo, Maria; Trallero, Gloria; Pena, María José; Cilla, Amaia; Megias, Gregoria; Muñoz-Almagro, Carmen; Del Amo, Eva; Roda, Diana; Mensalvas, Ana Isabel; Moreno-Docón, Antonio; García-Costa, Juan; Rabella, Nuria; Omeñaca, Manuel; Romero, María Pilar; Sanbonmatsu-Gámez, Sara; Pérez-Ruiz, Mercedes; Santos-Muñoz, María José; Calvo, Cristina; Study Group of Enterovirus and parechovirus infections in children under 3 years-old, Spain; Instituto de Salud Carlos IIIHuman parechoviruses (HPeV) have been recently recognized as important viral agents in paediatric infections. The aims of this study were to investigate the HPeV infection prevalence in infants <1 month in Spain and, secondly, to analyse the clinical and epidemiological characteristics of the infected patients compared with those infected by enterovirus (EV). Infants <1 month with neurological or systemic symptoms were included in a multicentre prospective study. EV and HPeV detection by RT-PCR and genotyping were performed in cerebrospinal fluids (CSF), sera or throat swabs. Out of the total of 84 infants studied during 2013, 32 were EV positive (38 %) and 9 HPeV positive (11 %). HPeV-3 was identified in eight cases and HPeV-5 in one. Mean age of HPeV-positive patients was 18 days. Diagnoses were fever without source (FWS) (67 %), clinical sepsis (22 %) and encephalitis (11 %). Leukocytes in blood and CSF were normal. Pleocytosis (p = 0.03) and meningitis (p = 0.001) were significantly more frequent in patients with EV infections than with HPeV. Conclusions: Although HPeV-3 infections were detected less frequently than EV, they still account for approximately 10 % of the cases analysed in infants younger than 1 month. HPeV-3 was mainly associated with FWS and without leukocytosis and pleocytosis in CSF. In these cases, HPeV screening is desirable to identify the aetiologic agent and prevent unnecessary treatment and prolonged hospitalization.Publication Enterovirus D68-associated respiratory and neurological illness in Spain, 2014-2018(Taylor & Francis, 2019) Gonzalez-Sanz, Ruben; Taravillo, Irene; Reina, Jordi; Navascués, Ana; Moreno-Docón, Antonio; Aranzamendi, Maitane; Romero, María Pilar; Del Cuerpo, Margarita; Pérez-González, Carmen; Pérez-Castro, Sonia; Otero, Almudena; Cabrerizo, Maria; Instituto de Salud Carlos IIIDuring 2014, enterovirus D68 (EV-D68) outbreaks were described globally, causing severe respiratory diseases in children and, in some cases, subsequent paralysis. In this study, the type characterization of enterovirus (EV) detected in respiratory illnesses and the epidemiology and clinical association of EV-D68 infections in Spain over a five-year period were described. A total of 546 EV-positive samples from hospitalized patients with respiratory infections were included. EV-D68 was the most frequently detected type (46.6%, 191/410 typed EV). Other EV from species A (25.1%), B (27.8%) and C (0.5%) were also identified. EV-D68 infections were more associated with bronchitis while EV-A/B types were more frequent in upper respiratory illness (p < 0.01). EV-D68 was also detected in patients with neurological symptoms (nine meningitis/meningoencephalitis and eight acute flaccid paralysis cases). Phylogenetic analysis of 3'-VP1 region showed most Spanish EV-D68 sequences from 2014 to 2016 belonged to subclades B2/B3, as other American and European strains circulating during the same period. However, those detected in 2017 and 2018 clustered to the emerged subclade D1. In summary, different EV can cause respiratory infections but EV-D68 was the most prevalent, with several strains circulating in Spain at least since 2014. Association between EV-D68 infection and neurological disease was also described.Publication Impact of the bacterial nasopharyngeal microbiota on the severity of genus enterovirus lower respiratory tract infection in children: A case-control study(Wiley, 2023-06) Penela-Sánchez, Daniel; Rocafort, Muntsa; Henares, Desiree; Jordan, Iolanda; Brotons, Pedro; Cabrerizo, Maria; Launes, Cristian; Muñoz-Almagro, Carmen; Instituto de Salud Carlos III; Unión Europea. Fondo Europeo de Desarrollo Regional (FEDER/ERDF)Introduction: Rhinoviruses (RV) and enteroviruses (EV) are among the main causative etiologies of lower respiratory tract infection (LRTI) in children. The clinical spectrum of RV/EV infection is wide, which could be explained by diverse environmental, pathogen-, and host-related factors. Little is known about the nasopharyngeal microbiota as a risk factor or disease modifier for RV/EV infection in pediatric patients. This study describes distinct nasopharyngeal microbiota profiles according to RV/EV LRTI status in children. Methods: Cross-sectional case-control study, conducted at Hospital Sant de Déu (Barcelona, Spain) from 2017 to 2020. Three groups of children <5 years were included: healthy controls without viral detection (Group A), mild or asymptomatic controls with RV/EV infection (Group B), and cases with severe RV/EV infection admitted to the pediatric intensive care unit (PICU) (Group C). Nasopharyngeal samples were collected from participants for viral DNA/RNA detection by multiplex-polymerase chain reaction and bacterial microbiota characterization by 16S rRNA gene sequencing. Results: A total of 104 subjects were recruited (A = 17, B = 34, C = 53). Children's nasopharyngeal microbiota composition varied according to their RV/EV infection status. Richness and diversity were decreased among children with severe infection. Nasopharyngeal microbiota profiles enriched in genus Dolosigranulum were related to respiratory health, while genus Haemophilus was specifically predominant in children with severe RV/EV LRTI. Children with mild or asymptomatic RV/EV infection showed an intermediate profile. Conclusions: These results suggest a close relationship between the nasopharyngeal microbiota and different clinical presentations of RV/EV infection.Publication Lower Respiratory Tract Infection and Genus Enterovirus in Children Requiring Intensive Care: Clinical Manifestations and Impact of Viral Co-Infections(Multidisciplinary Digital Publishing Institute (MDPI), 2021-10-14) Penela-Sánchez, Daniel; Gonzalez-de-Audicana, Jon; Armero, Georgina; Henares, Desiree; Esteva, Cristina; de-Sevilla, Mariona-Fernández; Ricart, Silvia; Jordan, Iolanda; Brotons, Pedro; Cabrerizo, Maria; Muñoz-Almagro, Carmen; Launes, Cristian; Instituto de Salud Carlos III; Sociedad Española de Enfermedades Infecciosas y Microbiología ClínicaInfection by rhinovirus (RV) and enterovirus (EV) in children ranges from asymptomatic infection to severe lower respiratory tract infection (LRTI). This cohort study evaluates the clinical impact of RV/EV species, alone or in codetection with other viruses, in young children with severe LRTI. Seventy-one patients aged less than 5 years and admitted to the Paediatric Intensive Care Unit (PICU) of a reference children's hospital with RV or EV (RV/EV) LRTI were prospectively included from 1/2018 to 3/2020. A commercial PCR assay for multiple respiratory pathogens was performed in respiratory specimens. In 22/71, RV/EV + respiratory syncytial virus (RSV) was found, and 18/71 had RV/EV + multiple viral detections. Patients with single RV/EV detection required invasive mechanical ventilation (IMV) as frequently as those with RSV codetection, whereas none of those with multiple viral codetections required IMV. Species were determined in 60 samples, 58 being RV. No EV-A, EV-C, or EV-D68 were detected. RV-B and EV-B were only found in patients with other respiratory virus codetections. There were not any associations between RV/EV species and severity outcomes. To conclude, RV/EV detection alone was observed in young children with severe disease, while multiple viral codetections may result in reduced clinical severity. Differences in pathogenicity between RV and EV species could not be drawn.Publication Molecular Epidemiology and Evolutionary Trajectory of Emerging Echovirus 30, Europe(Centers for Disease Control and Prevention (CDC), 2021-06) Benschop, Kimberley S M; Broberg, Eeva K; Hodcroft, Emma; Schmitz, Dennis; Albert, Jan; Baicus, Anda; Bailly, Jean-Luc; Baldvinsdottir, Gudrun; Berginc, Natasa; Blomqvist, Soile; Böttcher, Sindy; Brytting, Mia; Bujaki, Erika; Cabrerizo, Maria; Celma, Cristina; Cinek, Ondrej; Claas, Eric C J; Cremer, Jeroen; Dean, Jonathan; Dembinski, Jennifer L; Demchyshyna, Iryna; Diedrich, Sabine; Dudman, Susanne; Dunning, Jake; Dyrdak, Robert; Emmanouil, Mary; Farkas, Agnes; De Gascun, Cillian; Fournier, Guillaume; Georgieva, Irina; Gonzalez-Sanz, Ruben; van Hooydonk-Elving, Jolanda; Jääskeläinen, Anne J; Jancauskaite, Ruta; Keeren, Kathrin; Fischer, Thea K; Krokstad, Sidsel; Nikolaeva-Glomb, Lubomira; Novakova, Ludmila; Midgley, Sofie E; Mirand, Audrey; Molenkamp, Richard; Morley, Ursula; Mossong, Joël; Muralyte, Svajune; Murk, Jean-Luc; Nguyen, Trung; Nordbø, Svein A; Österback, Riikka; Pas, Suzan; Pellegrinelli, Laura; Pogka, Vassiliki; Prochazka, Birgit; Rainetova, Petra; Van Ranst, Marc; Roorda, Lieuwe; Schuffenecker, Isabelle; Schuurman, Rob; Stoyanova, Asya; Templeton, Kate; Verweij, Jaco J; Voulgari-Kokota, Androniki; Vuorinen, Tytti; Wollants, Elke; Wolthers, Katja C; Zakikhany, Katherina; Neher, Richard; Harvala, Heli; Simmonds, Peter; Ministry of Health Welfare and Sport (Países Bajos); Unión Europea. Comisión Europea. H2020; Aristotle University of Thessaloniki (Grecia); Wellcome Trust; National Institute for Health and Disability Insurance (Bélgica)In 2018, an upsurge in echovirus 30 (E30) infections was reported in Europe. We conducted a large-scale epidemiologic and evolutionary study of 1,329 E30 strains collected in 22 countries in Europe during 2016-2018. Most E30 cases affected persons 0-4 years of age (29%) and 25-34 years of age (27%). Sequences were divided into 6 genetic clades (G1-G6). Most (53%) sequences belonged to G1, followed by G6 (23%), G2 (17%), G4 (4%), G3 (0.3%), and G5 (0.2%). Each clade encompassed unique individual recombinant forms; G1 and G4 displayed >2 unique recombinant forms. Rapid turnover of new clades and recombinant forms occurred over time. Clades G1 and G6 dominated in 2018, suggesting the E30 upsurge was caused by emergence of 2 distinct clades circulating in Europe. Investigation into the mechanisms behind the rapid turnover of E30 is crucial for clarifying the epidemiology and evolution of these enterovirus infections.Publication Molecular epidemiology of an enterovirus A71 outbreak associated with severe neurological disease, Spain, 2016(European Centre for Disease Prevention and Control (ECDC), 2019-02) Gonzalez-Sanz, Ruben; Casas-Alba, Didac; Launes, Cristian; Muñoz-Almagro, Carmen; Ruiz-García, Montserrat; Alonso, Mercedes; González-Abad, María José; Megías, Gregoria; Rabella, Nuria; Del Cuerpo, Margarita; Gozalo-Margüello, Mónica; González-Praetorius, Alejandro; Martínez-Sapiña, Ana; Goyanes-Galán, María José; Romero, María Pilar; Calvo, Cristina; Antón, Andrés; Imaz, Manuel; Aranzamendi, Maitane; Hernández-Rodríguez, Águeda; Moreno-Docón, Antonio; Rey-Cao, Sonia; Navascués, Ana; Otero, Almudena; Cabrerizo, MariaIntroductionEnterovirus A71 (EV-A71) is an emerging pathogen that causes a wide range of disorders including severe neurological manifestations. In the past 20 years, this virus has been associated with large outbreaks of hand, foot and mouth disease with neurological complications in the Asia-Pacific region, while in Europe mainly sporadic cases have been reported. In spring 2016, however, an EV-A71 outbreak associated with severe neurological cases was reported in Catalonia and spread further to other Spanish regions.AimOur objective was to investigate the epidemiology and clinical characteristics of the outbreak.MethodsWe carried out a retrospective study which included 233 EV-A71-positive samples collected during 2016 from hospitalised patients. We analysed the clinical manifestations associated with EV-A71 infections and performed phylogenetic analyses of the 3'-VP1 and 3Dpol regions from all Spanish strains and a set of EV-A71 from other countries.ResultsMost EV-A71 infections were reported in children (mean age: 2.6 years) and the highest incidence was between May and July 2016 (83%). Most isolates (218/233) were classified as subgenogroup C1 and 217 of them were grouped in one cluster phylogenetically related to a new recombinant variant strain associated with severe neurological diseases in Germany and France in 2015 and 2016. Moreover, we found a clear association of EV-A71-C1 infection with severe neurological disorders, brainstem encephalitis being the most commonly reported.ConclusionAn emerging recombinant variant of EV-A71-C1 was responsible for the large outbreak in 2016 in Spain that was associated with many severe neurological cases.Publication Neurodevelopmental Outcomes of Infants Younger Than 90 Days Old Following Enterovirus and Parechovirus Infections of the Central Nervous System(Frontiers Media, 2021-09) Ceano-Vivas, María de; García, M Luz; Velázquez, Ana; Martín del Valle, Fernando; Menasalvas, Ana; Cilla, Amaia; Epalza, Cristina; Romero, M Pilar; Cabrerizo, Maria; Calvo, Cristina; Instituto de Salud Carlos IIIEnteroviruses (EVs) and human parechoviruses (HPeVs) are a major cause of central nervous system (CNS) infection in young infants. They have been implicated in neurodevelopmental delay, however limited data are available. The aim of this study is to describe the clinical outcome of young infants and to assess and compare the medium-term neurodevelopment following CNS infections caused by EV and HPeV. A multicentre observational ambispective study was conducted between May 2013 and March 2018. Children under 3 months of age with EV or HPeV CNS infection excluding encephalitis were included. Infants were contacted 1 year after the acute infection and their neurological development was evaluated using the Ages and Stages Questionnaire-3 (ASQ-3). If any area assessed was abnormal during the first round of tests, a second round was completed 6 to 12 months later. Forty-eight young infants with EV and HPeV CNS infection were identified: 33 (68.8%) were positive for EV and 15 (31.3%) for HPeV. At first assessment 14 out of 29 EV (48.3%) and 3 out of 15 HPeV (20%) positive cases presented some developmental concern in the ASQ-3 test. EV-positive infants showed mild and moderate alteration in all domains analyzed and HPeV-positive infants showed mild alterations only in gross and fine motor domains. Significant alterations in communication were observed in EV-positive but not in HPeV-positive infants (31 vs. 0%, p = 0.016). At second assessment 4 out of 13 EV-positive patients (30.8%) showed mild to moderate concerns in communication and gross motor function domains and 3 out of 13 (23.1%) showed significant concern in fine motor function. Although CNS infections without associated encephalitis are generally assumed to be benign our study shows that at a median age of 18 months almost half of the EV-infected infants (48.3%) and 20% of HPeV-positive infants presented some developmental concern in the ASQ-3 test. We recommend monitor the neurological development of infants during the first years of life after HPeV CNS infection and especially after EV CNS infection, even in mild cases, for an early intervention and stimulation of psychomotor development if necessary.Publication Plan de Acción en España para la erradicación de la poliomelitis: Vigilancia de la Parálisis Flácida Aguda y Vigilancia de Enterovirus en España. Informe 2019(2020-07-01) Lopez-Perea, Noemi; Fernandez Martinez, Beatriz; Masa-Calles, Josefa; Cabrerizo Sanz, María; Gallardo, V; Malo, C; Margolles, M; Portell, M; Rojo, ML; Blasco, A; García Hernández, S; Marcos, H; Torner, N; Gómez, C; Guiral, S; Marín, C; Ramos, JM; Losada, I; Nieto, A; García Ortúzar, V; García Cenoz, M; Arteagoitia, JM; González-Garril, F; Martínez-Ochoa, E; Blanco, A; Rivas, A; Castrillejo, D; Limia, A; Sanbonmatsu, S; Navarro, JM; Pérez-González, C; Rabellà, N; Moreno-Docón, A; Navascués, A; Pérez-Castro, S; Martínez-Sapiña, A; Muñoz-Almagro, C; Romero, MP[ES]Los resultados de la vigilancia de parálisis flácida aguda (PFA) y de la vigilancia de enterovirus (EV) muestran que en España en el año 2019 no hubo casos de poliomielitis ni circulación de poliovirus. La sensibilidad del sistema está por debajo del objetivo establecido por la OMS–Europa de 1 caso de PFA al año por cada 100.000 menores de 15 años, al situarse en 0,55/104 hab (0,58/104 <15años en 2018 ). Sin embargo, su estudio una vez detectados es adecuado. El índice de vigilancia, que sintetiza la sensibilidad del sistema de vigilancia y su estudio en laboratorio, fue de 0,28, similar a otros años. Gracias a la vigilancia de EV se detectó un PV derivado de vacuna (PVDV) en un paciente excretor inmunodeprimido; además se hallaron diferentes EV-no polio, los serotipos identificados fundamentalmente fueron E-7, E-30, E-11, CV-A6 y E-13. En 2019 la OMS declaró la eliminación del PV salvaje tipo 3(PVS3) a nivel mundial, aunque resulta preocupante el aumento en la detección de PVS1 y PVDVc 2 tanto en muestras humanas como medioambientales. La Evaluación de la Comisión Regional de Certificación clasifica a España en 2018 como de riesgo bajo de transmisión de poliovirus. En Europa hay tres países con riesgo alto, debido fundamentalmente a la baja inmunidad de su población. Hay que mantener los sistemas ya establecidos de vigilancia de la circulación de EV -polio y no polio- (vigilancia de PFA, meningitis víricas y EV), de manera que permitan detectar a tiempo la circulación inesperada de un poliovirus o de otro tipo de EV clínicamente relevante. [EN]The results of acute flaccid paralysis (AFP) and enterovirus (EV) surveillance show that there were no cases of polio or poliovirus circulation in Spain in 2019. The sensitivity of the system is below the target set by WHO-Europe of 1 case of AFP per year per 100,000 children under 15 years, at 0.55/104 inhab (0.58/104 <15 years in 2018 ). However, their study once detected is adequate. The surveillance index, which synthesizes the sensitivity of the surveillance system and its laboratory study, was 0.28, similar to other years. Thanks to the surveillance of EV, a vaccine derived PV (PVDV) was detected in an immunosuppressed excretory patient; in addition, different non-polio-EV were found. The serotypes identified were mainly E-7, E-30, E-11, CV-A6 and E-13. In 2019 the WHO declared the elimination of wild PV type 3 (PVS3) worldwide, although the increase in detection of PVS1 and cVP2 in both human and environmental samples is of concern. The evaluation of the Regional Certification Commission classifies Spain in 2019 as having a low risk of poliovirus transmission. In Europe there are three countries at high risk, mainly due to the low immunity of their population. The already established systems for surveillance of the circulation of EV-polio and non-polio- (surveillance of AFP, viral meningitis and EV) must be maintained, so that the unexpected circulation of a poliovirus or other clinically relevant EV can be detected in time.Publication Plan de Acción en España para la erradicación de la poliomelitis: Vigilancia de la Parálisis Flácida Aguda y Vigilancia de Enterovirus en España. Informe 2020(2021-11-05) Lopez-Perea, Noemi; Fernandez Martinez, Beatriz; Masa-Calles, Josefa; Cabrerizo Sanz, María; Gallardo, V; Malo, C; Margolles, M; Portell, M; Rojo, ML; Blasco, A; García Hernández, S; Marcos, H; Izquierdo, C; Marín, C; Ramos, JM; Losada, I; Nieto, A; García Ortúzar, V; Alarcón, E; Garcia-Cenoz, Manuel; Arteagoitia, JM; González Carril, Fernando; Martínez-Ochoa, E; Blanco, A; Rivas, A; Castrillejo, D; Limia, A; Sanbonmatsu, S; Navarro, JM; Bordes Benítez, Ana; Pérez-González, C; Rabellà, N; Moreno-Docón, A; Navascués, A; Pérez-Castro, S; Martínez-Sapiña, A; Muñoz-Almagro, C; Romero, MP[ES] En España la situación libre de polio se monitoriza con la vigilancia de Parálisis Flácida Aguda (PFA) en niños menores de 15 años, como recomienda la Organización Mundial de la Salud (OMS). La vigilancia la realizan los servicios de vigilancia autonómicos y la red de laboratorios de PFA y a nivel nacional se coordina en el Centro Nacional de Epidemiología (CNE, ISCIII) y en el Laboratorio de Poliovirus del Centro Nacional de Microbiología (CNM, ISCIII). En el año 2020 en España no hubo casos de poliomielitis. Se notificaron 0,17 casos de PFA por 100.000 niños menores de 15 años, por debajo del objetivo de sensibilidad establecido por la OMS de un caso de PFA al año por cada 100.000 menores de 15 años. Solamente se detectaron enterovirus no-polio (EVNP) en las muestras de dos casos (EV-D68 y EV-B, respectivamente). En España también se realiza la vigilancia de EVNP en otros síndromes neurológicos para complementar el sistema de vigilancia de PFA. En las muestras investigadas en 2020 no se identificó ningún poliovirus y los EVNP más frecuentemente identificados fueron E-18, CV-A6 y E-21. Mientras haya circulación de poliovirus en el mundo hay que mantener activos los sistemas de vigilancia para detectar a tiempo cualquier importación de poliovirus. [EN] Spain monitors its polio-free status by conducting surveillance for cases of acute flaccid paralysis (AFP) in children less than 15 years of age, as recommended by the World Health Organization (WHO). The AFP surveillance is performed by the 19 Regional Epidemiological Surveillance Units and the AFP Surveillance Laboratory Network, coordinated at national level by the National Centre for Epidemiology (CNE. ISCIII) and the National Poliovirus Laboratory at Nacional Center of Microbiology (CNM. ISCIII) respectively. In 2020, no cases of poliomyelitis were reported from clinical surveillance; Spain reported 0.17 non-polio AFP cases per 100,000 children, below the WHO's performance criterion for a sensitive surveillance system (1 non-polio AFP cases per 100,000 children). The non-polio enteroviruses EV-D68, EV-B were identified from clinical specimens collected from AFP cases. Spain also performs enterovirus surveillance to complement the clinical system In 2020, non poliovirus were identified; The non-polioviruses E-18, CV-A6 y E-21 were the most frequently identified serotypes. As long as poliovirus is circulating in the world, surveillance systems must remain active to detect any importation of poliovirus in a timely manner.Publication Re-emergence of enterovirus D68 in Europe after easing the COVID-19 lockdown, September 2021(European Centre for Disease Prevention and Control (ECDC), 2021-11) Benschop, Kimberley Sm; Albert, Jan; Antón, Andrés; Andrés, Cristina; Aranzamendi, Maitane; Armannsdóttir, Brynja; Bailly, Jean-Luc; Baldanti, Fausto; Baldvinsdóttir, Guðrún Erna; Beard, Stuart; Berginc, Natasa; Böttcher, Sindy; Blomqvist, Soile; Bubba, Laura; Calvo, Cristina; Cabrerizo, Maria; Cavallero, Annalisa; Celma, Cristina; Ceriotti, Ferruccio; Costa, Inês; Cottrell, Simon; Del Cuerpo, Margarita; Dean, Jonathan; Dembinski, Jennifer L; Diedrich, Sabine; Diez-Domingo, Javier; Dorenberg, DagnyHaug; Duizer, Erwin; Dyrdak, Robert; Fanti, Diana; Farkas, Agnes; Feeney, Susan; Flipse, Jacky; De Gascun, Cillian; Galli, Cristina; Georgieva, Irina; Gifford, Laura; Guiomar, Raquel; Hönemann, Mario; Ikonen, Niina; Jeannoël, Marion; Josset, Laurence; Keeren, Kathrin; López-Labrador, F Xavier; Maier, Melanie; McKenna, James; Meijer, Adam; Mengual-Chuliá, Beatriz; Midgley, Sofie E; Mirand, Audrey; Montes, Milagrosa; Moore, Catherine; Morley, Ursula; Murk, Jean-Luc; Nikolaeva-Glomb, Lubomira; Numanovic, Sanela; Oggioni, Massimo; Palminha, Paula; Pariani, Elena; Pellegrinelli, Laura; Piralla, Antonio; Pietsch, Corinna; Piñeiro, Luis; Rabella, Núria; Rainetova, Petra; Uceda Renteria, Sara Colonia; Romero, María P; Reynders, Marijke; Roorda, Lieuwe; Savolainen-Kopra, Carita; Schuffenecker, Isabelle; Soynova, Aysa; Swanink, Caroline Ma; Ursic, Tina; Verweij, Jaco J; Vila, Jorgina; Vuorinen, Tytti; Simmonds, Peter; Fischer, Thea K; Harvala, HeliWe report a rapid increase in enterovirus D68 (EV-D68) infections, with 139 cases reported from eight European countries between 31 July and 14 October 2021. This upsurge is in line with the seasonality of EV-D68 and was presumably stimulated by the widespread reopening after COVID-19 lockdown. Most cases were identified in September, but more are to be expected in the coming months. Reinforcement of clinical awareness, diagnostic capacities and surveillance of EV-D68 is urgently needed in Europe.