sˈɪns ðˈɛn, ˈʌðɚɹ ˈɛktiːvˌiː stɹˈeɪnz ænd ˈaʊtbɹeɪks hɐvbɪn sˈiːn ɪn jˈʊɹɹəp ænd ðə jˌuːˌɛsˈeɪ wɪð dˈɪfɹənsᵻz ɪnðə səvˈɛɹᵻɾi ʌvðə dɪzˈiːz.
Since then, other ECTV strains and outbreaks have been seen in Europe and the USA with differences in the severity of the disease.