Molecular epidemiology of enterovirus and parechovirus infections according to patient age over a 4‐year period in Spain

The epidemiology and clinical association of enterovirus (EV) and parechovirus (HPeV) infections, as well as the type‐distribution‐according‐to‐age, were determined during a 4‐year study period in Spain. During 2010–2013, a total of 21,832 clinical samples were screened for EV and the detection frequency was 6.5% (1,430). Of the total EV‐negative samples, only 1,873 samples from 2011 to 2013 were available for HPeV testing. HPeV was detected in 42 (2%) of them. Positive samples were genotyped using PCR and sequencing. EV infections occurred in all age groups of patients: neonates (17%), children 28 days to 2 years (29%), children 2–14 years (40%), and adults (14%). Thirty‐four different EV types were identified. HPeV infections were detected exclusively in infants <8 m (70% neonates, P  < 0.05). All but one HPeV were HPeV‐3. Differences in type frequency detection were found according to age and clinical manifestation. Coxsackievirus (CV)‐B4 (61%), CV‐B5 (83%), and HPeV‐3 (64%) were more frequent in neonates than in older patients ( P  < 0.05). Echovirus (E)‐3 (60%), E‐18 (47%), E‐25 (62%), CV‐A6 (61%), CV‐A16 (72%), and EV‐71 (75%) were mainly detected in children 28 days to 2 years ( P  < 0.05), whereas, E‐6 (79%), E‐20 (88%), and E‐30 (85%) were predominant in children >2 years and adults ( P  < 0.05). Clinically, meningitis was associated with EV ( P  < 0.01) whereas, encephalitis was more frequent in HPeV‐infected patients. CV‐B types were associated with myocarditis (90%; P  < 0.05) and EV species A with hand–foot–mouth‐disease/atypical exanthema (88%; P  < 0.05). J. Med. Virol. 89:435–442, 2017 . © 2016 Wiley Periodicals, Inc.