201
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Kirkley MJ, Robinson C, Dominguez SR, Messacar K. Neonatal parechovirus infection mimicking a surgical abdomen. BMJ Case Rep 2019; 12:12/6/e229053. [PMID: 31248894 DOI: 10.1136/bcr-2018-229053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Human parechovirus-3 (PeVA3) infection is a common cause of febrile illness in young infants and the spectrum of clinical presentation is broad. We describe a term infant who presented with marked abdominal distension and anorexia, concerning for an acute surgical abdomen. Evaluation revealed that the infant had PeVA3 infection. This case highlights the importance of recognising severe abdominal distension and discomfort as a clinical presentation associated with PeV and the potential utility of rapid testing for PeV.
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Affiliation(s)
- Megan J Kirkley
- Children's Hospital Colorado, Aurora, Colorado, USA.,Department of Pediatrics, University of Colorado, Aurora, Colorado, USA
| | | | - Samuel R Dominguez
- Children's Hospital Colorado, Aurora, Colorado, USA.,Department of Pediatrics, University of Colorado, Aurora, Colorado, USA
| | - Kevin Messacar
- Children's Hospital Colorado, Aurora, Colorado, USA.,Department of Pediatrics, University of Colorado, Aurora, Colorado, USA
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202
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Nhan LNT, Turner HC, Khanh TH, Hung NT, Lien LB, Hong NTT, Nhu LNT, Ny NTH, Nguyet LA, Thanh TT, Van HMT, Viet HL, Tung TH, Phuong TTL, Devine A, Thwaites G, Chau NVV, Thwaites L, van Doorn HR, Tan LV. Economic Burden Attributed to Children Presenting to Hospitals With Hand, Foot, and Mouth Disease in Vietnam. Open Forum Infect Dis 2019; 6:5514500. [PMID: 31363772 PMCID: PMC6657964 DOI: 10.1093/ofid/ofz284] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 06/12/2019] [Indexed: 11/13/2022] Open
Abstract
Background Hand, foot, and mouth disease (HFMD) has become a major public health concern in the Asia-Pacific region. Knowledge of its economic burden is essential for policy makers in prioritizing the development and implementation of interventions. Methods A multi-hospital-based study was prospectively conducted at 3 major hospitals in Ho Chi Minh City, Vietnam, during 2016–2017. Data on direct and productivity costs were collected alongside clinical information and samples and demographic information from study participants. Results A total of 466 patients were enrolled. Two hundred three of 466 (43.6%) patients lived in Ho Chi Minh City, and 72/466 (15.5%) had severe HFMD. An enterovirus was identified in 74% of 466 patients, with EV-A71, CV-A6, CV-A10, and CV-A16 being the most common viruses identified (236/466, 50.6%). The mean economic burden per case was estimated at US$400.80 (95% confidence interval [CI], $353.80–$448.90), of which the total direct (medical) costs accounted for 69.7%. There were considerable differences in direct medical costs between groups of patients with different clinical severities and pathogens (ie, EV-A71 vs non-EV-A71). In Vietnam, during 2016–2017, the economic burden posed by HFMD was US$90 761 749 (95% CI, $79 033 973–$103 009 756). Conclusions Our findings are of public health significance because for the first time we demonstrate that HFMD causes a substantial economic burden in Vietnam, and although multivalent vaccines are required to control HFMD, effective EV-A71 vaccine could substantially reduce the burden posed by severe HFMD. The results will be helpful for health policy makers in prioritizing resources for the development and implementation of intervention strategies to reduce the burden of HFMD.
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Affiliation(s)
- Le Nguyen Thanh Nhan
- Children's Hospital 1, Ho Chi Minh City, Vietnam.,Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Hugo C Turner
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | | | - Le Bich Lien
- Children's Hospital 1, Ho Chi Minh City, Vietnam
| | | | | | | | - Lam Anh Nguyet
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Tran Tan Thanh
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | - Ho Lu Viet
- Children's Hospital 2, Ho Chi Minh City, Vietnam
| | | | | | - Angela Devine
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK.,Mahidol Oxford Tropical Research Unit, Bangkok, Thailand
| | - Guy Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Louise Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - H Rogier van Doorn
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Le Van Tan
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
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203
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Abedi GR, Messacar K, Luong W, Nix WA, Rogers S, Queen K, Tong S, Oberste MS, Watt J, Rothrock G, Dominguez S, Gerber SI, Watson JT. Picornavirus etiology of acute infections among hospitalized infants. J Clin Virol 2019; 116:39-43. [PMID: 31100674 PMCID: PMC7172211 DOI: 10.1016/j.jcv.2019.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 04/17/2019] [Accepted: 04/23/2019] [Indexed: 11/17/2022]
Abstract
Enteroviruses (EV) and parechoviruses (PeV) cause a range of illness, including severe illness in young children. Of 319 patients aged <1 year, CSF specimens from 13 (4.1%) were positive for EV and from 11 (3.4%) for PeV. Sequencing revealed a variety of EV types and the predominance of PeV-A3 among the PeV-positive case-patients. Clinicians should consider EV and PeV infections in infants presenting with febrile illness.
Background Enteroviruses (EV) and parechoviruses (PeV) are ubiquitous viruses that cause a range of illness, including acute illness in children aged <1 year. Objectives We describe EV and PeV infections among children from 2 US study sites aged <1 year and hospitalized with acute infections. For EV- and PeV-negative case-patients, we explored other viral etiologies. Methods Participants were aged <1 year, hospitalized during 2016, and had cerebrospinal fluid (CSF) collected for routine diagnostic testing. Demographic and clinical data were abstracted from medical charts, and residual specimens were sent to CDC for confirmatory testing and typing. Results Of 472 eligible case-patients, CSF specimen was available for 319 (67.6%). Among those, 13 (4.1%) were positive for EV and 11 (3.4%) for PeV. Most case-patients (86.8%, n = 277) were aged <2 months, as were all EV- or PeV-positive case-patients. None of the positive case-patients had underlying conditions, and the chief complaint for 91.7% (n = 22) was fever. Twelve positive case-patients were admitted to intensive care (ICU) and had brief hospital stays (median 2 days). Sequencing revealed a variety of EV types and the predominance of PeV-A3 among the PeV-positive case-patients. Conclusions A range of EV and PeV types were associated with acute febrile illnesses leading to hospitalization in children aged <2 months. Approximately half of EV and PeV case-patients were admitted to ICU, but length of hospital stay was brief and illnesses were generally self-limiting. Clinicians should consider EV and PeV infections in infants presenting with febrile illness.
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Affiliation(s)
- Glen R Abedi
- Division of Viral Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States.
| | - Kevin Messacar
- Colorado Emerging Infections Program, Denver, CO, United States
| | - William Luong
- California Emerging Infections Program, Richmond, CA, United States
| | - W Allan Nix
- Division of Viral Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Shannon Rogers
- Division of Viral Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Krista Queen
- Division of Viral Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Suxiang Tong
- Division of Viral Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - M Steven Oberste
- Division of Viral Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - James Watt
- California Emerging Infections Program, Richmond, CA, United States
| | | | | | - Susan I Gerber
- Division of Viral Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - John T Watson
- Division of Viral Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA, United States
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204
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Zhang J, Liu H, Zhao Y, Zhang H, Sun H, Huang X, Yang Z, Liu J, Ma S. Identification of a new recombinant strain of echovirus 33 from children with hand, foot, and mouth disease complicated by meningitis in Yunnan, China. Virol J 2019; 16:63. [PMID: 31068194 PMCID: PMC6506940 DOI: 10.1186/s12985-019-1164-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 04/15/2019] [Indexed: 12/19/2022] Open
Abstract
Background Hand, foot, and mouth disease (HFMD) is a common childhood disease, which is usually caused by enterovirus A (EV-A) serotypes. Enterovirus A71 (EV-A71) and coxsackievirus A16 (CV-A16) are the main etiologic agents. Multiple serotypes of enterovirus B serotypes (EV-B) have been detected in outbreaks or sporadic cases of HFMD. Results During HFMD surveillance in Yunnan, China in 2013, two echovirus 33 (E-33) isolates were recovered in cell culture and typed by molecular methods from the cerebrospinal fluid (CSF) and feces of two sporadic cases of HFMD complicated by meningitis. Sequence analysis indicated that the study isolates, YNK35 and YNA12, formed an independent branch, and belonged to E-33 genotype H. Recombination analysis indicated multiple recombination events in the genomic sequence of isolate YNK35. The recombination mainly occurred in the non-structural coding region of P2 and P3, and involved intra-species recombination of species B. Conclusion In this study, the complete sequences of two E-33 isolates were determined. This is the first report of severe HFMD associated with E-33 in Yunnan China, and it enriches the number of full-length genome sequences of E-33 in the GenBank database. Electronic supplementary material The online version of this article (10.1186/s12985-019-1164-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jie Zhang
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, 650118, People's Republic of China.,Yunnan Key Laboratory of Vaccine Research Development on Severe Infectious Disease, Kunming, 650118, People's Republic of China
| | - Hongbo Liu
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, 650118, People's Republic of China.,Yunnan Key Laboratory of Vaccine Research Development on Severe Infectious Disease, Kunming, 650118, People's Republic of China
| | - Yilin Zhao
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, 650118, People's Republic of China.,Yunnan Key Laboratory of Vaccine Research Development on Severe Infectious Disease, Kunming, 650118, People's Republic of China
| | - Haihao Zhang
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, 650118, People's Republic of China.,Yunnan Key Laboratory of Vaccine Research Development on Severe Infectious Disease, Kunming, 650118, People's Republic of China
| | - Hao Sun
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, 650118, People's Republic of China.,Yunnan Key Laboratory of Vaccine Research Development on Severe Infectious Disease, Kunming, 650118, People's Republic of China
| | - Xiaoqin Huang
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, 650118, People's Republic of China.,Yunnan Key Laboratory of Vaccine Research Development on Severe Infectious Disease, Kunming, 650118, People's Republic of China
| | - Zhaoqing Yang
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, 650118, People's Republic of China.,Yunnan Key Laboratory of Vaccine Research Development on Severe Infectious Disease, Kunming, 650118, People's Republic of China
| | - Jiansheng Liu
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, 650118, People's Republic of China. .,Yunnan Key Laboratory of Vaccine Research Development on Severe Infectious Disease, Kunming, 650118, People's Republic of China.
| | - Shaohui Ma
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, 650118, People's Republic of China. .,Yunnan Key Laboratory of Vaccine Research Development on Severe Infectious Disease, Kunming, 650118, People's Republic of China.
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205
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Maruo Y, Nakanishi M, Suzuki Y, Kaneshi Y, Terashita Y, Narugami M, Takahashi M, Kato S, Suzuki R, Goto A, Miyoshi M, Nagano H, Sugisawa T, Okano M. Outbreak of aseptic meningitis caused by echovirus 30 in Kushiro, Japan in 2017. J Clin Virol 2019; 116:34-38. [PMID: 31082730 DOI: 10.1016/j.jcv.2019.05.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 04/23/2019] [Accepted: 05/05/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Echovirus 30 (E30) is one of the most common causative agents for aseptic meningitis. OBJECTIVES In the autumn of 2017, there was an outbreak caused by E30 in Kushiro, Hokkaido, Japan. The aim of this study was to characterize this outbreak. STUDY DESIGN Fifty-nine patients were admitted to the Department of Pediatrics, Kushiro Red Cross Hospital (KRCH) with clinical diagnosis of aseptic meningitis. Among those, 36 patients were finally diagnosed as E30-associated aseptic meningitis by the detection of viral RNA using reverse transcription-polymerase chain reaction (RT-PCR) and/or the evidence of more than four-fold rise in neutralizing antibody (NA) titers in the convalescent phase relative to those in the acute phase. We investigated these 36 confirmed cases. RESULTS The median age was 6 years (range: 6 months-14 years). The positive signs and symptoms were as follows: fever (100%), headache (94%), vomiting (92%), jolt accentuation (77%), neck stiffness (74%), Kernig sign (29%), and abdominal pain (28%). The median cerebrospinal fluid (CSF) white cell count, neutrophil count, and lymphocyte count were 222/μL (range: 3-1434/μL), 144/μL (range: 1-1269/μL), and 85/μL (range: 2-354/μL), respectively. Although the detected viral genes demonstrated same cluster, they were different from E30 strains observed in Japan between 2010 and 2014. CONCLUSION We mainly showed clinical and virological features of the E30-associated aseptic meningitis outbreak that occurred in Kushiro. To prevent further spread of E30 infection, continuous surveillance of enterovirus (EV) circulation and standard precautions are considered essential.
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Affiliation(s)
- Yuji Maruo
- Department of Pediatrics, Kushiro Red Cross Hospital, 21-14, Shinei-cho, Kushiro 085-8512, Japan.
| | - Masanori Nakanishi
- Department of Pediatrics, Kushiro Red Cross Hospital, 21-14, Shinei-cho, Kushiro 085-8512, Japan
| | - Yasuto Suzuki
- Department of Pediatrics, Kushiro Red Cross Hospital, 21-14, Shinei-cho, Kushiro 085-8512, Japan
| | - Yosuke Kaneshi
- Department of Pediatrics, Kushiro Red Cross Hospital, 21-14, Shinei-cho, Kushiro 085-8512, Japan
| | - Yukayo Terashita
- Department of Pediatrics, Kushiro Red Cross Hospital, 21-14, Shinei-cho, Kushiro 085-8512, Japan
| | - Masashi Narugami
- Department of Pediatrics, Kushiro Red Cross Hospital, 21-14, Shinei-cho, Kushiro 085-8512, Japan
| | - Michi Takahashi
- Department of Pediatrics, Kushiro Red Cross Hospital, 21-14, Shinei-cho, Kushiro 085-8512, Japan
| | - Sho Kato
- Department of Pediatrics, Kushiro Red Cross Hospital, 21-14, Shinei-cho, Kushiro 085-8512, Japan
| | - Ryota Suzuki
- Department of Pediatrics, Kushiro Red Cross Hospital, 21-14, Shinei-cho, Kushiro 085-8512, Japan
| | - Akiko Goto
- Hokkaido Institute of Public Health, North 19 West 12, Kita-ku, Sapporo 060-0819, Japan
| | - Masahiro Miyoshi
- Hokkaido Institute of Public Health, North 19 West 12, Kita-ku, Sapporo 060-0819, Japan
| | - Hideki Nagano
- Hokkaido Institute of Public Health, North 19 West 12, Kita-ku, Sapporo 060-0819, Japan
| | - Takahisa Sugisawa
- Kushiro Center of Public Health, 4-22, Shiroyama 2, Kushiro 085-0826, Japan
| | - Motohiko Okano
- Hokkaido Institute of Public Health, North 19 West 12, Kita-ku, Sapporo 060-0819, Japan
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206
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Cremer J, Morley U, Pas S, Wolthers K, Vennema H, Duizer E, Benschop K. Highly sensitive parechovirus CODEHOP PCR amplification of the complete VP1 gene for typing directly from clinical specimens and correct typing based on phylogenetic clustering. J Med Microbiol 2019; 68:1194-1203. [PMID: 31050627 DOI: 10.1099/jmm.0.000974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Human parechoviruses (HPeVs), particularly type 3, can cause severe neurological disease and neonatal sepsis in infants. HPeV3 lacks the receptor-binding motif arginine-glycine aspartic acid (RGD), and is proposed to use a different receptor associated with severe disease. In contrast, HPeV1, which contains the RGD motif, is associated with mild disease. Rapid characterization of the presence/absence of this motif is essential for understanding their epidemiology and differential disease profiles. Current HPeV typing assays are based on partial capsid genes and often do not encompass the C-terminus where the RGD region is localized/absent. In addition, these assays lack sensitivity to enable characterization within low viral-load samples, such as cerebral spinal fluid. METHODOLOGY We developed a highly sensitive HPeV CODEHOP PCR, which enables typing of parechoviruses directly from clinical samples while generating a complete VP1 gene, including the C-terminus. RESULTS The assay was HPeV-specific and has a sensitivity of 6.3 TCID50 ml-1 for HPeV1 and 0.63 TCID50 ml-1 for HPeV3. Analysis of the complete VP1 gene in comparison to partial VP1 fragments generated by previously published PCRs showed homologous clustering for most types. However, phylogenetic analysis of partial VP1 fragments showed incongruent typing based on the 75 % homology classification rule. In particular, the strains designated as type 17 were found to be either type 3 or 4 when using the (near-) complete VP1 fragment. CONCLUSION While enabling sensitive characterization of HPeVs directly from clinical samples, the HPeV CODEHOP PCR enables the characterization of RGD and non-RGD strains and correct HPeV typing based on the complete VP1.
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Affiliation(s)
- Jeroen Cremer
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Ursula Morley
- National Virus Reference Laboratory, University College Dublin (UCD), Belfield, Dublin, Ireland
| | - Suzan Pas
- Erasmus Medical Center (EMC), Rotterdam, The Netherlands.,Present address: Microvida, Roosendaal, The Netherlands
| | - Katja Wolthers
- University Medical Centers Amsterdam-AMC, Amsterdam, The Netherlands
| | - Harry Vennema
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Erwin Duizer
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Kimberley Benschop
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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207
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Acute flaccid myelitis associated with enterovirus D68 in a non-epidemic setting. IDCases 2019; 17:e00549. [PMID: 31193053 PMCID: PMC6515126 DOI: 10.1016/j.idcr.2019.e00549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 04/30/2019] [Accepted: 04/30/2019] [Indexed: 01/28/2023] Open
Abstract
Acute flaccid myelitis (AFM) is a recently defined clinical disease accompanied by the national outbreak of enterovirus D68 (EV-D68) in the United States during the late summer/fall of 2014; 258 cases of EV-D68 and 59 cases of AFM were reported in Japan during the late summer/fall of 2015. Subsequently, there have been no epidemics of AFM or EV-D68. However, we encountered a patient who had AFM associated with EV-D68 in 2017. This is the first case of AFM caused by EV-D68 after the 2015 epidemic, and the only reported case in 2017. This report indicates that AFM caused by EV-D68 can arise even in non-epidemic situations. If a patient presents with paralysis, AFM caused by EV-D68 should be included in the differential diagnosis, regardless of the absence of an epidemic of EV-D68 infection.
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208
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Sadeuh-Mba SA, Kavunga-Membo H, Joffret ML, Yogolelo R, Endegue-Zanga MC, Bessaud M, Njouom R, Muyembe-Tamfu JJ, Delpeyroux F. Genetic landscape and macro-evolution of co-circulating Coxsackieviruses A and Vaccine-derived Polioviruses in the Democratic Republic of Congo, 2008-2013. PLoS Negl Trop Dis 2019; 13:e0007335. [PMID: 31002713 PMCID: PMC6505894 DOI: 10.1371/journal.pntd.0007335] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 05/06/2019] [Accepted: 03/27/2019] [Indexed: 02/06/2023] Open
Abstract
Enteroviruses (EVs) are among the most common viruses infecting humans worldwide
but only a few Non-Polio Enterovirus (NPEV) isolates have been characterized in
the Democratic Republic of Congo (DR Congo). Moreover, circulating
vaccine-derived polioviruses (PVs) [cVDPVs] isolated during multiple outbreaks
in DR Congo from 2004 to 2018 have been characterized so far only by the
sequences of their VP1 capsid coding gene. This study was carried to i)
investigate the circulation and genetic diversity of NPEV and polio vaccine
isolates recovered from healthy children and Acute Flaccid Paralysis (AFP)
patients, ii) evaluate the occurrence of genetic recombination among EVs
belonging to the Enterovirus C species (including PVs) and iii)
identify the virological factors favoring multiple emergences of cVDPVs in DR
Congo. The biological material considered in this study included i) a collection
of 91 Sabin-like PVs, 54 cVDPVs and 150 NPEVs isolated from AFP patients between
2008 and 2012 in DR Congo and iii) a collection of 330 stool specimens collected
from healthy children in 2013 in the Kasai Oriental and Maniema provinces of DR
Congo. Studied virus isolates were sequenced in four distinct sub-genomic
regions 5’-UTR, VP1, 2CATPase and 3Dpol. Resulting
sequences were compared through comparative phylogenetic analyses. Virus
isolation showed that 19.1% (63/330) healthy children were infected by EVs
including 17.9% (59/330) of NPEVs and 1.2% (4/330) of type 3 Sabin-like PVs.
Only one EV-C type, EV-C99 was identified among the NPEV collection from AFP
patients whereas 27.5% of the 69 NPEV isolates typed in healthy children
belonged to the EV-C species: CV-A13 (13/69), A20 (5/69) and A17 (1/69).
Interestingly, 50 of the 54 cVDPVs featured recombinant genomes containing
exogenous sequences in at least one of the targeted non-structural regions of
their genomes: 5’UTR, 2CATPase and 3Dpol. Some of these
non-vaccine sequences of the recombinant cVDPVs were strikingly related to
homologous sequences from co-circulating CV-A17 and A20 in the
2CATPase region as well as to those from co-circulating CV-A13,
A17 and A20 in the 3Dpol region. This study provided the first
evidence uncovering CV-A20 strains as major recombination partners of PVs. High
quality AFP surveillance, sensitive environmental surveillance and efficient
vaccination activities remain essential to ensure timely detection and efficient
response to recombinant cVDPVs outbreaks in DR Congo. Such needs are valid for
any epidemiological setting where high frequency and genetic diversity of
Coxsackieviruses A13, A17 and A20 provide a conducive viral ecosystem for the
emergence of virulent recombinant cVDPVs. The strategy of the Global Polio Eradication Initiative is based on the
surveillance of patients suffering from Acute Flaccid Paralysis (AFP) and mass
vaccination with live-attenuated vaccine strains of polioviruses (PVs) in
endemic areas. However, vaccine strains of PVs can circulate and replicate for a
long time when the vaccine coverage of the population is low. Such prolonged
circulation and replication of vaccine strains of PVs can result to the
emergence of circulating vaccine-derived polioviruses [cVDPVs] that are as
virulent as wild PVs. In this study, we performed the molecular characterization
of a large collection of 377 virus isolates recovered from paralyzed patients
between 2008 and 2012 in DR Congo and healthy children in 2013 in the Kasai
Oriental and Maniema provinces of DR Congo. We found that the genetic diversity
of enteroviruses of the species Enterovirus C is more important
than previously reported. Interestingly, 50 of the 54 cVDPVs featured
recombinant genomes containing exogenous sequences of the 2C ATPase and/or 3D
polymerase coding genes acquired from co-circulating Coxsackieviruses A13, A17
and A20. Coxsackieviruses A20 strains were identified for the first time as
major partners of genetic recombination with co-circulating live-attenuated
polio vaccine strains. Our findings highlight the need to reinforce and maintain high quality
surveillance of PVs and efficient immunization activities in order to ensure
early detection and control of emerging cVDPVs in all settings where high
frequency and diversity of Coxsackieviruses A13, A17 and A20 have been
documented.
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Affiliation(s)
- Serge Alain Sadeuh-Mba
- Virology Service, Centre Pasteur of Cameroon, Yaounde, Centre region,
Cameroon
- * E-mail: ,
| | - Hugo Kavunga-Membo
- Virology Department, Institut National de Recherche Biomédicale,
Kinshasa, Democratic Republic of Congo
| | - Marie-Line Joffret
- Biology of Enteric Viruses Unit, Institut Pasteur, Paris,
France
- INSERM U994 Unit, INSERM, Paris, France
| | - Riziki Yogolelo
- Virology Department, Institut National de Recherche Biomédicale,
Kinshasa, Democratic Republic of Congo
| | | | - Maël Bessaud
- Biology of Enteric Viruses Unit, Institut Pasteur, Paris,
France
- INSERM U994 Unit, INSERM, Paris, France
| | - Richard Njouom
- Virology Service, Centre Pasteur of Cameroon, Yaounde, Centre region,
Cameroon
| | | | - Francis Delpeyroux
- Biology of Enteric Viruses Unit, Institut Pasteur, Paris,
France
- INSERM U994 Unit, INSERM, Paris, France
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Complete Genome Sequence of a Human Enterovirus C99 Strain Isolated from a Healthy Child in Yunnan, China, in 2013. Microbiol Resour Announc 2019; 8:8/16/e01489-18. [PMID: 31000560 PMCID: PMC6473154 DOI: 10.1128/mra.01489-18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The complete genome sequence of a human enterovirus C99 strain isolated from a healthy child in Yunnan, China, in 2013 was determined. The isolate belonged to genotype C, according to phylogenetic and homogeneity analyses. The complete genome sequence of a human enterovirus C99 strain isolated from a healthy child in Yunnan, China, in 2013 was determined. The isolate belonged to genotype C, according to phylogenetic and homogeneity analyses.
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210
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Shen L, Gong C, Xiang Z, Zhang T, Li M, Li A, Luo M, Huang F. Upsurge of Enterovirus D68 and Circulation of the New Subclade D3 and Subclade B3 in Beijing, China, 2016. Sci Rep 2019; 9:6073. [PMID: 30988475 PMCID: PMC6465342 DOI: 10.1038/s41598-019-42651-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 03/25/2019] [Indexed: 12/14/2022] Open
Abstract
We conducted a surveillance among acute respiratory tract infection (ARTI) cases to define the epidemiology, clinical characteristics and genetic variations of enterovirus D68 (EV-D68) in Beijing, China from 2015 to 2017. Nasopharyngeal swabs and sputum were collected from 30 sentinel hospitals in Beijing and subjected to EV and EV-D68 detection by real-time PCR. The VP1 gene region and complete genome sequences of EV-D68 positive cases were analyzed. Of 21816 ARTI cases, 619 (2.84%) were EV positive and 42 cases were EV-D68 positive. The detection rates of EV-D68 were 0 (0/6644) in 2015, 0.53% (40/7522) in 2016 and 0.03% (2/7650) in 2017, respectively. Two peaks of EV-D68 infections occurred in late summer and early-winter. Ten cases (23.81%) with upper respiratory tract infection and 32 cases (76.19%) presented with pneumonia, including 3 cases with severe pneumonia. The phylogenetic analysis suggested 15 subclade D3 strains and 27 subclade B3 strains of EV-D68 were circulated in China from 2016 to 2017. A total of 52 amino acid polymorphisms were identified between subclades D1 and D3. These data suggest an upsurge of EV-D68 occurred in Beijing in 2016, the new subclade D3 emerged in 2016 and co-circulated with subclade B3 between 2016 and 2017.
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Affiliation(s)
- Lingyu Shen
- School of Public Health, Capital Medical University, Beijing, 100069, P.R. China
- Institute for immunization and prevention, Beijing Municipal Center for Disease Prevention and Control, Beijing, 100013, P.R. China
| | - Cheng Gong
- Institute for immunization and prevention, Beijing Municipal Center for Disease Prevention and Control, Beijing, 100013, P.R. China
| | - Zichun Xiang
- MOH Key Laboratory of Systems Biology of Pathogens and Christophe Mérieux Laboratory, IPB, CAMS-Foundation Mérieux, Institute of Pathogen Biology (IPB), Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College, Beijing, 100730, P.R. China
| | - Tiegang Zhang
- Institute for immunization and prevention, Beijing Municipal Center for Disease Prevention and Control, Beijing, 100013, P.R. China
| | - Maozhong Li
- Institute for immunization and prevention, Beijing Municipal Center for Disease Prevention and Control, Beijing, 100013, P.R. China
| | - Aihua Li
- Institute for immunization and prevention, Beijing Municipal Center for Disease Prevention and Control, Beijing, 100013, P.R. China
| | - Ming Luo
- School of Public Health, Capital Medical University, Beijing, 100069, P.R. China
| | - Fang Huang
- School of Public Health, Capital Medical University, Beijing, 100069, P.R. China.
- Institute for immunization and prevention, Beijing Municipal Center for Disease Prevention and Control, Beijing, 100013, P.R. China.
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211
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Puenpa J, Auphimai C, Korkong S, Vongpunsawad S, Poovorawan Y. Enterovirus A71 Infection, Thailand, 2017. Emerg Infect Dis 2019; 24:1386-1387. [PMID: 29912701 PMCID: PMC6038748 DOI: 10.3201/eid2407.171923] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
An outbreak of hand, foot and mouth disease among children in Thailand peaked in August 2017. Enterovirus A71 subgenogroup B5 caused most (33.8%, 163/482) cases. Severe disease (myocarditis and encephalitis) was observed in 1 patient. Coxsackievirus A6 was detected in 6.0% (29/482) of patients, and coxsackievirus A16 was detected in 2.7% (13/482) of patients.
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212
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Kim HJ, Son HS, Lee SW, Yoon Y, Hyeon JY, Chung GT, Lee JW, Yoo JS. Efficient expression of enterovirus 71 based on virus-like particles vaccine. PLoS One 2019; 14:e0210477. [PMID: 30845175 PMCID: PMC6405078 DOI: 10.1371/journal.pone.0210477] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 12/25/2018] [Indexed: 01/23/2023] Open
Abstract
Enterovirus (EV) 71 is the main pathogen associated with hand-foot-mouth disease (HFMD) and can lead to the disease with severe mortality in children. Since 2009, in the Republic of Korea, an outbreak of EV71 C4a infection with neurologic involvement emerged, where in HFMD involvement was identified and central nervous system complications were reported. In this study, EV71 C4a virus-like particles (VLPs) produced by recombinant technology were generated in a baculovirus expression system. To improve the production yield, EV71 VLP was constructed using the dual promoter system baculovirus P1 and 3CD (baculo-P1-3CD), which harbored both the structural protein-encoding P1 region under the control of the polyhedron promoter and the 3CD protease gene under the regulation of the CMV-IE, lef3, gp41, or chitinase promoters to augment the level of gene transcription. Efficient VLP expression was demonstrated through optimization of incubation time and insect cell type. In addition, to evaluate the potential of VLP as a vaccine candidate, we tested the neutralizing antibodies and total anti-EV71 IgG from the purified EV71 C4a VLP serum. The recombinant EV71 VLP exhibited the morphology of self-assembled VLP, as determined by electron microscopy. Use of baculo-P1-3CD-gp41 led to a high yield (11.3mg/L < 40kDa) of VLPs in High-FiveTM cells at 3 days post-infection. Furthermore, the potential of VLP as a vaccine was evaluated through the neutralizing ability elicited by the purified EV71 VLP after immunization of BALB/c mice, which was shown to induce potent and long-lasting humoral immune responses as evidenced by the cross-neutralization titer. Our results could be used to expedite the developmental process for vaccines under clinical trials and to ensure manufacturing consistency for licensing requirements.
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Affiliation(s)
- Hye-Jin Kim
- Division of Vaccine Research, Center for Infectious Diseases, Korea National Institutes of Health, Korea Centers for Disease Control and Prevention, Osong-eup, Cheongju, Chungcheongbuk-do, Republic of Korea
| | - Ho Sun Son
- Division of Vaccine Research, Center for Infectious Diseases, Korea National Institutes of Health, Korea Centers for Disease Control and Prevention, Osong-eup, Cheongju, Chungcheongbuk-do, Republic of Korea
| | - Sang Won Lee
- Division of Strategic Planning for Emerging Infectious Disease, Centers for Disease Control and Prevention, Osong, CheongJu, Chungcheongbuk-do, South Korea
| | - Youngsil Yoon
- Division of Viral Disease, Center for Laboratory control of Infectious Disease, Centers for Disease Control and Prevention, Osong, CheongJu, Chungcheongbuk-do, South Korea
| | - Ji-Yeon Hyeon
- Division of Vaccine Research, Center for Infectious Diseases, Korea National Institutes of Health, Korea Centers for Disease Control and Prevention, Osong-eup, Cheongju, Chungcheongbuk-do, Republic of Korea
| | - Gyung Tae Chung
- Division of Strategic Planning for Emerging Infectious Disease, Centers for Disease Control and Prevention, Osong, CheongJu, Chungcheongbuk-do, South Korea
| | - June-Woo Lee
- Division of Vaccine Research, Center for Infectious Diseases, Korea National Institutes of Health, Korea Centers for Disease Control and Prevention, Osong-eup, Cheongju, Chungcheongbuk-do, Republic of Korea
- * E-mail: (JSY); (JWL)
| | - Jung Sik Yoo
- Division of Vaccine Research, Center for Infectious Diseases, Korea National Institutes of Health, Korea Centers for Disease Control and Prevention, Osong-eup, Cheongju, Chungcheongbuk-do, Republic of Korea
- * E-mail: (JSY); (JWL)
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213
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Xiao K, Duan L, Peng Y, Wu M, Mai G, Yan Z, Chen S, Lu Y. Epidemiologic features of enterovirus associated with hand, foot and mouth disease in 2013 and 2014 in Shenzhen, China. Sci Rep 2019; 9:3856. [PMID: 30846756 PMCID: PMC6405776 DOI: 10.1038/s41598-019-40402-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 02/12/2019] [Indexed: 02/05/2023] Open
Abstract
Hand, foot and mouth disease (HFMD) is responsible for a heavy economic and social burden in the Asia-Pacific region. Previous studies have shown that coxsackievirus A6 (CVA6) and coxsackievirus A10 (CVA10) have become the predominant agents of HFMD in mainland China in recent years, replacing enterovirus 71 (EV71) and coxsackievirus A16 (CVA16), although it is unclear if this is consistent throughout China. In this study, samples from 253 HFMD cases were collected in Shenzhen, China, from May 2013 through April 2014 to identify the etiological agent of HFMD. In total, 64.8% (164/253) of HFMD cases were enterovirus positive, in which 81.1% (133/164) were determined to be CVA6. The phylogenetic tree of the partial viral protein 1 sequence showed that the CVA6 isolates were divided into four clusters (Clusters A to D), and cluster D was further divided into four sub-clusters (Clusters D1 to D4). The 133 CVA6 samples isolated in our study were classified into cluster D4, in which the first identified sequence was isolated in Shenzhen in 2008. This study demonstrated that the CVA6 cluster D4, which is predominantly circulating in HFMD in mainland China, may have originated from a local strain identified in 2008 in Shenzhen.
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Affiliation(s)
- Kelin Xiao
- International institute of Infection and Immunity, Shantou University Medical College, Shantou, 515041, China
- Central Laboratory, Maternal-Fetal Medicine Institute, Baoan Maternal and Child Health Hospital, Jinan University, Shenzhen, 518102, China
| | - Lian Duan
- Shenzhen liver diseases institute, Shenzhen Third People's Hospital, Shenzhen, 518112, China
| | - Yun Peng
- Shenzhen liver diseases institute, Shenzhen Third People's Hospital, Shenzhen, 518112, China
| | - Maocai Wu
- Shenzhen liver diseases institute, Shenzhen Third People's Hospital, Shenzhen, 518112, China
| | - Guangxing Mai
- Central Laboratory, Maternal-Fetal Medicine Institute, Baoan Maternal and Child Health Hospital, Jinan University, Shenzhen, 518102, China
| | - Zehao Yan
- Central Laboratory, Maternal-Fetal Medicine Institute, Baoan Maternal and Child Health Hospital, Jinan University, Shenzhen, 518102, China
| | - Shuiwen Chen
- Department of pediatrics, Baoan Maternal and Child Health Hospital, Jinan University, Shenzhen, 518102, China.
| | - Yihan Lu
- Department of Epidemiology, The Key Laboratory of Public Health Safety of Minister of Education, School of Public Health, Fudan University, Shanghai, 200032, China.
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214
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Bian L, Gao F, Mao Q, Sun S, Wu X, Liu S, Yang X, Liang Z. Hand, foot, and mouth disease associated with coxsackievirus A10: more serious than it seems. Expert Rev Anti Infect Ther 2019; 17:233-242. [PMID: 30793637 DOI: 10.1080/14787210.2019.1585242] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Hand, foot, and mouth disease (HFMD) is a common viral childhood illness, that has been a severe public health concern worldwide, particularly in the Asia-Pacific region. According to epidemiological data of HFMD during the past decade, the most prevalent causal viruses were enterovirus (EV)-A71, coxsackievirus (CV)-A16, CV-A6, and CV-A10. The public health burden of CV-A10-related diseases has been underestimated as their incidence was lower than that of EV-A71 and CV-A16 in most HFMD outbreaks. However, cases of CV-A10 infection are more severe, and its genome is more variable, which has alerted the research community worldwide. Areas covered: In this paper, studies on the epidemiology, laboratory diagnosis, clinical manifestations, molecular epidemiology, seroepidemiology, animal models of CV-A10, and vaccines and antiviral strategies against this genotype are reviewed. In addition, the genetic evolution of circulating strains was analyzed. Expert opinion: Multivalent vaccines against EV-A71, CV-A16, CV-A6, and CV-A10 should be a next-step HFMD vaccine strategy.
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Affiliation(s)
- Lianlian Bian
- a Division of Hepatitis Virus Vaccines , National Institutes for Food and Drug Control , Beijing , China.,b Division of Hepatitis Virus Vaccines , Wuhan Institute of Biological Products Co., Ltd , Wuhan , China
| | - Fan Gao
- a Division of Hepatitis Virus Vaccines , National Institutes for Food and Drug Control , Beijing , China
| | - Qunying Mao
- a Division of Hepatitis Virus Vaccines , National Institutes for Food and Drug Control , Beijing , China
| | - Shiyang Sun
- a Division of Hepatitis Virus Vaccines , National Institutes for Food and Drug Control , Beijing , China
| | - Xing Wu
- a Division of Hepatitis Virus Vaccines , National Institutes for Food and Drug Control , Beijing , China
| | - Siyuan Liu
- a Division of Hepatitis Virus Vaccines , National Institutes for Food and Drug Control , Beijing , China
| | - Xiaoming Yang
- b Division of Hepatitis Virus Vaccines , Wuhan Institute of Biological Products Co., Ltd , Wuhan , China
| | - Zhenglun Liang
- a Division of Hepatitis Virus Vaccines , National Institutes for Food and Drug Control , Beijing , China
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215
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Near-Complete Genome Sequences of 12 Coxsackievirus Group A Strains from Hand, Foot, and Mouth Disease and Herpangina Cases with Different Clinical Symptoms. Microbiol Resour Announc 2019; 8:MRA01655-18. [PMID: 30834371 PMCID: PMC6386572 DOI: 10.1128/mra.01655-18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 01/21/2019] [Indexed: 12/20/2022] Open
Abstract
Coxsackievirus group A (CV-A) strains are important pathogens of hand, foot, and mouth disease and herpangina. We report here the near-complete genome sequences of 12 CV-A strains isolated from infants and children with different clinical diseases. The presented data will be very useful for future genome-based epidemiological studies.
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216
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Molecular Identification of Enteroviruses from Cattle and Goat Feces and Environment in Thailand. Appl Environ Microbiol 2019; 85:AEM.02420-18. [PMID: 30552188 DOI: 10.1128/aem.02420-18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 12/07/2018] [Indexed: 12/29/2022] Open
Abstract
The identification and characterization of viruses of the genus Enterovirus in healthy and infected livestock, including cattle and goats, have been increasing. Enterovirus E (EV-E) and Enterovirus F (EV-F) are commonly found in cattle, whereas Enterovirus G (EV-G) is found in goats. In this study, molecular and phylogenetic analyses were performed to determine the prevalence of EVs in cattle and goat feces from Kanchanaburi Province, Thailand. The presence of EVs in water samples and the feces of other animals collected from the areas surrounding cattle and goat farms was also investigated. By use of 5'-untranslated region (5' UTR) real-time reverse transcription-PCR (RT-PCR), EVs were detected in 39.5% of cattle samples, 47% of goat samples, 35.3% of water samples, and one pool of chicken feces. Phylogenetic analysis revealed the presence of EV-E and EV-F in cattle, EV-E and EV-G in goats, and EV-F in water samples and chicken feces. Analysis of enteroviral VP1 sequences from cattle revealed that the EV-E genotypes circulating in the study region were EV-E1, with a possible new genotype that is closely related to EV-E2. Analysis of enteroviral VP1 sequences from goats suggested the circulation of EV-G5 and a possible new genotype that is closely related to EV-G20. Sequence analyses also suggested that although the VP1 sequences from goats were closely related to those of EV-G, which were considered porcine enterovirus sequences, their 5' UTRs form a separated cluster with sequences of sheep and goat origin, suggesting a new classification of the ovine/caprine-specific enterovirus group.IMPORTANCE Possible new EV-E and EV-G genotypes were identified for EVs detected in this study. The EV-E viruses were also successfully isolated from MDBK cells. The goat EV sequence analysis suggested the presence of an ovine/caprine-specific EV group that is different from EV-G of porcine origin. The significance of our research is that it identifies and characterizes possible novel EVs, thereby indicating that enteroviruses in animals are continually evolving. The facts that enteroviruses can persist in the environment, contaminate it for long periods, and be transmitted between animals raise serious concerns regarding this group of viruses as emerging livestock pathogens.
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217
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N’Guyen Y, Lebreil AL, Simphal P, Pietrement C, Bednarek N, Orquevaux P, Gretteau PA, Andreoletti L. Impact of Enterovirus Molecular Assay Turnaround Time on Hospitalization Length During an Echovirus 30 Meningitis Outbreak, France, Fall 2014. Open Virol J 2019. [DOI: 10.2174/1874357901913010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
The impact of Enterovirus Real Time-Polymerase Chain Reaction assay (EV RT-PCR) on hospitalization lengths of patients with aseptic meningitis has been investigated but the impact of early EV RT-PCR results released on time before patient discharge remains unclear during Echovirus meningitis outbreaks.
Objective:
To assess a potential correlation between EV RT-PCR turn-around time and hospitalization lengths during an Echovirus meningitis outbreak.
Method:
Eighteen patients demonstrating a positive EV RT-PCR assay performed on Cerebrospinal Fluid (CSF) samples collected between October 1st 2014 and December 31st 2014 were retrospectively included. Viral protein 1 (VP1) gene region was amplified and sequenced using a classical Sanger sequencing reaction. Clinical data were retrospectively collected from patient’s records. Quantitative variables expressed as median values and ranges were compared using Mann Whitney U test. Correlations were performed using simple regression analysis.
Results:
Phylogenetic VP1 sequence analyses identified that the outbreak was related to an Echovirus 30 strain in 7 out of the 10 cases with available sequencing data. The three remaining sequences analyses evidenced Echovirus 14, 9 and 7 strains. Hospitalization length was statistically shorter in children without comorbidity (n=5) than in adult patients (n=10) or neonates and children with comorbidity (n=3) (p=0.003 and 0.01 respectively), whereas EV RT-PCR turnaround time was not statistically different between these groups. Correlation between hospitalization length and EV RT-PCR turnaround time was poor (R2=0.06), especially in adults (R2=0.01)
Conclusion:
Our data indicated that EV RT-PCR turnaround time was not correlated to hospitalization length during a short Echovirus meningitis outbreak.
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218
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Bersani I, Auriti C, Piersigilli F, Dotta A, Diomedi-Camassei F, Di Pede A, Buttinelli G, Danhaive O. Neonatal acute liver failure due to enteroviruses: a 14 years single NICU experience. J Matern Fetal Neonatal Med 2019; 33:2576-2580. [PMID: 30513031 DOI: 10.1080/14767058.2018.1555806] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Neonatal acute liver failure (ALF) is a severe condition with a mortality rate up to 70%. Human enterovirus (HEV) infections are associated with serious diseases in newborns, including myocarditis, meningoencephalitis and, more rarely, ALF with a fulminant course.Methods: Cases of neonatal-onset ALF were identified using the institutional clinical database. The history and clinical data of infants with HEV infection were collected by medical record revision. Viral testing by nested real- time PCR (nRT-PCR) was performed by the Bambino Gesù Children's Hospital Clinical Laboratory and by National Institute of Public Health in Rome.Results: Among ten infants referred to our Institution with neonatal-onset ALF in the 2004-2018 period, we identified five cases due to HEV. In three of these, the mother reported an episode of mild fever and diarrhea during the last trimester of gestation, suggesting fetal-maternal transmission. All were late preterm infants (32-36 weeks). Two infants died as a result of ALF; the other three survived with full normalization of liver function. In four, the causing agents were coxsackie B serotypes 3 (n = 1), 4 (n = 1) and 5 (n = 2), in the fifth case we identified echovirus serotype 11.Conclusions: Human enterovirus (HEV) are a rare but relevant cause of ALF in neonates. HEV testing should be systematically performed in cases of neonatal ALF for diagnostic and management purposes.
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Affiliation(s)
- Iliana Bersani
- Department of Neonatology, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | - Cinzia Auriti
- Department of Neonatology, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | | | - Andrea Dotta
- Department of Neonatology, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | | | - Alessandra Di Pede
- Department of Neonatology, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy
| | | | - Olivier Danhaive
- Department of Neonatology, Bambino Gesù Children's Hospital - IRCCS, Rome, Italy.,Division of Neonatology, St-Luc University Hospital, Catholic University of Louvain, Brussels, Belgium
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219
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Maan HS, Dhole TN, Chowdhary R. Identification and characterization of nonpolio enterovirus associated with nonpolio-acute flaccid paralysis in polio endemic state of Uttar Pradesh, Northern India. PLoS One 2019; 14:e0208902. [PMID: 30699113 PMCID: PMC6353074 DOI: 10.1371/journal.pone.0208902] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 11/27/2018] [Indexed: 11/18/2022] Open
Abstract
Despite polio eradication, nonpolio enterovirus (NPEV) detection amid polio surveillance, which is considered to have implications in paralysis, requires attention. The attributes of NPEV infections in nonpolio-AFP (NPAFP) cases from Uttar Pradesh (UP), India, remain undetermined and are thus investigated. A total of 1839 stool samples collected from patients with acute flaccid paralysis (AFP) from UP, India, between January 2010 and October 2011 were analyzed as per the WHO algorithm. A total of 359 NPAFP cases yielded NPEVs, which were subjected to microneutralization assay, partial VP1 gene-based molecular serotyping and phylogenetic analysis. Demographic and clinical-epidemiological features were also ascertained. Echoviruses (29%) and Coxsackievirus (CV)-B (17%) were the most common viruses identified by the microneutralization assay. The molecular genotyping characterized the NPEVs into 34 different serotypes, corresponding to Enterovirus (EV)-A (1.6%), EV-B (94%) and EV-C (5.3%) species. The rarely described EV serotypes, such as EV-C95, CV-A20, EV-C105, EV-B75, EV-B101, and EV-B107, were also identified. NPEV-associated AFP was more prevalent in younger male children, peaked in the monsoon months and was predominantly found in the central part of the state. The NPEV strains isolated in the study exhibited genetic diversity from those isolated in other countries. These form part of a different cluster or subcluster existing in cocirculation, limited to India only. This study augments the understanding of epidemiological features and demonstrates the extensive diversity exhibited by the NPEV strains in NPAFP cases from the polio-endemic region. It also underscores the need or effective long-term strategies to monitor NPEV circulation and its associated health risks in the post-polio eradication era.
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Affiliation(s)
- Harjeet Singh Maan
- Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Tapan N. Dhole
- Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
- * E-mail:
| | - Rashmi Chowdhary
- Department of Biochemistry, All Indian Institute of Medical Sciences, Bhopal, India
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220
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Du Z, Zhao Y, Luo Y, Du L, Gan Q, Zhang H, Li J, Yang Z, Ma S. Ongoing change of severe hand, foot, and mouth disease pathogens in Yunnan, China, 2012 to 2016. J Med Virol 2019; 91:881-885. [PMID: 30613995 DOI: 10.1002/jmv.25393] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 01/04/2019] [Indexed: 11/09/2022]
Abstract
Hand, foot, and mouth disease (HFMD) is a common infectious disease caused by enteroviruses (EVs). In this study, a total of 341 children with serious HFMD were admitted to a pediatric hospital in Yunnan, China in 2012 to 2016. EVs were detected in 283 specimens (83.0%) and were assigned to 17 EV types. Enterovirus A71 (EV-A71) was predominant, accounting for 41.6%, and was followed by coxsackievirus A16 (CV-A16; 18.8%), CV-A6 (9.1%), CV-A10 and E-9 (2.9%), CV-B5 (1.8%), CV-A9 (1.2%), E-30 (0.9%), E-18, CV-A4, C-B3, and CV-A2 (0.6%) and other EV types such as CV-A8, CV-A14, E-14, E-11, and CV-B4 (0.3%). All of the EV-A71 isolates belonged to C4a; the CV-A16 belonged to B1b or B1a, although the B1b strains were predominant; and CV-A6 belonged to D3. In 2012 to 2014, E-9 was the third most frequent serotype (8.2%, 5.0%, and 6.5%, respectively). E-9 was not detected in 2015 and 2016. CV-A6 was not detected in 2012 but was the second most frequent serotype (25.3%) in 2015. Active etiological surveillance of HFMD makes it necessary to be aware of these emerging pathogens.
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Affiliation(s)
- Zengqing Du
- Department of Infectious Diseases, Kunming Children's Hospital, Kunming, China
| | - Yilin Zhao
- The Department of Medical Genetics, Institute of Medical Biology, Chinese Academy of Medical Sciences, and Peking Union Medical College, Kunming, China.,Yunnan Key Laboratory of Vaccine Research & Development on Severe Infectious Diseases, Kunming, China
| | - Yunjiao Luo
- Department of Infectious Diseases, Kunming Children's Hospital, Kunming, China
| | - Lijiang Du
- Department of Infectious Diseases, Kunming Children's Hospital, Kunming, China
| | - Quan Gan
- Department of Infectious Diseases, Kunming Children's Hospital, Kunming, China
| | - Haihao Zhang
- The Department of Medical Genetics, Institute of Medical Biology, Chinese Academy of Medical Sciences, and Peking Union Medical College, Kunming, China.,Yunnan Key Laboratory of Vaccine Research & Development on Severe Infectious Diseases, Kunming, China
| | - Jianlan Li
- The Department of Medical Genetics, Institute of Medical Biology, Chinese Academy of Medical Sciences, and Peking Union Medical College, Kunming, China.,Yunnan Key Laboratory of Vaccine Research & Development on Severe Infectious Diseases, Kunming, China
| | - Zhaoqing Yang
- The Department of Medical Genetics, Institute of Medical Biology, Chinese Academy of Medical Sciences, and Peking Union Medical College, Kunming, China.,Yunnan Key Laboratory of Vaccine Research & Development on Severe Infectious Diseases, Kunming, China
| | - Shaohui Ma
- The Department of Medical Genetics, Institute of Medical Biology, Chinese Academy of Medical Sciences, and Peking Union Medical College, Kunming, China.,Yunnan Key Laboratory of Vaccine Research & Development on Severe Infectious Diseases, Kunming, China
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221
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Twenty-nine Cases of Enterovirus-D68-associated Acute Flaccid Myelitis in Europe 2016: A Case Series and Epidemiologic Overview. Pediatr Infect Dis J 2019; 38:16-21. [PMID: 30234793 PMCID: PMC6296836 DOI: 10.1097/inf.0000000000002188] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Enterovirus-D68 (EV-D68) is a respiratory virus within the genus Enterovirus and the family of Picornaviridae. Genetically, it is closely related to rhinovirus that replicates in the respiratory tract and causes respiratory disease. Since 2014, EV-D68 has been associated with the neurologic syndrome of acute flaccid myelitis (AFM). METHODS In October 2016, questionnaires were sent out to a European network including 66 virologists and clinicians, to develop an inventory of EV-D68-associated AFM cases in Europe. Clinical and virologic information of case patients was requested. In addition, epidemiologic information on EV testing was collected for the period between March and October 2016. RESULTS Twenty-nine cases of EV-D68-associated AFM were identified, from 12 different European countries. Five originated from France, 5 from Scotland and 3 each from Sweden, Norway and Spain. Twenty-six were children (median age 3.8 years), 3 were adults. EV-D68 was detected in respiratory materials (n = 27), feces (n = 8) and/or cerebrospinal fluid (n = 2). Common clinical features were asymmetric flaccid limb weakness, cranial nerve deficits and bulbar symptoms. On magnetic resonance imaging, typical findings were hyperintensity of the central cord and/or brainstem; low motor amplitudes with normal conduction velocities were seen on electromyography. Full clinical recovery was rare (n = 3), and 2 patients died. The epidemiologic data from 16 European laboratories showed that of all EV-D68-positive samples, 99% was detected in a respiratory specimen. CONCLUSIONS For 2016, 29 EV-D68-related AFM cases were identified in mostly Western Europe. This is likely an underestimation, because case identification is dependent on awareness among clinicians, adequate viral diagnostics on respiratory samples and the capability of laboratories to type EVs.
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Shiratori M, Fukai K, Hikita N, Seto T, Tsuruta D. Case of hand, foot and mouth disease with vesicular Koebner phenomenon on the ankles caused by Coxsackievirus A6 in an adult. J Dermatol 2018; 46:e191-e192. [PMID: 30536870 DOI: 10.1111/1346-8138.14723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Miyu Shiratori
- Department of Dermatology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kazuyoshi Fukai
- Department of Dermatology, Osaka City University Graduate School of Medicine, Osaka, Japan.,Department of Dermatology, Osaka City General Hospital, Osaka, Japan
| | - Norikatsu Hikita
- Department of Pediatrics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Toshiyuki Seto
- Department of Pediatrics, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Daisuke Tsuruta
- Department of Dermatology, Osaka City University Graduate School of Medicine, Osaka, Japan
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223
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Cinek O, Kramna L, Mazankova K, Kunteová K, Chudá K, C J Claas E, Stene LC, Tapia G. Virus genotyping by massive parallel amplicon sequencing: adenovirus and enterovirus in the Norwegian MIDIA study. J Med Virol 2018; 91:606-614. [PMID: 30537228 DOI: 10.1002/jmv.25361] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 11/04/2018] [Indexed: 01/30/2023]
Abstract
OBJECTIVES Direct genotyping of adenovirus or enterovirus from clinical material using polymerase chain reaction (PCR) followed by Sanger sequencing is often difficult due to the presence of multiple virus types in a sample, or due to varying efficacy of PCR amplifying the capsid gene on the background of foreign nucleic acids. Here we present a simple protocol for virus genotyping using massive parallel amplicon sequencing. METHODS The protocol utilized a set of 16 tailed degenerate primers flanking the seventh hypervariable region of the adenovirus hexon gene and 9 tailed degenerate primers targeted to the proximal portion of the enterovirus VP1 gene. Subsequent addition of dual indices enabled simultaneous sequencing of 384 different samples on an Illumina MiSeq instrument. Downstream bioinformatic analysis was based on remapping to a set of references representative of the presently known repertoire of virus types. RESULTS After validation with known virus types, the sequencing method was applied on 301 adenovirus-positive samples and 350 enterovirus-positive samples from a longitudinally collected series of stools from 83 children aged 3 to 36 months. We detected 7 different adenovirus types and 27 different enterovirus types. There were 37 (6.2%) samples containing more than one genotype of the same viral genus. At least one dual infection was experienced by 23 of 83 (28%) of the children observed over the 3 years' observation period. CONCLUSIONS Amplicon sequencing with a multiplex set of degenerate primers seems to be a rapid and reliable technical solution for genotyping of large collections of samples where simultaneous infections with multiple strains can be expected.
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Affiliation(s)
- Ondrej Cinek
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague and University Hospital Motol, Prague, Czech Republic
| | - Lenka Kramna
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague and University Hospital Motol, Prague, Czech Republic
| | - Karla Mazankova
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague and University Hospital Motol, Prague, Czech Republic
| | - Kateřina Kunteová
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague and University Hospital Motol, Prague, Czech Republic
| | - Kateřina Chudá
- Department of Pediatrics, 2nd Faculty of Medicine, Charles University in Prague and University Hospital Motol, Prague, Czech Republic
| | - Eric C J Claas
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lars C Stene
- Division of Mental and Physical Health, Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - German Tapia
- Division of Mental and Physical Health, Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
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Reference Echovirus 7 and 19 Genomes from Nigeria. Microbiol Resour Announc 2018; 7:MRA01465-18. [PMID: 30533861 PMCID: PMC6284093 DOI: 10.1128/mra.01465-18] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 11/04/2018] [Indexed: 12/27/2022] Open
Abstract
We describe the genomes of two echovirus isolates from Nigeria as reference enterovirus species B genomes for the region. These echovirus 7 and 19 genomes have 7,411 nucleotides (nt) and 7,426 nt and were recovered from sewage-contaminated water (in 2010) and an acute flaccid paralysis case (in 2014), respectively. We describe the genomes of two echovirus isolates from Nigeria as reference enterovirus species B genomes for the region. These echovirus 7 and 19 genomes have 7,411 nucleotides (nt) and 7,426 nt and were recovered from sewage-contaminated water (in 2010) and an acute flaccid paralysis case (in 2014), respectively.
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Delogu R, Battistone A, Buttinelli G, Fiore S, Fontana S, Amato C, Cristiano K, Gamper S, Simeoni J, Frate R, Pellegrinelli L, Binda S, Veronesi L, Zoni R, Castiglia P, Cossu A, Triassi M, Pennino F, Germinario C, Balena V, Cicala A, Mercurio P, Fiore L, Pini C, Stefanelli P. Poliovirus and Other Enteroviruses from Environmental Surveillance in Italy, 2009-2015. FOOD AND ENVIRONMENTAL VIROLOGY 2018; 10:333-342. [PMID: 29948963 DOI: 10.1007/s12560-018-9350-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 06/08/2018] [Indexed: 06/08/2023]
Abstract
Within the initiatives for poliomyelitis eradication by WHO, Italy activated an environmental surveillance (ES) in 2005. ES complements clinical Acute Flaccid Paralysis (AFP) surveillance for possible polio cases, detects poliovirus circulation in environmental sewage, and is used to monitor transmission in communities. In addition to polioviruses, the analyses comprised: (i) the monitoring of the presence of non-polio enteroviruses in sewage samples and (ii) the temporal and geographical distribution of the detected viruses. From 2009 to 2015, 2880 sewage samples were collected from eight cities participating in the surveillance. Overall, 1479 samples resulted positive for enteroviruses. No wild-type polioviruses were found, although four Sabin-like polioviruses were detected. The low degree of mutation found in the genomes of these four isolates suggests that these viruses have had a limited circulation in the population. All non-polio enteroviruses belonged to species B and the most frequent serotype was CV-B5, followed by CV-B4, E-11, E-6, E-7, CV-B3, and CV-B2. Variations in the frequency of different serotypes were also observed in different seasons and/or Italian areas. Environmental surveillance in Italy, as part of the 'WHO global polio eradication program', is a powerful tool to augment the polio surveillance and to investigate the silent circulation or the re-emergence of enteroviruses in the population.
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Affiliation(s)
- Roberto Delogu
- National Centre for the Control and the Evaluation of Medicines, Istituto Superiore di Sanità, Rome, Italy.
- National Centre for the Control and the Evaluation of Medicines, Istituto Superiore di Sanità, Viale Regina Elena, 299, 00161, Rome, Italy.
| | - Andrea Battistone
- National Centre for the Control and the Evaluation of Medicines, Istituto Superiore di Sanità, Rome, Italy
| | - Gabriele Buttinelli
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Stefano Fiore
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Stefano Fontana
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Concetta Amato
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Karen Cristiano
- National Centre for the Control and the Evaluation of Medicines, Istituto Superiore di Sanità, Rome, Italy
| | - Sabine Gamper
- Comprensorio Sanitario di Bolzano, Servizio Igiene e Sanità Pubblica, Bolzano, Italy
| | - Josef Simeoni
- Comprensorio Sanitario di Bolzano, Servizio Igiene e Sanità Pubblica, Bolzano, Italy
| | | | - Laura Pellegrinelli
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Sandro Binda
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Licia Veronesi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Roberta Zoni
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Paolo Castiglia
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Andrea Cossu
- Department of Biomedical Sciences, University of Sassari, Sassari, Italy
| | - Maria Triassi
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | - Francesca Pennino
- Department of Public Health, University of Naples Federico II, Naples, Italy
| | | | - Viviana Balena
- Hygiene Unit, Department DIMO, University of Bari, Bari, Italy
| | | | | | - Lucia Fiore
- National Centre for the Control and the Evaluation of Medicines, Istituto Superiore di Sanità, Rome, Italy
| | - Carlo Pini
- National Centre for the Control and the Evaluation of Medicines, Istituto Superiore di Sanità, Rome, Italy
| | - Paola Stefanelli
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
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Lizasoain A, Burlandy FM, Victoria M, Tort LFL, da Silva EE, Colina R. An Environmental Surveillance in Uruguay Reveals the Presence of Highly Divergent Types of Human Enterovirus Species C and a High Frequency of Species A and B Types. FOOD AND ENVIRONMENTAL VIROLOGY 2018; 10:343-352. [PMID: 29907902 DOI: 10.1007/s12560-018-9351-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/12/2018] [Indexed: 06/08/2023]
Abstract
Information about Human Enterovirus circulation in Uruguay is scarce. The aim of this study was to generate the first description about their circulation in the country through the study of sewage samples collected before and after the switch from Oral Poliovirus Vaccine to Inactivated Poliovirus Vaccine. Viruses were concentrated by an adsorption-elution to a negatively charged membrane, and real-time quantitative PCR and qualitative PCR methods were used to detect, quantify, and characterize enteroviruses. Positive samples were inoculated in RD cells and two passages were performed. Additionally, RD+ samples were subsequently passed onto L20B cells. Human Enteroviruses were detected in 67.6% of the samples, with concentrations between 4.9 and 6.6 Log10 genomic copies per liter. 10% of positive samples replicated in RD cells, of which none in L20B cells. Molecular characterization of Human Enterovirus strains directly detected from sewage sample concentrates allowed the identification of highly divergent members of species C such as Enterovirus C99 and Coxsackievirus A13, as well as the frequent detection of species A and B members (particularly Coxsackievirus A16 and Echovirus 6, respectively). Other detected types were Coxsackievirus A2, A22, B1, B5, Echovirus 5, and 9. The characterization of viruses isolated in cell culture revealed the presence of Echovirus 6 and Coxsackievirus B3. Despite the absence of poliovirus, a wide circulation of different enterovirus types was evidenced in Uruguayan sewage samples, highlighting that the local populations are exposed to different kinds of diseases originated by several human enterovirus.
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Affiliation(s)
- Andrés Lizasoain
- Laboratorio de Virología Molecular, CENUR Litoral Norte, Sede Salto, Universidad de la República, Gral. Rivera 1350, 50000, Salto, Uruguay
| | - Fernanda M Burlandy
- Laboratório de Enterovírus, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Avda. Brasil 4365, Rio de Janeiro, 21040-360, Brazil
| | - Matías Victoria
- Laboratorio de Virología Molecular, CENUR Litoral Norte, Sede Salto, Universidad de la República, Gral. Rivera 1350, 50000, Salto, Uruguay
| | - Luis F López Tort
- Laboratorio de Virología Molecular, CENUR Litoral Norte, Sede Salto, Universidad de la República, Gral. Rivera 1350, 50000, Salto, Uruguay
| | - Edson E da Silva
- Laboratório de Enterovírus, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Avda. Brasil 4365, Rio de Janeiro, 21040-360, Brazil
| | - Rodney Colina
- Laboratorio de Virología Molecular, CENUR Litoral Norte, Sede Salto, Universidad de la República, Gral. Rivera 1350, 50000, Salto, Uruguay.
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Adewumi OM, Faleye TOC, Okeowo CO, Oladapo AM, Oyathelemhi J, Olaniyi OA, Isola OC, Adeniji JA. Identification of previously untypable RD cell line isolates and detection of EV-A71 genotype C1 in a child with AFP in Nigeria. Pathog Glob Health 2018; 112:421-427. [PMID: 30474520 DOI: 10.1080/20477724.2018.1548117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
We previously attempted to identify 96 nonpolio enteroviruses (EVs) recovered in RD cell culture from children <15 years with acute flaccid paralysis in Nigeria. We succeeded in identifying 69 of the isolates. Here, we describe an attempt to identify the remaining 27 isolates. Twenty-six (the 27th isolate was exhausted) isolates/samples that could not be typed previously were further analyzed. All were subjected to RNA extraction, cDNA synthesis, enterovirus 5'-UTR-VP2 PCR assay and a modified VP1 snPCR assay. Both the 5'-UTR-VP2 and VP1 amplicons were sequenced, isolates identified and subjected to phylogenetic analysis.Twenty of the 26 samples analyzed were identified. Altogether, 23 (three samples had co-infection) EV strains were recovered. These belong to 11 EV (one EVA, nine EVB and one EVC) types which were EVA71 genotype C1 (1 strain), CVB3 (7 strains), CVB5 (1 strain), E5 (2 strain), E11 (3 strains), E13 (2 strain), E19 (1 strain), E20 (1 strain), E24 (2 strains), EVB75 (1 strain) and EVC99 (2 strains). Of the 11 EV types, the 5'-UTR-VP2 assay identified seven while the VP1 assay identified 10. Both assays simultaneously detected 7 of the 11 EV types identified in this study with 100% congruence. We successfully identified 20 of 26 samples that were previously untypable. We also provided evidence that suggests a clade of EVA71 genotype C1 might have been circulating in sub-Saharan Africa since 2008. Finally, we showed that the 5'-UTR -VP2 assay might be as valuable as the VP1 assay in EV identification.
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Affiliation(s)
| | - Temitope Oluwasegun Cephas Faleye
- a Department of Virology , College of Medicine, University of Ibadan , Ibadan , Nigeria.,b Department of Microbiology, Faculty of Science , Ekiti State University , Ado-Ekiti , Nigeria
| | - Christopher Olaoluwa Okeowo
- c Department of Science Laboratory Technology, Faculty of Science , Ekiti State University , Ado-Ekiti , Nigeria
| | - Akintunde Michael Oladapo
- c Department of Science Laboratory Technology, Faculty of Science , Ekiti State University , Ado-Ekiti , Nigeria
| | - Joyce Oyathelemhi
- c Department of Science Laboratory Technology, Faculty of Science , Ekiti State University , Ado-Ekiti , Nigeria
| | - Olawumi A Olaniyi
- c Department of Science Laboratory Technology, Faculty of Science , Ekiti State University , Ado-Ekiti , Nigeria
| | - Oluwatoyosi Catherine Isola
- c Department of Science Laboratory Technology, Faculty of Science , Ekiti State University , Ado-Ekiti , Nigeria
| | - Johnson Adekunle Adeniji
- a Department of Virology , College of Medicine, University of Ibadan , Ibadan , Nigeria.,d WHO National Polio Laboratory , University of Ibadan , Ibadan , Nigeria
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Base-By-Base Version 3: New Comparative Tools for Large Virus Genomes. Viruses 2018; 10:v10110637. [PMID: 30445717 PMCID: PMC6265842 DOI: 10.3390/v10110637] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 11/10/2018] [Accepted: 11/13/2018] [Indexed: 11/24/2022] Open
Abstract
Base-By-Base is a comprehensive tool for the creation and editing of multiple sequence alignments that is coded in Java and runs on multiple platforms. It can be used with gene and protein sequences as well as with large viral genomes, which themselves can contain gene annotations. This report describes new features added to Base-By-Base over the last 7 years. The two most significant additions are: (1) The recoding and inclusion of “consensus-degenerate hybrid oligonucleotide primers” (CODEHOP), a popular tool for the design of degenerate primers from a multiple sequence alignment of proteins; and (2) the ability to perform fuzzy searches within the columns of sequence data in multiple sequence alignments to determine the distribution of sequence variants among the sequences. The intuitive interface focuses on the presentation of results in easily understood visualizations and providing the ability to annotate the sequences in a multiple alignment with analytic and user data.
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229
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Cassidy H, Poelman R, Knoester M, Van Leer-Buter CC, Niesters HGM. Enterovirus D68 - The New Polio? Front Microbiol 2018; 9:2677. [PMID: 30483226 PMCID: PMC6243117 DOI: 10.3389/fmicb.2018.02677] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 10/19/2018] [Indexed: 12/20/2022] Open
Abstract
Enterovirus D68 (EV-D68) has emerged over the recent years, with large outbreaks worldwide. Increased occurrence has coincided with improved clinical awareness and surveillance of non-polio enteroviruses. Studies showing its neurotropic nature and the change in pathogenicity have established EV-D68 as a probable cause of Acute Flaccid Myelitis (AFM). The EV-D68 storyline shows many similarities with poliovirus a century ago, stimulating discussion whether EV-D68 could be ascertaining itself as the "new polio." Increasing awareness amongst clinicians, incorporating proper diagnostics and integrating EV-D68 into accessible surveillance systems in a way that promotes data sharing, will be essential to reveal the burden of disease. This will be a necessary step in preventing EV-D68 from becoming a threat to public health.
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Affiliation(s)
| | | | | | | | - Hubert G. M. Niesters
- Department of Medical Microbiology and Infection Prevention, Division of Clinical Virology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
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230
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Azuma J, Yamamoto T, Sakurai M, Amou R, Yamada C, Hashimoto K, Kajita S, Yamamoto K, Kijima E, Mizoguchi Y, Nakata K, Shimotsuji T, Ozono K. Urinary β2-microglobulin as an early marker of infantile enterovirus and human parechovirus infections. Medicine (Baltimore) 2018; 97:e12930. [PMID: 30412100 PMCID: PMC6221734 DOI: 10.1097/md.0000000000012930] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Enterovirus and human parechovirus (HPeV) are RNA viruses belonging to the family Picornaviridae that frequently infect infants. These infections show a wide variety of clinical manifestations, from mild to severe. However, there are no known early clinical markers for diagnosis and prediction of disease severity. The aim of this study was to examine the clinical utility of urinary beta 2-microglobulin (β2MG) for the early detection and prognosis of infantile enterovirus and HPeV infections.This retrospective study included 108 full-term infants younger than 60 days of age, including 15 with enterovirus or HPeV-3 (enterovirus/HPeV-3), 22 with respiratory syncytial virus (RSV), and 24 with bacterial infections. Laboratory data and clinical characteristics were compared among these 3 groups. Of the 15 patients with enterovirus/HPeV-3, 6 were treated with intravenous immunoglobulin (IVIG subgroup) because of severe clinical conditions.Urinary β2MG to creatinine ratio (β2MG/Cr) was significantly higher in the enterovirus/HPeV-3 group compared to bacterial and RSV infection groups (both P < .001). In the enterovirus/HPeV-3 group, mean peak urinary β2MG/Cr was observed on day 1 or 2. Urinary β2MG/Cr values were significantly higher in the IVIG subgroup than the non-IVIG subgroup (P < .001).Increased urinary β2MG/Cr in early-stage infection may be a useful clinical marker for the detection and prediction of infantile enterovirus and HPeV infection severity.
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Affiliation(s)
- Junji Azuma
- Department of Pediatrics, Minoh City Hospital
| | | | | | - Ryuko Amou
- Department of Pediatrics, Minoh City Hospital
| | | | | | | | | | - Eri Kijima
- Department of Pediatrics, Minoh City Hospital
| | | | - Keiko Nakata
- Department of Infectious Diseases, Osaka Institute of Public Health, Osaka, Japan
| | | | - Keiichi Ozono
- Department of Pediatrics, Osaka University Graduate School of Medicine
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Updates on the molecular epidemiology of Enterovirus D68 after installation of screening test among acute flaccid paralysis patients in Taiwan. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2018; 51:688-691. [DOI: 10.1016/j.jmii.2017.12.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 10/11/2017] [Accepted: 12/12/2017] [Indexed: 12/15/2022]
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Joffret ML, Polston PM, Razafindratsimandresy R, Bessaud M, Heraud JM, Delpeyroux F. Whole Genome Sequencing of Enteroviruses Species A to D by High-Throughput Sequencing: Application for Viral Mixtures. Front Microbiol 2018; 9:2339. [PMID: 30323802 PMCID: PMC6172331 DOI: 10.3389/fmicb.2018.02339] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 09/12/2018] [Indexed: 01/06/2023] Open
Abstract
Human enteroviruses (EV) consist of more than 100 serotypes classified within four species for enteroviruses (EV-A to -D) and three species for rhinoviruses, which have been implicated in a variety of human illnesses. Being able to simultaneously amplify the whole genome and identify enteroviruses in samples is important for studying the viral diversity in different geographical regions and populations. It also provides knowledge about the evolution of these viruses. Therefore, we developed a rapid, sensitive method to detect and genetically classify all human enteroviruses in mixtures. Strains of EV-A (15), EV-B (40), EV-C (20), and EV-D (2) viruses were used in addition to 20 supernatants from RD cells infected with stool extracts or sewage concentrates. Two overlapping fragments were produced using a newly designed degenerated primer targeting the conserved CRE region for enteroviruses A-D and one degenerated primer set designed to specifically target the conserved region for each enterovirus species (EV-A to -D). This method was capable of sequencing the full genome for all viruses except two, for which nearly 90% of the genome was sequenced. This method also demonstrated the ability to discriminate, in both spiked and unspiked mixtures, the different enterovirus types present.
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Affiliation(s)
- Marie-Line Joffret
- Unité de Biologie des Virus Entériques, Institut Pasteur, Paris, France
- Institut National de la Santé et de la Recherche Médicale, Paris, France
- WHO Collaborating Center for Research on Enteroviruses and Viral Vaccines, Institut Pasteur, Paris, France
| | - Patsy M. Polston
- Unité de Biologie des Virus Entériques, Institut Pasteur, Paris, France
- Institut National de la Santé et de la Recherche Médicale, Paris, France
| | | | - Maël Bessaud
- Unité de Biologie des Virus Entériques, Institut Pasteur, Paris, France
- Institut National de la Santé et de la Recherche Médicale, Paris, France
- WHO Collaborating Center for Research on Enteroviruses and Viral Vaccines, Institut Pasteur, Paris, France
| | - Jean-Michel Heraud
- Unité de Virologie, Institut Pasteur de Madagascar, Antananarivo, Madagascar
| | - Francis Delpeyroux
- Unité de Biologie des Virus Entériques, Institut Pasteur, Paris, France
- Institut National de la Santé et de la Recherche Médicale, Paris, France
- WHO Collaborating Center for Research on Enteroviruses and Viral Vaccines, Institut Pasteur, Paris, France
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Messacar K, Burakoff A, Nix WA, Rogers S, Oberste MS, Gerber SI, Spence-Davizon E, Herlihy R, Dominguez SR. Notes from the Field: Enterovirus A71 Neurologic Disease in Children - Colorado, 2018. MMWR-MORBIDITY AND MORTALITY WEEKLY REPORT 2018; 67:1017-1018. [PMID: 30212441 PMCID: PMC6146947 DOI: 10.15585/mmwr.mm6736a5] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Sioofy-Khojine AB, Oikarinen S, Honkanen H, Huhtala H, Lehtonen JP, Briese T, Hyöty H. Molecular epidemiology of enteroviruses in young children at increased risk of type 1 diabetes. PLoS One 2018; 13:e0201959. [PMID: 30192755 PMCID: PMC6128458 DOI: 10.1371/journal.pone.0201959] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 07/25/2018] [Indexed: 12/15/2022] Open
Abstract
Background Young children are susceptible to enterovirus (EV) infections, which cause significant morbidity in this age group. However, the current knowledge regarding the epidemiology of EVs and the circulating virus strains is mostly based on viruses detected in children with severe diseases leading to contact with the health care system, while the vast reservoir of EVs that circulate in the general population is less characterized. Methodology The present study investigates the types and the prevalence of EVs circulating in the young children of the background population in Georgia, Colorado, and Washington State in the USA, and Germany, Sweden, and Finland in Europe. A total of 4018 stool samples, collected monthly from 300 healthy and non-hospitalized children at the age of 3–18 months in 2005–2009, were analyzed for the presence of EVs using RT-PCR, followed by sequencing of the VP1-2A region of the viral genome to type the EV(s) present. All of the children carried type HLA-DQ2 or -DQ8 alleles associated with type 1 diabetes. Principal findings Altogether 201 children (67%) were found to be EV positive. The prevalence was much lower in Finnish children (26%) than in the children of the other counties combined (75%). Infections increased by age and showed a nadir during the winter months. Children who carried both the HLA-DQ2 and -DQ8 alleles had less infections than children who were homozygous for these alleles. Coxsackieviruses type A were the most frequently detected viruses in all geographical regions. Coxsackievirus type A4, Echovirus type 18, and Echovirus type 25 were shed for longer time periods than the other EV types. Conclusions Compared to prevalence data from symptomatic patients requiring medical attention, this study provides a better view of EVs circulating in young children in the USA and in Europe. The observations may prove useful for the selection of strategies for designing EV vaccines in the future. The study also confirms our previous serological findings suggesting that EV infections are relatively rare in Finland.
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Affiliation(s)
- Amir-Babak Sioofy-Khojine
- Department of Virology, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
- * E-mail:
| | - Sami Oikarinen
- Department of Virology, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
- Fimlab Laboratories, Pirkanmaa Hospital District, Tampere, Finland
| | - Hanna Honkanen
- Department of Virology, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, University of Tampere, Tampere, Finland
| | - Jussi P. Lehtonen
- Department of Virology, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
| | - Thomas Briese
- Center for Infection and Immunity, Mailman School of Public Health, Columbia University, New York, New York
| | - Heikki Hyöty
- Department of Virology, Faculty of Medicine and Life Sciences, University of Tampere, Tampere, Finland
- Fimlab Laboratories, Pirkanmaa Hospital District, Tampere, Finland
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Genetic characteristics of the P1 coding region of Coxsackievirus A16 associated with hand, foot, and mouth disease in China. Mol Biol Rep 2018; 45:1947-1955. [PMID: 30182173 DOI: 10.1007/s11033-018-4345-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 08/29/2018] [Indexed: 01/04/2023]
Abstract
Coxsackievirus A16 (CVA16) is one of the major etiological agents of hand, foot, and mouth disease (HFMD) in young children. To investigate the genetic characteristics of the P1 coding region gene of CVA16 associated with HFMD in China, we included the sequences of CVA16 specimens obtained from outbreak investigations and sporadic HFMD cases between 1998 and 2014 in China from GenBank, we genotyped the CVA16 sequences and analyzed P1 coding region sequences that encode structural proteins with bioinformatics software. CVA16 was classified into genotypes A and B1 based on the VP1 gene; the B1b and B1a subgenotypes were the major CVA16 strains and predominated in the coastal areas of China. Four strains were found to show inter- and intra-typic recombination in the P1 region. The amino acid identities of VP1, VP2, VP3, and VP4 proteins in all Chinese CVA16 strains were 88.2-100%, 83.0-100%, 87.6-100%, and 72.4-100%, respectively. A total of 251 amino acid substitution sites were detected in the structural proteins encoded by the P1 coding region gene. The amino acid sequences of the P1 coding region in Chinese CVA16 strains were highly conserved, although some amino acid mutations occurred with high frequency: VP1-T11A (10%), N14S (14%), L23M/V (11%), T98M (16%), V107A (14%), N102D (6.1%), E145V (8.8%), N218D (10%), E241K (22%), T248A/I (6.8%); VP2-I217V (22%), T226A (38%); VP3-N141S/G (5.4%), and N240D (15%). The genetic characteristics of CVA16 in the P1 coding region gene may provide a basis for developing a CVA16 vaccine and preventing and controlling HFMD in China.
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236
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Sousa IP, Burlandy FM, Lima STS, Maximo ACB, Figueiredo MAA, Maia Z, da Silva EE. Echovirus 30 detection in an outbreak of acute myalgia and rhabdomyolysis, Brazil 2016-2017. Clin Microbiol Infect 2018; 25:252.e5-252.e8. [PMID: 30149136 DOI: 10.1016/j.cmi.2018.08.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 08/15/2018] [Accepted: 08/17/2018] [Indexed: 01/04/2023]
Abstract
OBJECTIVES To describe an outbreak of acute myalgia accompanied by elevated levels of muscle enzymes that occurred in the northeast region of Brazil from December 2016 through to May 2017. METHODS Clinical data were analysed and laboratory tests were performed in 86 specimens obtained from 52 individuals with suspected acute myalgia. A broader reactive enterovirus real-time RT-PCR followed by a semi-nested PCR amplification of partial VP1 gene were performed to identify the causative agent. RESULTS Eighty-six clinical samples were received in our laboratory during the myalgia outbreak. Median age of individuals was 39 years. Sudden acute myalgia and dark urine were the most common symptoms. Creatine phosphokinase levels were elevated with mean value ∼16 893 U/L. Human enterovirus was detected in 67% (58/86) of the patient's specimens (urine, serum, faeces and rectal swab). The enterovirus positivity per patient was 82.7% (43/52). Echovirus 30 (E-30) (82% of the typed specimens, 18/22; 76.4% (13/17) of the typed specimens per patient) was the main enterovirus identified. In addition to E-30, CV-A16 (1/22) and E-6 (3/22) were detected in 4% and 14% of the typed specimens, respectively. No deaths occurred. CONCLUSION The 2016-2017 outbreak of acute myalgia that occurred in the northeast region of Brazil can be associated with E-30. Despite the clinical manifestations, a favourable outcome was observed for all patients.
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Affiliation(s)
- I P Sousa
- Instituto Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - S T S Lima
- Laboratório Central de Saúde Pública do Ceará, Ceará, Brazil
| | - A C B Maximo
- Laboratório Central de Saúde Pública do Ceará, Ceará, Brazil
| | - M A A Figueiredo
- Divisão de Vigilância Epidemiológica do Estado da Bahia, Bahia, Brazil
| | - Z Maia
- Laboratório Central de Saúde Pública Prof. Gonçalo Muniz, Bahia, Brazil
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Sousa IP, Burlandy FM, Costa EV, Tavares FN, da Silva EE. Enteroviruses associated with hand, foot, and mouth disease in Brazil. J Infect 2018; 77:448-454. [PMID: 30149028 DOI: 10.1016/j.jinf.2018.08.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Accepted: 08/19/2018] [Indexed: 11/15/2022]
Affiliation(s)
- Ivanildo P Sousa
- Laboratório de Enterovírus, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Fernanda M Burlandy
- Laboratório de Enterovírus, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Eliane V Costa
- Laboratório de Enterovírus, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Fernando N Tavares
- Laboratório de Enterovírus, Seção de Virologia, Instituto Evandro Chagas, Ananindeua/PA, Brazil
| | - Edson E da Silva
- Laboratório de Enterovírus, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
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Li J, Zhu R, Huo D, Du Y, Yan Y, Liang Z, Luo Y, Yang Y, Jia L, Chen L, Wang Q, He Y. An outbreak of Coxsackievirus A6-associated hand, foot, and mouth disease in a kindergarten in Beijing in 2015. BMC Pediatr 2018; 18:277. [PMID: 30131060 PMCID: PMC6103857 DOI: 10.1186/s12887-018-1253-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 08/13/2018] [Indexed: 12/13/2022] Open
Abstract
Background Coxsackievirus A6 (CVA6) is one of the major agents to cause hand, foot and mouth disease (HFMD) outbreaks globally. The objective of this study is to investigate the epidemiologic and clinical manifestations of CVA6 outbreak, and thus guide the diagnosis and treatment of the disease, as well as disease prevention. Methods An HFMD outbreak in a kindergarten was reported to Shijingshan District Center for Disease Control and Prevention (SCDC) on November 2, 2015 in Beijing, China. Epidemiological investigation was conducted. We performed a nine-week follow-up study to collect and analyze the clinical manifestations of HFMD cases. Results The outbreak yield 56 (15.7%) clinical diagnosed HFMD cases out of 357 registered children in the kindergarten with the mean age of 3.5 years old. This outbreak lasted for three days and ceased after initiating infectious disease controlling procedures, including periodical suspension of the kindergarten activities, environmental disinfection, and family health education. Fifty-one cases were followed for nine weeks. The positive rate of clinical manifestations of rash, fever, desquamation, pigmentation and onychomadesis were 100.0%, 84.3%, 68.6%, 17.6% and 43.1%, respectively. Children developed desquamation within the first 4 weeks after disease onset and developed onychomadesis between the 3th and 8th week after disease onset. Children with desquamation had 9.3 (95%CI: 1.836–47.437) times higher odds of developing onychomadesis compared to those without this manifestation. Ten out of 14 collected samples were CVA6 positive, and five positive samples shared a high degree of similarity in the VP1 nucleotide and amino acid sequences (99.9–100.0% and 100%). Conclusion This HFMD outbreak was caused by CVA6, featured with delayed symptoms. Emerging CVA6-associated HFMD and its delayed symptoms should be paid more attention to reduce outbreaks and provide more information to doctors and parents. Electronic supplementary material The online version of this article (10.1186/s12887-018-1253-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jie Li
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, No. 10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, People's Republic of China.,Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, No.16, Hepingli Middle Street, Beijing, 100013, People's Republic of China
| | - Rong Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, No. 10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, People's Republic of China
| | - Da Huo
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, No.16, Hepingli Middle Street, Beijing, 100013, People's Republic of China
| | - Yiwei Du
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, No.16, Hepingli Middle Street, Beijing, 100013, People's Republic of China
| | - Yuxiang Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, No. 10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, People's Republic of China
| | - Zhichao Liang
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, No.16, Hepingli Middle Street, Beijing, 100013, People's Republic of China
| | - Yanxia Luo
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, No. 10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, People's Republic of China
| | - Yang Yang
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, No.16, Hepingli Middle Street, Beijing, 100013, People's Republic of China
| | - Lei Jia
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, No.16, Hepingli Middle Street, Beijing, 100013, People's Republic of China
| | - Lijuan Chen
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, No.16, Hepingli Middle Street, Beijing, 100013, People's Republic of China
| | - Quanyi Wang
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, No.16, Hepingli Middle Street, Beijing, 100013, People's Republic of China.
| | - Yan He
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, No. 10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, People's Republic of China.
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239
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Molecular characterization of echovirus 12 strains isolated from healthy children in China. Sci Rep 2018; 8:11716. [PMID: 30082917 PMCID: PMC6078983 DOI: 10.1038/s41598-018-30250-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 07/25/2018] [Indexed: 12/26/2022] Open
Abstract
Human echovirus 12 (E-12) belongs to the enterovirus B species. To date, only one full-length genome sequence of E-12 (prototype strain Travis) is available in the GenBank database. This study determined the complete sequence of three E-12 strains, which were isolated from the stools of three healthy children in Yunnan, China, in 2013. We revealed that the three Yunnan E-12 strains had only 80.8-80.9% nucleotide identity and 96.4-96.8% amino acid identity with the Travis strain based on pairwise comparisons of the complete genome nucleotide and amino acid sequences. The three Yunnan strains shared 99.7% nucleotide identity and 99.1-99.5% amino acid similarity. Phylogenetic and similarity plot analyses showed that intertypic recombination occurred in the non-structural regions of the three Yunnan E-12 strains. This is the first report of the complete genome sequence of E-12 in China and it enriches the complete genome sequences of E-12 in the GenBank database.
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240
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Zhao Y, Zhang H, Liu H, Zhang J, He L, Sun H, Huang X, Yang Z, Ma S. Molecular characteristics of hand, foot, and mouth disease for hospitalized pediatric patients in Yunnan, China. Medicine (Baltimore) 2018; 97:e11610. [PMID: 30075535 PMCID: PMC6081097 DOI: 10.1097/md.0000000000011610] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 06/28/2018] [Indexed: 12/29/2022] Open
Abstract
Hand, foot, and mouth disease (HFMD) is a common infectious disease caused by multiple enteroviruses (EVs) in China. To better define the etiologic agents and clinical characteristics of HFMD, we conducted this study in Yunnan, China.In this study, 1280 stool specimens were collected from pediatric patients hospitalized for treatment of HFMD in 2010. EV was detected with nested reverse transcription polymerase chain reaction and directly genotyped by gene sequencing of the viral protein 1 (VP1) region. Phylogenetic analysis was performed based on the VP1 partial gene and the clinical characteristics were analyzed using SPSS Software.Of 1280 specimens, 1115 (87.1%) tested positive for EV. Seventeen different EV serotypes were detected. Coxsackievirus A16 (CA16) was the most frequently detected serotype (615/1115 cases, 55.1%), followed by enterovirus 71 (EV71; 392/1115, 35.2%), CA10 (45/1115, 4.0%), and CA4 (23/1115, 2.1%). Among the 709 severe cases, CA16, EV71, CA10, and CA4 accounted for 48.0%, 42.0%, 3.5%, and 2.3%, respectively. Of the 26 critical cases, 13 were caused by EV71, 9 by CA16, 2 by CA4, and 1 each were the result of CA10 and E9, respectively. All EV71, CA16, CA10, and CA4 isolates were highly homologous to the strains isolated from mainland China, and belonged to the C4a, B1a, G, and C genotypes, respectively.Our study showed that EV71 and CA16 were the main causative agents for severe and critical HFMD, but other serotypes can also cause severe and critical cases.
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Affiliation(s)
- Yilin Zhao
- Institute of Medical Biology, Chinese Academy of Medical Sciences, Peking Union Medical College
- Yunnan Key Laboratory of Vaccine Research Development on Severe Infectious Disease, Kunming, Yunnan, PR China
| | - Haihao Zhang
- Institute of Medical Biology, Chinese Academy of Medical Sciences, Peking Union Medical College
- Yunnan Key Laboratory of Vaccine Research Development on Severe Infectious Disease, Kunming, Yunnan, PR China
| | - Hongbo Liu
- Institute of Medical Biology, Chinese Academy of Medical Sciences, Peking Union Medical College
- Yunnan Key Laboratory of Vaccine Research Development on Severe Infectious Disease, Kunming, Yunnan, PR China
| | - Jie Zhang
- Institute of Medical Biology, Chinese Academy of Medical Sciences, Peking Union Medical College
- Yunnan Key Laboratory of Vaccine Research Development on Severe Infectious Disease, Kunming, Yunnan, PR China
| | - Licun He
- Institute of Medical Biology, Chinese Academy of Medical Sciences, Peking Union Medical College
- Yunnan Key Laboratory of Vaccine Research Development on Severe Infectious Disease, Kunming, Yunnan, PR China
| | - Hao Sun
- Institute of Medical Biology, Chinese Academy of Medical Sciences, Peking Union Medical College
- Yunnan Key Laboratory of Vaccine Research Development on Severe Infectious Disease, Kunming, Yunnan, PR China
| | - Xiaoqin Huang
- Institute of Medical Biology, Chinese Academy of Medical Sciences, Peking Union Medical College
- Yunnan Key Laboratory of Vaccine Research Development on Severe Infectious Disease, Kunming, Yunnan, PR China
| | - Zhaoqing Yang
- Institute of Medical Biology, Chinese Academy of Medical Sciences, Peking Union Medical College
- Yunnan Key Laboratory of Vaccine Research Development on Severe Infectious Disease, Kunming, Yunnan, PR China
| | - Shaohui Ma
- Institute of Medical Biology, Chinese Academy of Medical Sciences, Peking Union Medical College
- Yunnan Key Laboratory of Vaccine Research Development on Severe Infectious Disease, Kunming, Yunnan, PR China
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Characterization of the Genome Sequences of Enterovirus C109 from Two Respiratory Disease Cases in Florida, 2016. Microbiol Resour Announc 2018; 7:MRA00803-18. [PMID: 30533870 PMCID: PMC6211354 DOI: 10.1128/mra.00803-18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 06/26/2018] [Indexed: 12/05/2022] Open
Abstract
The genomic sequences of two enterovirus C109 isolates (EV-C109 USA/FL/2016-21003 and EV-C109 USA/FL/2016-21002) were obtained during two separate case investigations of respiratory disease in two children. This marks the first description of EV-C109 genomes in the United States. The genomic sequences of two enterovirus C109 isolates (EV-C109 USA/FL/2016-21003 and EV-C109 USA/FL/2016-21002) were obtained during two separate case investigations of respiratory disease in two children. This marks the first description of EV-C109 genomes in the United States.
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Yoshitomi H, Ashizuka Y, Ichihara S, Nakamura T, Nakamura A, Kobayashi T, Kajiwara J. Molecular epidemiology of coxsackievirus A6 derived from hand, foot, and mouth disease in Fukuoka between 2013 and 2017. J Med Virol 2018; 90:1712-1719. [PMID: 29981169 DOI: 10.1002/jmv.25250] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 05/29/2018] [Indexed: 01/23/2023]
Abstract
Coxsackievirus (CV)-A6 has been the primary causative agent of hand, foot, and mouth disease (HFMD) in Japan since 2011. In Fukuoka, CV-A6-associated HFMD caused epidemics in 2013, 2015, and 2017. This paper reports the genetic characteristics of the CV-A6 entire viral protein 1 (VP1) derived from patients with HFMD in Fukuoka between 2013 and 2017. CV-A6 was detected in 105 of 280 clinical specimens, and the entire VP1 sequences could be analyzed for 90 of the 105 specimens. Phylogenetic analysis revealed that the CV-A6 strains were classified into clade A and subgrouped into subclade A3 or subclade A4. Each subclade strain carried amino acid substitutions in the presumed DE and GH loops of the VP1, and no amino acid substitutions were identified as deleterious to the protein function. No significant difference was found in the clinical symptoms between the genetic subclades using statistical analyses. In conclusion, this study clarified the genetic diversity of CV-A6 in Fukuoka from 2013 to 2017. The emergence of the CV-A6 strains was classified into derived new subclades based on phylogenetic analysis of the VP1 gene that may cause CV-A6-associated HFMD epidemics approximately every 2 years.
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Affiliation(s)
- Hideaki Yoshitomi
- Division of Virus, Fukuoka Institute of Health and Environmental Sciences, Fukuoka, Japan
| | - Yuki Ashizuka
- Division of Virus, Fukuoka Institute of Health and Environmental Sciences, Fukuoka, Japan
| | - Sachiko Ichihara
- Division of Research Planning and Information Science, Fukuoka Institute of Health and Environmental Sciences, Fukuoka, Japan
| | - Tomofumi Nakamura
- Research Department, The Research Foundation for Microbial Diseases of Osaka University (BIKEN), Kagawa, Japan
| | - Asako Nakamura
- Division of Virus, Fukuoka Institute of Health and Environmental Sciences, Fukuoka, Japan
| | - Takayuki Kobayashi
- Division of Virus, Fukuoka Institute of Health and Environmental Sciences, Fukuoka, Japan
| | - Junboku Kajiwara
- Division of Virus, Fukuoka Institute of Health and Environmental Sciences, Fukuoka, Japan
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The emergence and spread of one Coxsackievirus A16 Genogroup D novel recombinant strain that caused a clustering HFMD outbreak in Shanghai, China, 2016. Emerg Microbes Infect 2018; 7:131. [PMID: 30022051 PMCID: PMC6052075 DOI: 10.1038/s41426-018-0134-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 05/29/2018] [Accepted: 06/09/2018] [Indexed: 01/24/2023]
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244
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Sousa IP, Burlandy FM, Tavares FN, da Silva EE. Enterovirus B74 associated with hand, foot and mouth disease. INFECTION GENETICS AND EVOLUTION 2018; 65:15-17. [PMID: 30017847 DOI: 10.1016/j.meegid.2018.07.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 07/10/2018] [Accepted: 07/10/2018] [Indexed: 11/17/2022]
Abstract
Enterovirus 74 (EV-B74) has been associated with cases of acute flaccid paralysis (AFP) but it is not a commonly found enterovirus. In this work, we present the characterization of an EV-B74 detected from the serum sample of a one-year-old boy presenting with signs and symptoms clinically compatible with hand, foot and mouth disease (HFMD). This is the first report of EV-B74 in Brazil.
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Affiliation(s)
- Ivanildo P Sousa
- Laboratório de Enterovírus, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Fernanda M Burlandy
- Laboratório de Enterovírus, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Fernando N Tavares
- Laboratório de Enterovírus, divisão de virologia, Instituto Evandro Chagas, Belém, Brazil
| | - Edson E da Silva
- Laboratório de Enterovírus, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
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Tsuno K, Miyatake C, Nishijima H, Hotta C, Ogawa T, Asano T. Coxsackievirus B5 Aseptic Meningitis in Infants in Chiba Prefecture, Japan, in 2016. J NIPPON MED SCH 2018; 85:187-190. [DOI: 10.1272/jnms.jnms.2018_85-28] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Kanae Tsuno
- Department of Pediatrics, Nippon Medical School Chiba Hokusoh Hospital
| | - Chiharu Miyatake
- Department of Pediatrics, Nippon Medical School Chiba Hokusoh Hospital
| | - Haruna Nishijima
- Division of Virology, Chiba Prefectural Institute of Public Health
| | - Chiemi Hotta
- Division of Virology, Chiba Prefectural Institute of Public Health
| | - Tomoko Ogawa
- Division of Virology, Chiba Prefectural Institute of Public Health
| | - Takeshi Asano
- Department of Pediatrics, Nippon Medical School Chiba Hokusoh Hospital
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246
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Analysis of enterovirus types in patients with symptoms of aseptic meningitis in 2014 in Shandong, China. Virology 2018; 516:196-201. [PMID: 29407377 DOI: 10.1016/j.virol.2018.01.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 01/10/2018] [Accepted: 01/25/2018] [Indexed: 11/20/2022]
Abstract
We reviewed the epidemiological and clinical characteristics of 927 aseptic meningitis patients in Shandong in 2014, and the phylogeny of predominant enterovirus (EV) types causing this disease was analyzed. A total of 209 patients that were positive for EV were identified by both cell culture and a reverse transcription-seminested PCR in cerebrospinal fluid samples. The positive patients were most likely to be children within 15 years of age, had symptoms such as fever, vomiting and nausea (P< .05). The 209 EV sequences belonged to 11 types, and coxsackievirus B5, echovirus types 6 and 30 were predominant types. VP1 analysis exhibited multiple lineages were co-circulating. The significance of the study could come from the fact that surveillance is important to monitor the prevalence of EV types in population, which shows enterovirus meningitis maintains an important public health problem in China.
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247
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Pennino F, Nardone A, Montuori P, Aurino S, Torre I, Battistone A, Delogu R, Buttinelli G, Fiore S, Amato C, Triassi M. Large-Scale Survey of Human Enteroviruses in Wastewater Treatment Plants of a Metropolitan Area of Southern Italy. FOOD AND ENVIRONMENTAL VIROLOGY 2018; 10:187-192. [PMID: 29248990 DOI: 10.1007/s12560-017-9331-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 12/07/2017] [Indexed: 05/21/2023]
Abstract
Human enteroviruses (HEVs) occur in high concentrations in wastewater and can contaminate receiving environmental waters, constituting a major cause of acute waterborne disease worldwide. In this study, we investigated the relative abundance, occurrence, and seasonal distribution of polio and other enteroviruses at three wastewater treatment plants (WWTPs) in Naples, Southern Italy, from January 2010 to December 2014. Influent and effluent samples from the three WWTPs were collected monthly. One hundred and sixty-one of the 731 wastewater samples collected (22.0%) before and after water treatment were CPE positive on RD cells; while no samples were positive on L20B cells from any WWTPs. Among the 140 non-polio enterovirus isolated from inlet sewage, 69.3% were Coxsackieviruses type B and 30.7% were Echoviruses. Among these, CVB3 and CVB5 were most prevalent, followed by CVB4 and Echo6. The twenty-one samples tested after treatment contained 6 CVB4, 5 CVB3, 3 Echo11, and 2 Echo6; while other serotypes were isolated less frequently. Data on viral detection in treated effluents of WWTPs confirmed the potential environmental contamination by HEVs and could be useful to establish standards for policies on wastewater management.
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Affiliation(s)
- Francesca Pennino
- Department of Public Health, University of Naples "Federico II", Via Sergio Pansini No 5, 80131, Naples, Italy
| | - Antonio Nardone
- Department of Public Health, University of Naples "Federico II", Via Sergio Pansini No 5, 80131, Naples, Italy
| | - Paolo Montuori
- Department of Public Health, University of Naples "Federico II", Via Sergio Pansini No 5, 80131, Naples, Italy.
| | - Sara Aurino
- Department of Public Health, University of Naples "Federico II", Via Sergio Pansini No 5, 80131, Naples, Italy
| | - Ida Torre
- Department of Public Health, University of Naples "Federico II", Via Sergio Pansini No 5, 80131, Naples, Italy
| | - Andrea Battistone
- National Center for the Control and Evaluation of Medicines (CNCF), Istituto Superiore di Sanità, Rome, Italy
| | - Roberto Delogu
- National Center for the Control and Evaluation of Medicines (CNCF), Istituto Superiore di Sanità, Rome, Italy
| | - Gabriele Buttinelli
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Stefano Fiore
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Concetta Amato
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Maria Triassi
- Department of Public Health, University of Naples "Federico II", Via Sergio Pansini No 5, 80131, Naples, Italy
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248
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High frequency of Polio-like Enterovirus C strains with differential clustering of CVA-13 and EV-C99 subgenotypes in a cohort of Malawian children. Arch Virol 2018; 163:2645-2653. [PMID: 29808442 PMCID: PMC6132918 DOI: 10.1007/s00705-018-3878-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 03/08/2018] [Indexed: 01/02/2023]
Abstract
Enteroviruses (EVs) are among the most commonly detected viruses infecting humans worldwide. Although the prevalence of EVs is widely studied, the status of EV prevalence in sub-Saharan Africa remains largely unknown. The objective of our present study was therefore to increase our knowledge on EV circulation in sub-Saharan Africa. We obtained 749 fecal samples from a cross-sectional study conducted on Malawian children aged 6 to 60 months. We tested the samples for the presence of EVs using real time PCR, and typed the positive samples based on partial viral protein 1 (VP1) sequences. A large proportion of the samples was EV positive (89.9%). 12.9% of the typed samples belonged to EV species A (EV-A), 48.6% to species B (EV-B) and 38.5% to species C (EV-C). More than half of the EV-C strains (53%) belonged to subgroup C containing, among others, Poliovirus (PV) 1-3. The serotype most frequently isolated in our study was CVA-13, followed by EV-C99. The strains of CVA-13 showed a vast genetic diversity, possibly representing a new cluster, 'F'. The majority of the EV-C99 strains grouped together as cluster B. In conclusion, this study showed a vast circulation of EVs among Malawian children, with an EV prevalence of 89.9%. Identification of prevalences for species EV-C comparable to our study (38.5%) have only previously been reported in sub-Saharan Africa, and EV-C is rarely found outside of this region. The data found in this study are an important contribution to our current knowledge of EV epidemiology within sub-Saharan Africa.
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249
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Mohanty MC, Madkaikar MR, Desai M, Taur P, Nalavade UP, Sharma DK, Gupta M, Dalvi A, Shabrish S, Kulkarni M, Aluri J, Deshpande JM. Poliovirus Excretion in Children with Primary Immunodeficiency Disorders, India. Emerg Infect Dis 2018; 23:1664-1670. [PMID: 28930011 PMCID: PMC5621533 DOI: 10.3201/eid2310.170724] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Prolonged excretion of poliovirus can occur in immunodeficient patients who receive oral polio vaccine, which may lead to propagation of highly divergent vaccine-derived polioviruses (VDPVs), posing a concern for global polio eradication. This study aimed to estimate the proportion of primary immunodeficient children with enterovirus infection and to identify the long-term polio/nonpolio enterovirus excreters in a tertiary care unit in Mumbai, India. During September 2014–April 2017, 151 patients received diagnoses of primary immunodeficiency (PID). We isolated 8 enteroviruses (3 polioviruses and 5 nonpolio enteroviruses) in cell culture of 105 fecal samples collected from 42 patients. Only 1 patient with severe combined immunodeficiency was identified as a long-term VDPV3 excreter (for 2 years after identification of infection). Our results show that the risk of enterovirus excretion among children in India with PID is low; however, systematic screening is necessary to identify long-term poliovirus excreters until the use of oral polio vaccine is stopped.
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250
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Divergent Pathogenic Properties of Circulating Coxsackievirus A6 Associated with Emerging Hand, Foot, and Mouth Disease. J Virol 2018; 92:JVI.00303-18. [PMID: 29563294 DOI: 10.1128/jvi.00303-18] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/16/2018] [Indexed: 12/18/2022] Open
Abstract
Coxsackievirus A6 (CV-A6) is an emerging pathogen associated with hand, foot, and mouth disease (HFMD). Its genetic characterization and pathogenic properties are largely unknown. Here, we report 39 circulating CV-A6 strains isolated in 2013 from HFMD patients in northeast China. Three major clusters of CV-A6 were identified and related to CV-A6, mostly from Shanghai, indicating that domestic CV-A6 strains were responsible for HFMD emerging in northeast China. Four full-length CV-A6 genomes representing each cluster were sequenced and analyzed further. Bootscanning tests indicated that all four CV-A6-Changchun strains were most likely recombinants between the CV-A6 prototype Gdula and prototype CV-A4 or CV-A4-related viruses, while the recombination pattern was related to, yet distinct from, the strains isolated from other regions of China. Furthermore, different CV-A6 strains showed different capabilities of viral replication, release, and pathogenesis in a mouse model. Further analyses indicated that viral protein 2C contributed to the diverse pathogenic abilities of CV-A6 by causing autophagy and inducing cell death. To our knowledge, this study is the first to report lethal and nonlethal strains of CV-A6 associated with HFMD. The 2C protein region may play a key role in the pathogenicity of CV-A6 strains.IMPORTANCE Hand, foot, and mouth disease (HFMD) is a major and persistent threat to infants and children. Besides the most common pathogens, such as enterovirus A71 (EV-A71) and coxsackievirus A16 (CV-A16), other enteroviruses are increasingly contributing to HFMD. The present study focused on the recently emerged CV-A6 strain. We found that CV-A6 strains isolated in Changchun City in northeast China were associated with domestic origins. These Changchun viruses were novel recombinants of the CV-A6 prototype Gdula and CV-A4. Our results imply that measures to control CV-A6 transmission are urgently needed. Further analyses revealed differing pathogenicities in strains isolated in a neonatal mouse model. One of the possible causes has been narrowed down to the viral protein 2C, using phylogenetic studies, viral sequences, and direct tests on cultured human cells. Thus, the viral 2C protein is a promising target for antiviral drugs to prevent CV-A6-induced tissue damage.
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