| Summary: | <p>Enteroviruses are spread fecal–orally or via respiratory transmission and cause a wide
range of diseases. They generally cause mild and self-limited illness but have emerged to
cause outbreaks with more severe disease manifestations than previously known. The
principal public health needs for enterovirus surveillance include outbreak detection,
response and monitoring of enteroviruses associated with severe disease. However, the
burden of enterovirus infections is not adequately described due to inadequate systemic
surveillance. Here, serum neutralizing antibodies to EV-D68, EV-A71, CVA6 and EV-D111
were measured in samples collected in the UK and four African countries to estimate
population-level exposure.</p>
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<p>Overall, the serology data showed high antibody levels and seroprevalence that reached 100% in adults indicating extensive exposure and ubiquitous virus circulation. Clinical detection of enteroviruses in the UK showed biennial and annual occurrence of EV-A71 and CVA6, respectively. CVA6 detections were marked by an increasing trend from 2006 to 2017. Model fitting of the seroprevalence data showed possible existence of age-specific transmission or relative risk of infection. The increase in virus detection or clinical
occurrence without parallel increase in FOI could be attributed to a change in virus
characteristics or pathogenicity leading to pronounced clinical disease even without a
change in virus transmissibility. This thesis demonstrates the application of serology and
mathematical modelling to estimate pathogen prevalence. The data and inferences will be
beneficial for guiding future policies focused on enterovirus epidemiology and disease
burden. Certainly, better documentation of enterovirus true prevalence and collective
impact on human health is warranted.</p>
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