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Kim MJ, Lee JE, Kim KG, Park DW, Cho SJ, Kim TS, Kee HY, Kim SH, Park HJ, Seo MH, Chung JK, Seo JJ. Long-term sentinel surveillance of enteroviruses in Gwangju, South Korea, 2011-2020. Sci Rep 2023; 13:2798. [PMID: 36797345 PMCID: PMC9933826 DOI: 10.1038/s41598-023-29461-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 02/06/2023] [Indexed: 02/18/2023] Open
Abstract
Human enteroviruses (EVs) are associated with a broad spectrum of diseases. To understand EV epidemiology, we present longitudinal data reflecting changing EV prevalence patterns in South Korea. We collected 7160 specimens from patients with suspected EV infections in ten hospitals in Gwangju, Korea during 2011-2020. RNA extraction and real-time reverse transcription polymerase chain reaction using EV-specific probes and primers were performed. EV genotyping and phylogenetic analysis were performed; EVs were detected in 3076 samples (43.0%), and the annual EV detection rate varied. EV infection rates did not differ with sex, and children aged ≤ 4 years were the most prone to EV infection; this trend did not change over time. Overall, 35 different EV types belonging to four distinctive species and rhinoviruses were identified. Although serotype distribution changed annually, the most frequently observed EVs were EV-A71 (13.1% of the cases), CVA6 (8.3%), CVB5 (7.6%), CVA16 (7.6%), CVA10 (7.5%), E18 (7.5%), E30 (7.0%), and E11 (5.0%) during 2011-2020. The predominant EV genotypes by clinical manifestation were CVB5 for aseptic meningitis; EV-A71 for hand, foot, and mouth disease cases; and CVA10 for herpangina. These results will aid the development of vaccines against EV infection and allow comprehensive disease control.
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Affiliation(s)
- Min Ji Kim
- Department of Infectious Disease Research, Health & Environment Research Institute of Gwangju, 584 Mujin-Daero, Seogu, Gwangju, Republic of Korea, 61954.
| | - Ji-eun Lee
- Department of Infectious Disease Research, Health & Environment Research Institute of Gwangju, 584 Mujin-Daero, Seogu, Gwangju, Republic of Korea 61954
| | - Kwang gon Kim
- Department of Infectious Disease Research, Health & Environment Research Institute of Gwangju, 584 Mujin-Daero, Seogu, Gwangju, Republic of Korea 61954
| | - Duck Woong Park
- Department of Infectious Disease Research, Health & Environment Research Institute of Gwangju, 584 Mujin-Daero, Seogu, Gwangju, Republic of Korea 61954
| | - Sun Ju Cho
- Department of Infectious Disease Research, Health & Environment Research Institute of Gwangju, 584 Mujin-Daero, Seogu, Gwangju, Republic of Korea 61954
| | - Tae sun Kim
- Department of Infectious Disease Research, Health & Environment Research Institute of Gwangju, 584 Mujin-Daero, Seogu, Gwangju, Republic of Korea 61954
| | - Hye-young Kee
- Department of Infectious Disease Research, Health & Environment Research Institute of Gwangju, 584 Mujin-Daero, Seogu, Gwangju, Republic of Korea 61954
| | - Sun-Hee Kim
- Department of Infectious Disease Research, Health & Environment Research Institute of Gwangju, 584 Mujin-Daero, Seogu, Gwangju, Republic of Korea 61954
| | - Hye jung Park
- Department of Infectious Disease Research, Health & Environment Research Institute of Gwangju, 584 Mujin-Daero, Seogu, Gwangju, Republic of Korea 61954
| | - Mi Hee Seo
- Department of Infectious Disease Research, Health & Environment Research Institute of Gwangju, 584 Mujin-Daero, Seogu, Gwangju, Republic of Korea 61954
| | - Jae Keun Chung
- Department of Infectious Disease Research, Health & Environment Research Institute of Gwangju, 584 Mujin-Daero, Seogu, Gwangju, Republic of Korea 61954
| | - Jin-jong Seo
- Department of Infectious Disease Research, Health & Environment Research Institute of Gwangju, 584 Mujin-Daero, Seogu, Gwangju, Republic of Korea 61954
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Acute Flaccid Myelitis: Review of Clinical Features, Diagnosis, and Management with Nerve Transfers. Plast Reconstr Surg 2023; 151:85e-98e. [PMID: 36219869 DOI: 10.1097/prs.0000000000009788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
BACKGROUND Acute flaccid myelitis (AFM) is a devastating neurologic condition in children, manifesting as acute limb weakness and/or paralysis. Despite increased awareness of AFM following initiation of U.S. surveillance in 2014, no treatment consensus exists. The purpose of this systematic review was to summarize the most current knowledge regarding AFM epidemiology, cause, clinical features, diagnosis, and supportive and operative management, including nerve transfer. METHODS The authors systematically reviewed the literature based on Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using multiple databases to search the keywords ("acute flaccid myelitis"), ('acute flaccid myelitis'/exp OR 'acute flaccid myelitis'), and (Acute AND flaccid AND myelitis). Included articles reported on (1) AFM diagnosis and (2) patient-specific data regarding epidemiology, cause, clinical features, diagnostic features, or management of AFM. RESULTS Ninety-nine articles were included in this review. The precise cause and pathophysiologic mechanism of AFM remain undetermined, but AFM is strongly associated with nonpolio enterovirus infections. Clinical presentation typically comprises preceding viral prodrome, pleocytosis, spinal cord lesions on T2-weighted magnetic resonance imaging, and acute onset of flaccid weakness/paralysis with hyporeflexia in at least one extremity. Supportive care includes medical therapy and rehabilitation. Early studies of nerve transfer for AFM have shown favorable outcomes for patients with persistent weakness. CONCLUSIONS Supportive care and physical therapy are the foundation of a multidisciplinary approach to managing AFM. For patients with persistent limb weakness, nerve transfer has shown promise for improving function in distal muscle groups. Surgeons must consider potential spontaneous recovery, patient selection, donor nerve availability, recipient nerve appropriateness, and procedure timing.
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Ivanova OE, Shakaryan AK, Morozova NS, Vakulenko YA, Eremeeva TP, Kozlovskaya LI, Baykova OY, Shustova EY, Mikhailova YM, Romanenkova NI, Rozaeva NR, Dzhaparidze NI, Novikova NA, Zverev VV, Golitsyna LN, Lukashev AN. Cases of Acute Flaccid Paralysis Associated with Coxsackievirus A2: Findings of a 20-Year Surveillance in the Russian Federation. Microorganisms 2022; 10:microorganisms10010112. [PMID: 35056561 PMCID: PMC8780984 DOI: 10.3390/microorganisms10010112] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/22/2021] [Accepted: 12/29/2021] [Indexed: 11/16/2022] Open
Abstract
Surveillance for acute flaccid paralysis syndrome (AFP) in children under 15 is the backbone of the Global Polio Eradication Initiative. Laboratory examination of stool samples from AFP cases allows the detection of, along with polioviruses, a variety of non-polio enteroviruses (NPEV). The etiological significance of these viruses in the occurrence of AFP cases has been definitively established only for enteroviruses A71 and D68. Enterovirus Coxsackie A2 (CVA2) is most often associated with vesicular pharyngitis and hand, foot and mouth disease. Among 7280 AFP cases registered in Russia over 20 years (2001–2020), CVA2 was isolated only from five cases. However, these included three children aged 3 to 4 years, without overt immune deficiency, immunized with 4–5 doses of poliovirus vaccine in accordance with the National Vaccination Schedule. The disease resulted in persistent residual paralysis. Clinical and laboratory data corresponded to poliomyelitis developing during poliovirus infection. These findings are compatible with CVA2 being the cause of AFP. Molecular analysis of CVA2 from these patients and a number of AFP cases in other countries did not reveal association with a specific phylogenetic group, suggesting that virus genetics is unlikely to explain the pathogenic profile. The overall results highlight the value of AFP surveillance not just for polio control but for studies of uncommon AFP agents.
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Affiliation(s)
- Olga E. Ivanova
- Federal State Autonomous Scientific Institution “Chumakov Federal Center for Research and Development of Immune-and-Biological Products of the Russian Academy of Sciences” (Institute of Poliomyelitis) (FSASI “Chumakov FSC R&D IBP RAS”), 108819 Moscow, Russia; (A.K.S.); (T.P.E.); (L.I.K.); (O.Y.B.); (E.Y.S.)
- Department of Organization and Technology of Production of Immunobiological Preparations, Institute for Translational Medicine and Biotechnology, First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
- Correspondence: (O.E.I.); (A.N.L.); Tel.: +7-916-677-2403 (O.E.I.); +7-915-160-7489 (A.N.L.)
| | - Armen K. Shakaryan
- Federal State Autonomous Scientific Institution “Chumakov Federal Center for Research and Development of Immune-and-Biological Products of the Russian Academy of Sciences” (Institute of Poliomyelitis) (FSASI “Chumakov FSC R&D IBP RAS”), 108819 Moscow, Russia; (A.K.S.); (T.P.E.); (L.I.K.); (O.Y.B.); (E.Y.S.)
- Pirogov Russian National Research Medical University, 119121 Moscow, Russia
| | - Nadezhda S. Morozova
- Federal Budget Institution of Healthcare of Rospotrebnadzor “Center for Hygiene and Epidemiology in Moscow”, 129626 Moscow, Russia; (N.S.M.); (Y.M.M.)
| | - Yulia A. Vakulenko
- Martsinovsky Institute of Meidcal Parasitology, Tropical and Vector-Borne Diseases, First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia;
| | - Tatyana P. Eremeeva
- Federal State Autonomous Scientific Institution “Chumakov Federal Center for Research and Development of Immune-and-Biological Products of the Russian Academy of Sciences” (Institute of Poliomyelitis) (FSASI “Chumakov FSC R&D IBP RAS”), 108819 Moscow, Russia; (A.K.S.); (T.P.E.); (L.I.K.); (O.Y.B.); (E.Y.S.)
| | - Liubov I. Kozlovskaya
- Federal State Autonomous Scientific Institution “Chumakov Federal Center for Research and Development of Immune-and-Biological Products of the Russian Academy of Sciences” (Institute of Poliomyelitis) (FSASI “Chumakov FSC R&D IBP RAS”), 108819 Moscow, Russia; (A.K.S.); (T.P.E.); (L.I.K.); (O.Y.B.); (E.Y.S.)
- Department of Organization and Technology of Production of Immunobiological Preparations, Institute for Translational Medicine and Biotechnology, First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Olga Y. Baykova
- Federal State Autonomous Scientific Institution “Chumakov Federal Center for Research and Development of Immune-and-Biological Products of the Russian Academy of Sciences” (Institute of Poliomyelitis) (FSASI “Chumakov FSC R&D IBP RAS”), 108819 Moscow, Russia; (A.K.S.); (T.P.E.); (L.I.K.); (O.Y.B.); (E.Y.S.)
| | - Elena Y. Shustova
- Federal State Autonomous Scientific Institution “Chumakov Federal Center for Research and Development of Immune-and-Biological Products of the Russian Academy of Sciences” (Institute of Poliomyelitis) (FSASI “Chumakov FSC R&D IBP RAS”), 108819 Moscow, Russia; (A.K.S.); (T.P.E.); (L.I.K.); (O.Y.B.); (E.Y.S.)
| | - Yulia M. Mikhailova
- Federal Budget Institution of Healthcare of Rospotrebnadzor “Center for Hygiene and Epidemiology in Moscow”, 129626 Moscow, Russia; (N.S.M.); (Y.M.M.)
| | | | - Nadezhda R. Rozaeva
- Saint-Petersburg Pasteur Institute, 197101 Saint-Petersburg, Russia; (N.I.R.); (N.R.R.)
| | - Natela I. Dzhaparidze
- Federal Budgetary Institution of Healthcare of Rospotrebnadzor “Center for Hygiene and Epidemiology in the Vladimir Region”, 600005 Vladimir, Russia;
| | - Nadezhda A. Novikova
- Academician I.N. Blokhina Nizhny Novgorod Scientific Research Institute of Epidemiology and Microbiology, 603950 Nizhny Novgorod, Russia; (N.A.N.); (V.V.Z.); (L.N.G.)
| | - Vladimir V. Zverev
- Academician I.N. Blokhina Nizhny Novgorod Scientific Research Institute of Epidemiology and Microbiology, 603950 Nizhny Novgorod, Russia; (N.A.N.); (V.V.Z.); (L.N.G.)
| | - Lyudmila N. Golitsyna
- Academician I.N. Blokhina Nizhny Novgorod Scientific Research Institute of Epidemiology and Microbiology, 603950 Nizhny Novgorod, Russia; (N.A.N.); (V.V.Z.); (L.N.G.)
| | - Alexander N. Lukashev
- Martsinovsky Institute of Meidcal Parasitology, Tropical and Vector-Borne Diseases, First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia;
- Correspondence: (O.E.I.); (A.N.L.); Tel.: +7-916-677-2403 (O.E.I.); +7-915-160-7489 (A.N.L.)
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Emerging Non-Polio Enteroviruses recognized in the framework of the Acute Flaccid Paralyses (AFP) surveillance system in Northern Italy, 2016-2018. Int J Infect Dis 2021; 106:36-40. [PMID: 33771675 DOI: 10.1016/j.ijid.2021.03.057] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/16/2021] [Accepted: 03/18/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Acute Flaccid Paralyses Surveillance (AFPS) monitors the emergence of polioviruses and can track Non-Polio Enteroviruses (NPEVs). We report AFPS activity in the Lombardy region (Northern Italy) from 2016 to 2018. METHODS Fecal and respiratory samples were collected from children <15 years who met the WHO definition of an AFP case, analyzed by virus isolation in cell cultures (RD/L20B) and by a one-step real-time RT-PCR assay specific for the 5'-noncoding-region of NPEV. NPEV-positive specimens were further analyzed by sequencing a fragment of the VP1 gene. RESULTS 36 AFP cases (89 stool and 32 respiratory samples) were reported with an incidence of 1.1/100'000, 0.9/100'000, 0.6/100'000 children <15 years in 2016, 2017, 2018, respectively. Poliovirus was not identified, whereas NPEVs were detected in 19.4% (7/36) of AFP cases. The presence of one Echovirus-25 (2016), two EV- and D68 (2016 and 2018), one EV-A71 (2016), and one Echovirus-30 (2016) sharing high nucleotide identity with NPEVs detected in Europe was identified. CONCLUSION The absence of polio was confirmed. The unpredicted detection of emerging EV-D68, EV-A71, and E-30 sharing high sequence nucleotide similarity with viruses involved in the latest outbreaks, provided valuable and up-to-date information, emphasizing the importance of monitoring NPEVs through AFPS.
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Non-Polio Enteroviruses from Acute Flaccid Paralysis Surveillance in Korea, 2012-2019. Viruses 2021; 13:v13030411. [PMID: 33807557 PMCID: PMC8001888 DOI: 10.3390/v13030411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/27/2021] [Accepted: 03/02/2021] [Indexed: 12/18/2022] Open
Abstract
The risk of polio importation and re-emergence persists since epidemic polio still occurs in some countries, and the resurgence of polio occurring almost 20 years after polio eradication was declared in Asia has been reported. We analyzed the results of acute flaccid paralysis (AFP) surveillance in Korea to assess the quality of AFP surveillance and understand the etiology of non-polio enterovirus (NPEV)-associated central nervous system diseases in a polio-free area. We investigated 637 AFP patients under 15 years of age whose cases were confirmed during 2012–2019 by virus isolation, real-time reverse transcription polymerase chain reaction, and VP1 gene sequencing. Among the 637 AFP cases, NPEV was detected in 213 (33.4%) patients, with the majority observed in EV-A71, with 54.9% of NPEV positives. EV-A71 has been shown to play a role as a major causative agent in most neurological diseases except for Guillain-Barré syndrome (GBS), acute disseminated encephalomyelitis (ADEM), and meningitis. This study provides information on the AFP surveillance situation in Korea and highlights the polio eradication stage in the monitoring and characterization of NPEV against the outbreak of neurological infectious diseases such as polio.
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Suresh S, Rawlinson WD, Andrews PI, Stelzer‐Braid S. Global epidemiology of nonpolio enteroviruses causing severe neurological complications: A systematic review and meta‐analysis. Rev Med Virol 2019; 30:e2082. [DOI: 10.1002/rmv.2082] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 08/21/2019] [Accepted: 08/27/2019] [Indexed: 12/12/2022]
Affiliation(s)
- Sarika Suresh
- Melbourne Medical SchoolUniversity of Melbourne Parkville Australia
- Virology Research LaboratoryPrince of Wales Hospital Randwick Australia
| | - William D. Rawlinson
- Virology Research LaboratoryPrince of Wales Hospital Randwick Australia
- School of Medical Sciences, and School of Women's and Children's Health, Faculty of Medicine, and School of Biotechnology and Biomolecular Sciences, Faculty of ScienceUniversity of New South Wales Sydney Australia
- Serology and Virology Division (SAViD)Microbiology NSW Health Pathology Randwick Australia
| | - Peter Ian Andrews
- School of Medical Sciences, and School of Women's and Children's Health, Faculty of Medicine, and School of Biotechnology and Biomolecular Sciences, Faculty of ScienceUniversity of New South Wales Sydney Australia
- Department of Paediatric NeurologySydney Children's Hospital Randwick Australia
| | - Sacha Stelzer‐Braid
- Virology Research LaboratoryPrince of Wales Hospital Randwick Australia
- School of Medical Sciences, and School of Women's and Children's Health, Faculty of Medicine, and School of Biotechnology and Biomolecular Sciences, Faculty of ScienceUniversity of New South Wales Sydney Australia
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Chen P, Li Y, Tao Z, Wang H, Lin X, Liu Y, Wang S, Zhou N, Wang P, Xu A. Evolutionary phylogeography and transmission pattern of echovirus 14: an exploration of spatiotemporal dynamics based on the 26-year acute flaccid paralysis surveillance in Shandong, China. BMC Genomics 2017; 18:48. [PMID: 28061751 PMCID: PMC5219651 DOI: 10.1186/s12864-016-3418-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 12/13/2016] [Indexed: 02/05/2023] Open
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Wang J, Zhang Y, Zhang X, Hu Y, Dong C, Liu L, Yang E, Che Y, Pu J, Wang X, Song J, Liao Y, Feng M, Liang Y, Zhao T, Jiang L, He Z, Lu S, Wang L, Li Y, Fan S, Guo L, Li Q. Pathologic and immunologic characteristics of coxsackievirus A16 infection in rhesus macaques. Virology 2016; 500:198-208. [PMID: 27829175 DOI: 10.1016/j.virol.2016.10.031] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 10/02/2016] [Accepted: 10/31/2016] [Indexed: 11/26/2022]
Abstract
Coxsackievirus A16 (CV-A16) causes human hand, foot and mouth disease, but its pathogenesis is unclear. In rhesus macaques, CV-A16 infection causes characteristic vesicles in the oral mucosa and limbs as well as viremia and positive viral loads in the tissues, suggesting that these animals reflect the pathologic process of the infection. An immunologic analysis indicated a defective immune response, which included undetectable neutralizing antibodies and IFN-γ-specific memory T-cells in macaques infected with CV-A16. Furthermore, existing neutralizing antibodies in macaques immunized with the inactivated vaccine were surprisingly unable to protect against a viral challenge despite the presence of a positive T-cell memory response against viral antigens. The virus was capable of infecting pre-conventional dendritic cells and replicating within them, which may correlate with the immunological characteristics observed in the animals.
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Affiliation(s)
- Jingjing Wang
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming, Yunnan, China
| | - Ying Zhang
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming, Yunnan, China
| | - Xiaolong Zhang
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming, Yunnan, China
| | - Yajie Hu
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming, Yunnan, China
| | - Chenghong Dong
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming, Yunnan, China
| | - Longding Liu
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming, Yunnan, China
| | - Erxia Yang
- Jiangsu Convac Biotechnology Co., Ltd., Taizhou, Jiangsu, China
| | - Yanchun Che
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming, Yunnan, China
| | - Jing Pu
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming, Yunnan, China
| | - Xi Wang
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming, Yunnan, China
| | - Jie Song
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming, Yunnan, China
| | - Yun Liao
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming, Yunnan, China
| | - Min Feng
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming, Yunnan, China
| | - Yan Liang
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming, Yunnan, China
| | - Ting Zhao
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming, Yunnan, China
| | - Li Jiang
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming, Yunnan, China; Jiangsu Convac Biotechnology Co., Ltd., Taizhou, Jiangsu, China
| | - Zhanlong He
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming, Yunnan, China
| | - Shuaiyao Lu
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming, Yunnan, China
| | - Lichun Wang
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming, Yunnan, China
| | - Yanyan Li
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming, Yunnan, China
| | - Shengtao Fan
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming, Yunnan, China
| | - Lei Guo
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming, Yunnan, China
| | - Qihan Li
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming, Yunnan, China.
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Kim HJ, Hyeon JY, Hwang S, Lee YP, Lee SW, Yoo JS, Kang B, Ahn JB, Jeong YS, Lee JW. Epidemiology and virologic investigation of human enterovirus 71 infection in the Republic of Korea from 2007 to 2012: a nationwide cross-sectional study. BMC Infect Dis 2016; 16:425. [PMID: 27538397 PMCID: PMC4989503 DOI: 10.1186/s12879-016-1755-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 08/04/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Enterovirus (EV) 71 is the main pathogen associated with hand, foot and mouth disease (HFMD) or herpangina. Outbreaks of HFMD caused by EV71 infection are associated severe neurological disease and high mortality rates in children. Several sporadic cases of EV71 infection occurred in the Republic of Korea (ROK) in 2000, and EV71 infections were not reported thereafter until 2006. In this prospective study, we report the epidemic and virologic characteristics of the EV71 endemic from 2007 to 2012 in the Republic of Korea. METHODS We analyzed characteristics of the EV71 infection-associated epidemic from collected specimens and clinical information from 9987 patients with suspected EV infection from the National EV Surveillance System in ROK. To identify the EV71 subgenotype, the homology of viral protein 1 sequences obtained using reverse transcription polymerase chain reaction was compared with the sequences on other countries available from GenBank database. RESULTS EV71 was detected in 585 (16.7 %) specimens (cerebrospinal fluid, stool or rectal swabs, throat swabs and blood) during study period and was most frequently observed during epidemic seasons in 2009-2012. Major manifestations due to EV71 infection were HFMD (62.2 %) and HFMD with severe neurological complications (28.4 %). Five deaths (0.9 %) due to EV71 infection occurred, with an increased mortality rate during the period after 2009. Most patients (476; 81.4 %) were less than 5 years of age. Analysis of the monthly distribution showed that there was an obvious seasonal pattern to the epidemics, with infections appearing from June to August. The major subgenotype of EV71 isolates circulating in ROK was the C4a strain, which has also appeared in China, Japan and Vietnam. CONCLUSIONS This surveillance provided valuable data on the epidemic characteristics of EV71 infections in ROK during a 6-year period. Our findings provide data to assist during future outbreaks of EV71 and associated acute neurologic disease.
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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, 363-951, Republic of 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, 363-951, Republic of Korea
| | - Seoyeon Hwang
- 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, 363-951, Republic of Korea
| | - Yong-Pyo 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, 363-951, Republic of Korea
| | - Sang Won 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, 363-951, Republic of Korea
| | - 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, 363-951, Republic of Korea
| | - Byunghak Kang
- 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, 363-951, Republic of Korea
| | - Jeong-Bae Ahn
- 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, 363-951, Republic of Korea
| | - Yong-Seok Jeong
- Department of Biology Graduate School, Kyung Hee University, Seoul, Dongdaemun-gu, 130-701, Republic of 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, 363-951, Republic of Korea.
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Ho BC, Yang PC, Yu SL. MicroRNA and Pathogenesis of Enterovirus Infection. Viruses 2016; 8:v8010011. [PMID: 26751468 PMCID: PMC4728571 DOI: 10.3390/v8010011] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Revised: 12/04/2015] [Accepted: 12/18/2015] [Indexed: 12/15/2022] Open
Abstract
There are no currently available specific antiviral therapies for non-polio Enterovirus infections. Although several vaccines have entered clinical trials, the efficacy requires further evaluation, particularly for cross-strain protective activity. Curing patients with viral infections is a public health problem due to antigen alterations and drug resistance caused by the high genomic mutation rate. To conquer these limits in the development of anti-Enterovirus treatments, a comprehensive understanding of the interactions between Enterovirus and host cells is urgently needed. MicroRNA (miRNA) constitutes the biggest family of gene regulators in mammalian cells and regulates almost a half of all human genes. The roles of miRNAs in Enterovirus pathogenesis have recently begun to be noted. In this review, we shed light on recent advances in the understanding of Enterovirus infection-modulated miRNAs. The impacts of altered host miRNAs on cellular processes, including immune escape, apoptosis, signal transduction, shutdown of host protein synthesis and viral replication, are discussed. Finally, miRNA-based medication provides a promising strategy for the development of antiviral therapy.
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Affiliation(s)
- Bing-Ching Ho
- Department of Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan University, No. 1 Chang-Te Street, Taipei 10048, Taiwan.
- Center of Genomic Medicine, National Taiwan University, Taipei 10048, Taiwan.
| | - Pan-Chyr Yang
- Center of Genomic Medicine, National Taiwan University, Taipei 10048, Taiwan.
- Department of Internal Medicine, National Taiwan University Hospital, Taipei 10048, Taiwan.
- Institute of Biomedical Sciences, Academia Sinica, Taipei 10048, Taiwan.
| | - Sung-Liang Yu
- Department of Clinical Laboratory Sciences and Medical Biotechnology, College of Medicine, National Taiwan University, No. 1 Chang-Te Street, Taipei 10048, Taiwan.
- Center of Genomic Medicine, National Taiwan University, Taipei 10048, Taiwan.
- Center for Optoelectronic Biomedicine, College of Medicine, National Taiwan University, Taipei 10048, Taiwan.
- Graduate Institute of Pathology, College of Medicine, National Taiwan University, Taipei 10048, Taiwan.
- Department of Laboratory Medicine, National Taiwan University Hospital, Taipei 10048, Taiwan.
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11
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Neurotropic Enterovirus Infections in the Central Nervous System. Viruses 2015; 7:6051-66. [PMID: 26610549 PMCID: PMC4664993 DOI: 10.3390/v7112920] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 11/06/2015] [Accepted: 11/13/2015] [Indexed: 02/03/2023] Open
Abstract
Enteroviruses are a group of positive-sense single stranded viruses that belong to the Picornaviridae family. Most enteroviruses infect humans from the gastrointestinal tract and cause mild symptoms. However, several enteroviruses can invade the central nervous system (CNS) and result in various neurological symptoms that are correlated to mortality associated with enteroviral infections. In recent years, large outbreaks of enteroviruses occurred worldwide. Therefore, these neurotropic enteroviruses have been deemed as re-emerging pathogens. Although these viruses are becoming large threats to public health, our understanding of these viruses, especially for non-polio enteroviruses, is limited. In this article, we review recent advances in the trafficking of these pathogens from the peripheral to the central nervous system, compare their cell tropism, and discuss the effects of viral infections in their host neuronal cells.
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12
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Schuster JE, Newland JG. Management of the 2014 Enterovirus 68 Outbreak at a Pediatric Tertiary Care Center. Clin Ther 2015; 37:2411-8. [PMID: 26602757 DOI: 10.1016/j.clinthera.2015.06.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 06/24/2015] [Indexed: 11/15/2022]
Abstract
PURPOSE Enterovirus 68 (EV-D68) is an uncommonly recognized cause of acute respiratory tract infections. During the late summer of 2014, an international EV-D68 outbreak occurred. We review the steps of outbreak recognition and management in the context of 1 hospital's experience with the EV-D68 outbreak. METHODS We reviewed the role of Children's Mercy Hospital as one of the first hospitals to recognize the 2014 EV-D68 outbreak in the United States. The steps of outbreak management were applied to real-life examples as the outbreak unfolded at our hospital. FINDINGS Management of the 2014 EV-D68 outbreak was a multifaceted effort requiring close coordination with hospitals, local and state health departments, and the Centers for Disease Control and Prevention. The importance of clear and frequent communication is highlighted both intra- and interinstitutionally. Increased respiratory disease-related pediatric admissions at hospitals nationally were attributed to EV-D68. Outcomes for these children, including the association of EV-D68 with acute flaccid myelitis, remain under investigation. IMPLICATIONS Following the steps of outbreak management is critical to providing optimal patient care and ensuring the health of the public. During the 2014 EV-D68 outbreak, close adherence to outbreak principles led to swift recognition of illness, rapid diagnostic measures, institution of appropriate therapies, and dissemination of information to health care providers and the public. Equally important was the subsequent identification of an increase in acute flaccid myelitis cases against the backdrop of an increase in EV-D68 detections nationally. Future prospective studies are needed to determine the true burden of EV-D68 disease, potential vaccines and therapeutics, and outcomes of children with EV-D68 infection.
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Affiliation(s)
| | - Jason G Newland
- Department of Pediatrics, Children's Mercy Hospital, Kansas City, Missouri
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13
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Kim HJ, Hwang S, Lee S, Kwon Y, Park K, Park YJ, Bae GR, Lee SW, Jeong YS, Hyeon JY. A national cross-sectional study for poliovirus seroprevalence in the Republic of Korea in 2012: implication for deficiency in immunity to polio among middle-aged people. BMC Infect Dis 2015; 15:164. [PMID: 25881203 PMCID: PMC4391131 DOI: 10.1186/s12879-015-0894-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 03/12/2015] [Indexed: 11/10/2022] Open
Abstract
Background A worldwide poliomyelitis eradication program was initiated in 1988; however, strains of wild poliovirus (WPV) are still endemic in some countries. Until WPV transmission is eradicated globally, importation and outbreaks of WPV are alarming possibilities. This study is the first report to document the polio immunity after 2004, when an inactivated polio vaccine (IPV) was introduced in the Republic of Korea. Methods A total of 745 serum samples from randomly selected patients ranging from 6 to 84 years of age were used for neutralization tests, performed in the World Health Organization polio national reference laboratory. Results Among the 745 tested sera, 439 (58.9%) were seropositive and 19 (2.6%) were seronegative to all PV serotypes. In all age groups, PV3 showed the lowest level of seroprevalence, at 509 cases (68.3%), compared to 616 (82.7%) for PV1 and 685 (91.9%) for PV2. In the 6–10-year age group, which included IPV-immunized children, the highest seropositive rate was observed and the difference in seroprevalence between PV3 and other serotypes was the lowest compared to the other age groups immunized with oral PV vaccines (OPV). In addition, the seronegative rates of all three PV types in children aged 6–10 in this study were found to be lower than those in OPV-immunized children reported in a previous study from the Republic of Korea. Meanwhile, middle-aged subjects (41–60 years) had the lowest seroprevalence and geometric mean titer. Conclusions This study indicates a deficiency in immunity to PV in middle-aged individuals, and low seroprevalence to PV3 in all age groups. In addition, due to the ongoing risk of importing PV, middle-aged people should consider PV vaccination before visiting a PV-endemic country. Our findings provide data to assist those involved in deciding future national polio vaccination strategies for the maintenance of a polio-free status in Korea.
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Affiliation(s)
- Hye-Jin Kim
- WHO Polio National Reference Laboratory, 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, 363-951, Republic of Korea. .,Department of Biology Graduate School, Kyung Hee University, Seoul, Dongdaemon-gu, 130-701, Republic of Korea.
| | - Seoyeon Hwang
- WHO Polio National Reference Laboratory, 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, 363-951, Republic of Korea.
| | - Somin Lee
- WHO Polio National Reference Laboratory, 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, 363-951, Republic of Korea.
| | - Yunhyung Kwon
- Division of Vaccine Preventable Disease Control and Prevention, Center for Infectious Diseases Control, Korea Centers for Disease Control and Prevention, Osong-eup, Cheongju, Chungcheongbuk-do, 363-951, Republic of Korea. .,Current Address: Division of HIV/AIDS and TB Control, Center for Infectious Diseases Control, Korea Centers for Disease Control and Prevention, Osong-eup, Cheongju, Chungcheongbuk-do, 363-951, Republic of Korea.
| | - Kwangsook Park
- Division of Vaccine Preventable Disease Control and Prevention, Center for Infectious Diseases Control, Korea Centers for Disease Control and Prevention, Osong-eup, Cheongju, Chungcheongbuk-do, 363-951, Republic of Korea.
| | - Young Joon Park
- Division of Vaccine Preventable Disease Control and Prevention, Center for Infectious Diseases Control, Korea Centers for Disease Control and Prevention, Osong-eup, Cheongju, Chungcheongbuk-do, 363-951, Republic of Korea.
| | - Geun-Ryang Bae
- Division of Vaccine Preventable Disease Control and Prevention, Center for Infectious Diseases Control, Korea Centers for Disease Control and Prevention, Osong-eup, Cheongju, Chungcheongbuk-do, 363-951, Republic of Korea.
| | - Sang Won Lee
- WHO Polio National Reference Laboratory, 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, 363-951, Republic of Korea.
| | - Yong-Seok Jeong
- Department of Biology Graduate School, Kyung Hee University, Seoul, Dongdaemon-gu, 130-701, Republic of Korea.
| | - Ji-Yeon Hyeon
- WHO Polio National Reference Laboratory, 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, 363-951, Republic of Korea.
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