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Chavan NA, Rani VS, Shinde P, Shinde M, Pavani S, Srinath M, Mehreen SF, Reddy PS, Lavania M. Identification of coxsackievirus A-24 GIV C5 strain as the cause of acute hemorrhagic conjunctivitis outbreak in Hyderabad, India in 2022. Heliyon 2024; 10:e32254. [PMID: 38947457 PMCID: PMC11214445 DOI: 10.1016/j.heliyon.2024.e32254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 05/30/2024] [Accepted: 05/30/2024] [Indexed: 07/02/2024] Open
Abstract
Viral infection is frequently the cause for acute hemorrhagic conjunctivitis (AHC) epidemics. AHC can result from adenoviruses, with enterovirus 70 and coxsackievirus A24 being the primary agents. AHC was initially identified in Ghana in 1969, caused by enterovirus 70 and leading to a global pandemic. Since 2000, outbreaks of AHC linked to coxsackievirus A24 variant have been documented in Spain, Pakistan, Singapore, India, Korea, and China. A sudden surge of conjunctivitis cases reported in October 2022 in and out of the Hyderabad region. This infection presented with usual symptoms of redness of the eyes, discharge, pain in the eyes and crusting. Occular swab samples from 110 patients were collected in order to identify and characterize the virus that was causing the epidemic. We examined adenovirus, enterovirus, COVID-19 and Herpes Simplex Virus by using commercially kits available at the hospital. Conserved regions in the enteroviral 5'-UTR and VP2 gene were analyzed further for characterization of serotype at the National apex laboratory. None of them was found positive except Enterovirus in 16.36 % (18/110) of the patients. From enterovirus-positive samples, the coxsackievirus A24 was observed in all 18 positive samples. These clinical isolates constitute a new lineage cluster associated with genotype IV-C5, according to additional sequencing of the full-length VP2 genes and subsequent phylogenetic analysis. In conclusion, the current outbreak of acute haemorrhagic conjunctivitis in Hyderabad, India was traced to the coxsackievirus A24 strain GIV C5.
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Affiliation(s)
- Nutan A. Chavan
- Enteric Viruses Group, ICMR-National Institute of Virology, Pune, Maharashtra, India
| | - Vannavada Sudha Rani
- Viral Research and Diagnostics Laboratory, Department of Microbiology, Osmania Medical College, Koti, Hyderabad, India
| | - Pooja Shinde
- Enteric Viruses Group, ICMR-National Institute of Virology, Pune, Maharashtra, India
| | - Manohar Shinde
- Enteric Viruses Group, ICMR-National Institute of Virology, Pune, Maharashtra, India
| | - Sanka Pavani
- Viral Research and Diagnostics Laboratory, Department of Microbiology, Osmania Medical College, Koti, Hyderabad, India
| | - Mote Srinath
- Viral Research and Diagnostics Laboratory, Department of Microbiology, Osmania Medical College, Koti, Hyderabad, India
| | - Syeda Fakiha Mehreen
- Viral Research and Diagnostics Laboratory, Department of Microbiology, Osmania Medical College, Koti, Hyderabad, India
| | - Palkonda Shashikala Reddy
- Viral Research and Diagnostics Laboratory, Department of Microbiology, Osmania Medical College, Koti, Hyderabad, India
| | - Mallika Lavania
- Enteric Viruses Group, ICMR-National Institute of Virology, Pune, Maharashtra, India
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Mamidi P, Panda S, Ray A, Mohanty M, Mandal MC, Santra D, Moharana B, Nayak B, Chattopadhyay S, Mishra B. Molecular characterization of coxsackievirus A24 variants isolated from an outbreak of acute hemorrhagic conjunctivitis. Indian J Med Microbiol 2024; 49:100601. [PMID: 38705277 DOI: 10.1016/j.ijmmb.2024.100601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 04/27/2024] [Accepted: 04/27/2024] [Indexed: 05/07/2024]
Abstract
PURPOSE Acute Hemorrhagic conjunctivitis (AHC) is associated with CVA24v. Recently there was a severe outbreak of conjunctivitis in months of July and August 2023 in India. This study emphasizes the identification of the distinct mutations in the CVA24v strains, which were isolated during the AHC outbreak and could have potentially played a role in the high transmission of AHC in India during the 2023 outbreak. METHODS A total of 71 conjunctivitis patients aged 1-75 years comprising 47 males and 24 females who attended Ophthalmology department of a tertiary care hospital of easternIndia were studied.RNA was extracted from all conjunctival swab samples and converted into cDNA. Subsequently, the viral 5' UTR was amplified and the PCR positive samples were subjected to sequencing. The newly isolated viral 5' UTR sequences were aligned with other worldwide sequences using the Clustal W tool to conduct mutational analysis. A phylogenetic tree was built using the MEGA software for viral genotype identification. RESULTS All of the current outbreak strains belonged to genotype IV of CVA24v. The present outbreak strains formed a distinct clade in the phylogenetic tree and were different from previously reported Indian strains. Two persistent mutations, specifically in domain IV (T213C) and domain V (C475T), were exclusively detected within the internal ribosome entry site (IRES) of the 5' UTR of the current strains causing the outbreak. These two alterations have previously been shown to impact the virulence of another enterovirus (CV B3), but they have not been described in CVA24v until now. CONCLUSION Finding of the present study highlights the possibility and the significance of the aforementioned two mutations in enhancing the transmissibility of the newer CVA24v strains. Hence, these two distinct mutations should be investigated further for developing antiviral therapies to combat future AHC outbreaks associated with CVA24v.
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Affiliation(s)
- Prabhudutta Mamidi
- All India Institute of Medical Sciences, Bhubaneswar, 751019, Odisha, India.
| | - Sailendra Panda
- All India Institute of Medical Sciences, Bhubaneswar, 751019, Odisha, India.
| | - Amrita Ray
- Institute of Life Sciences, Bhubaneswar, 751023, Odisha, India.
| | - Monalisa Mohanty
- All India Institute of Medical Sciences, Bhubaneswar, 751019, Odisha, India.
| | | | - Debasish Santra
- All India Institute of Medical Sciences, Bhubaneswar, 751019, Odisha, India.
| | - Bruttendu Moharana
- All India Institute of Medical Sciences, Bhubaneswar, 751019, Odisha, India.
| | - Bhagabat Nayak
- All India Institute of Medical Sciences, Bhubaneswar, 751019, Odisha, India.
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Boro P, Gongo T, Ori K, Kamki Y, Ete N, Jini M, Jampa L, Patgiri SJ, Sarmah N, Siddique AI, Bhattacharjee CK, Bali NK, Borkakoty B. An outbreak of acute hemorrhagic conjunctivitis due to Coxsackievirus A24 in a residential school, Naharlagun, Arunachal Pradesh: July 2023. Indian J Med Microbiol 2024; 48:100549. [PMID: 38395257 DOI: 10.1016/j.ijmmb.2024.100549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 02/09/2024] [Accepted: 02/21/2024] [Indexed: 02/25/2024]
Abstract
PURPOSE An acute conjunctivitis outbreak was investigated at a residential school in Naharlagun, Arunachal Pradesh, Northeast India, in July 2023. We aimed to identify the etiological agent and assess any complications in follow-up cases. METHODS We used a structured questionnaire to record clinical findings and followed up with cases one-month post-conjunctivitis. Sixty-one cases were examined and eight conjunctival and oropharyngeal swab samples were collected after obtaining informed consent from guardians/school authorities. We screened for 33 viral and bacterial pathogens using an IVD-approved Real-time PCR assay. Further, the samples were subjected to nucleic acid sequencing. RESULTS Among 465 screened students and staff, 80 individuals (approximately 17.2%) showed acute hemorrhagic conjunctivitis symptoms among which 61 cases were available for clinical examination. We identified the Enterovirus responsible by targeted sequencing using next-generation sequencing. The etiological agent was found to be Coxsackievirus A24, a member of Enterovirus C, in seven out of eight samples subjected to sequencing. Common symptoms included conjunctival hyperemia and foreign body sensation (100%), bilateral eye involvement (73.8%), eye pain (70%), watery discharge (49.2%), and eyelid swelling (38%). Only 6.5% had purulent discharge. Most cases resolved within 5-6 days, with only 9.8% reporting abdominal symptoms post-conjunctivitis. No serious complications occurred within one month. Throat swabs aided in diagnosing enterovirus infections alongside eye swabs. CONCLUSIONS The outbreak of acute conjunctivitis was caused by Coxsackievirus A24, a member of Enterovirus C. Cases resolved spontaneously within 6-7 days, with no severe complications. Collecting oropharyngeal swabs alongside conjunctival swabs could improve enteroviral conjunctivitis diagnosis.
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Affiliation(s)
- Pallavi Boro
- Department of Community Medicine, Tomo Riba Institute of Health and Medical Sciences (TRIHMS), Naharlagun, Arunachal Pradesh, India.
| | - Tojum Gongo
- Department of Ophthalmology, Tomo Riba Institute of Health and Medical Sciences (TRIHMS), Naharlagun, Arunachal Pradesh, India.
| | - Kimo Ori
- Department of Community Medicine, Tomo Riba Institute of Health and Medical Sciences (TRIHMS), Naharlagun, Arunachal Pradesh, India.
| | - Yompe Kamki
- Department of Microbiology, Tomo Riba Institute of Health and Medical Sciences (TRIHMS), Naharlagun, Arunachal Pradesh, India.
| | - Nyai Ete
- Department of Ophthalmology, Tomo Riba Institute of Health and Medical Sciences (TRIHMS), Naharlagun, Arunachal Pradesh, India.
| | - Moji Jini
- Tomo Riba Institute of Health and Medical Sciences (TRIHMS), Naharlagun, Arunachal Pradesh, India.
| | | | - Saurav Jyoti Patgiri
- Indian Council of Medical Research-Regional Medical Research Centre for NE region (ICMR-RMRC NE), Dibrugarh, 786010, Assam, India.
| | - Neelanjana Sarmah
- Regional VRDL, Indian Council of Medical Research-Regional Medical Research Centre for NE region (ICMR-RMRC NE), Dibrugarh, 786010, Assam, India.
| | - Aktarul Islam Siddique
- Regional VRDL, Indian Council of Medical Research-Regional Medical Research Centre for NE region (ICMR-RMRC NE), Dibrugarh, 786010, Assam, India.
| | - Chandra Kanta Bhattacharjee
- Regional VRDL, Indian Council of Medical Research-Regional Medical Research Centre for NE region (ICMR-RMRC NE), Dibrugarh, 786010, Assam, India.
| | - Nargis K Bali
- Department of Clinical Microbiology, Sher-I Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu & Kashmir, India.
| | - Biswajyoti Borkakoty
- Regional VRDL, Indian Council of Medical Research-Regional Medical Research Centre for NE region (ICMR-RMRC NE), Dibrugarh, 786010, Assam, India.
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Liu R, Chen Y, Liu H, Huang X, Zhou F. Epidemiological trends and sociodemographic factors associated with acute hemorrhagic conjunctivitis in mainland China from 2004 to 2018. Virol J 2022; 19:34. [PMID: 35232483 PMCID: PMC8889670 DOI: 10.1186/s12985-022-01758-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 02/08/2022] [Indexed: 11/30/2022] Open
Abstract
Background Acute hemorrhagic conjunctivitis (AHC) is classified as a class C notifiable infectious disease in China and poses a great threat to public health. This study aimed to investigate the epidemiological trends and hotspots of AHC in mainland China. Sociodemographic factors that could contribute to early warning of AHC were further explored. Methods Yearly and monthly incidences of acute hemorrhagic conjunctivitis by date and region from 2004 to 2018 were extracted from the Data Center of China Public Health Science. Joinpoint regression and spatial autocorrelation analysis were performed to explore the epidemiological trends and hotspots of AHC. A generalized linear model was then applied to explore the relationship between sociodemographic factors and AHC incidence. Results The average annual AHC incidence was 3.58/100,000 in mainland China. The first-level spatial and temporal aggregation areas were distributed in Guangxi, Hainan, Guangdong, Guizhou, Hunan, Jiangxi, Fujian, Chongqing, Hubei, Anhui, and Zhejiang, with gathering times from 2010/1/1 to 2010/12/31 (RR = 20.13, LLR = 474,522.89, P < 0.01). After 2010, the AHC incidence was stable (APC = − 8.37, 95% CI: − 23.02–9.06). However, it was significantly increased in low- and middle-income provinces (AAPC = 10.65, 95% CI: 0.62–21.68, AAPC = 11.94, 95% CI: 0.62–24.53). The peak of AHC occurred during the August to October period. Children who age 0–3 years are identified as high-risk group with AHC incidence significantly increased (APC = 31.54, 95% CI: 0.27–72.56). Birth rate, population ages 0–14 (% of total population), passenger traffic, and urban population (% of total population) were positively associated with the AHC incidence, while per capita gross domestic product was negatively associated with the AHC incidence. Conclusion Overall, the AHC incidence was stable after 2010 in China, but it was significantly increased in low- and middle-income provinces. Regions with a high birth rate, population ages 0–14 (% of the total population), passenger traffic, urban population (% of the total population) and low per capita gross domestic product are at high risk of incidences of AHC. In the future, public health policy and resource priority for AHC in regions with these characteristics are necessary. Supplementary Information The online version contains supplementary material available at 10.1186/s12985-022-01758-6.
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Affiliation(s)
- Rong Liu
- Institute for Disaster Management and Reconstruction, Sichuan University, Chengdu, 610000, China
| | - Yuxing Chen
- Institute of Chronic and Non-Communicable Disease Control and Prevention, Hubei Provincial Center for Disease Control and Prevention, No. 35 Zhuodaoquan North Road, Hongshan District, Wuhan, 430079, China
| | - Hao Liu
- Institute of Chronic and Non-Communicable Disease Control and Prevention, Hubei Provincial Center for Disease Control and Prevention, No. 35 Zhuodaoquan North Road, Hongshan District, Wuhan, 430079, China
| | - Xihui Huang
- Subject Teaching (English), College of Foreign Languages, Fujian Normal University, Fuzhou, 350000, China
| | - Fang Zhou
- Institute of Chronic and Non-Communicable Disease Control and Prevention, Hubei Provincial Center for Disease Control and Prevention, No. 35 Zhuodaoquan North Road, Hongshan District, Wuhan, 430079, China.
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Brown DM, Zhang Y, Scheuermann RH. Epidemiology and Sequence-Based Evolutionary Analysis of Circulating Non-Polio Enteroviruses. Microorganisms 2020; 8:microorganisms8121856. [PMID: 33255654 PMCID: PMC7759938 DOI: 10.3390/microorganisms8121856] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/13/2020] [Accepted: 11/17/2020] [Indexed: 02/07/2023] Open
Abstract
Enteroviruses (EVs) are positive-sense RNA viruses, with over 50,000 nucleotide sequences publicly available. While most human infections are typically associated with mild respiratory symptoms, several different EV types have also been associated with severe human disease, especially acute flaccid paralysis (AFP), particularly with endemic members of the EV-B species and two pandemic types—EV-A71 and EV-D68—that appear to be responsible for recent widespread outbreaks. Here we review the recent literature on the prevalence, characteristics, and circulation dynamics of different enterovirus types and combine this with an analysis of the sequence coverage of different EV types in public databases (e.g., the Virus Pathogen Resource). This evaluation reveals temporal and geographic differences in EV circulation and sequence distribution, highlighting recent EV outbreaks and revealing gaps in sequence coverage. Phylogenetic analysis of the EV genus shows the relatedness of different EV types. Recombination analysis of the EV-A species provides evidence for recombination as a mechanism of genomic diversification. The absence of broadly protective vaccines and effective antivirals makes human enteroviruses important pathogens of public health concern.
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Affiliation(s)
- David M Brown
- Department of Synthetic Biology, J. Craig Venter Institute, Rockville, MD 20850, USA
| | - Yun Zhang
- Department of Informatics, J. Craig Venter Institute, La Jolla, CA 92037, USA
| | - Richard H Scheuermann
- Department of Informatics, J. Craig Venter Institute, La Jolla, CA 92037, USA
- Department of Pathology, University of California San Diego, La Jolla, CA 92093, USA
- La Jolla Institute for Immunology, La Jolla, CA 92065, USA
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Forecasting the incidence of acute haemorrhagic conjunctivitis in Chongqing: a time series analysis. Epidemiol Infect 2020; 148:e193. [PMID: 32807257 PMCID: PMC7482188 DOI: 10.1017/s095026882000182x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Acute haemorrhagic conjunctivitis is a highly contagious eye disease, the prediction of acute haemorrhagic conjunctivitis is very important to prevent and grasp its development trend. We use the exponential smoothing model and the seasonal autoregressive integrated moving average (SARIMA) model to analyse and predict. The monthly incidence data from 2004 to 2017 were used to fit two models, the actual incidence of acute haemorrhagic conjunctivitis in 2018 was used to validate the model. Finally, the prediction effect of exponential smoothing is best, the mean square error and the mean absolute percentage error were 0.0152 and 0.1871, respectively. In addition, the incidence of acute haemorrhagic conjunctivitis in Chongqing had a seasonal trend characteristic, with the peak period from June to September each year.
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Fonseca MC, Pupo-Meriño M, García-González LA, Resik S, Hung LH, Muné M, Rodríguez H, Morier L, Norder H, Sarmiento L. Molecular evolution of coxsackievirus A24v in Cuba over 23-years, 1986-2009. Sci Rep 2020; 10:13761. [PMID: 32792520 PMCID: PMC7427094 DOI: 10.1038/s41598-020-70436-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Accepted: 07/21/2020] [Indexed: 12/29/2022] Open
Abstract
Coxsackievirus A24 variant (CVA24v) is a major causative agent of acute hemorrhagic conjunctivitis outbreaks worldwide, yet the evolutionary and transmission dynamics of the virus remain unclear. To address this, we analyzed and compared the 3C and partial VP1 gene regions of CVA24v isolates obtained from five outbreaks in Cuba between 1986 and 2009 and strains isolated worldwide. Here we show that Cuban strains were homologous to those isolated in Africa, the Americas and Asia during the same time period. Two genotypes of CVA24v (GIII and GIV) were repeatedly introduced into Cuba and they arose about two years before the epidemic was detected. The two genotypes co-evolved with a population size that is stable over time. However, nucleotide substitution rates peaked during pandemics with 4.39 × 10-3 and 5.80 × 10-3 substitutions per site per year for the 3C and VP1 region, respectively. The phylogeographic analysis identified 25 and 19 viral transmission routes based on 3C and VP1 regions, respectively. Pandemic viruses usually originated in Asia, and both China and Brazil were the major hub for the global dispersal of the virus. Together, these data provide novel insight into the epidemiological dynamics of this virus and possibly other pandemic viruses.
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Affiliation(s)
- Magilé C Fonseca
- Virology Department, Center for Research, Diagnosis and Reference, Institute of Tropical Medicine "Pedro Kourí" (IPK), Novia del Mediodía Km 61/2, La Lisa, Marianao 13, P.O. Box: 601, Havana, Cuba.
| | - Mario Pupo-Meriño
- Departamento de Bioinformática, Centro de Matemática Computacional, Universidad de las Ciencias Informáticas (UCI), Havana, Cuba
| | - Luis A García-González
- Departamento de Ciencias de la Computación, Centro de Investigación Científica y de Educación Superior de Ensenada, Ensenada, Baja California, México
| | - Sonia Resik
- Virology Department, Center for Research, Diagnosis and Reference, Institute of Tropical Medicine "Pedro Kourí" (IPK), Novia del Mediodía Km 61/2, La Lisa, Marianao 13, P.O. Box: 601, Havana, Cuba
| | - Lai Heng Hung
- Virology Department, Center for Research, Diagnosis and Reference, Institute of Tropical Medicine "Pedro Kourí" (IPK), Novia del Mediodía Km 61/2, La Lisa, Marianao 13, P.O. Box: 601, Havana, Cuba
| | - Mayra Muné
- Virology Department, Center for Research, Diagnosis and Reference, Institute of Tropical Medicine "Pedro Kourí" (IPK), Novia del Mediodía Km 61/2, La Lisa, Marianao 13, P.O. Box: 601, Havana, Cuba
| | - Hermis Rodríguez
- Cell Culture Laboratory, Center for Research, Diagnosis and Reference, Institute of Tropical Medicine "Pedro Kourí" (IPK), Havana, Cuba
| | - Luis Morier
- Department of Microbiology and Virology, Biology Faculty, Havana University, Havana, Cuba
| | - Heléne Norder
- Department of Infectious Diseases/Virology, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Luis Sarmiento
- Immunovirology Unit, Department of Clinical Sciences, Skåne University Hospital, Lund University, Malmö, Sweden
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Liu X, Qiu S, Liu Z, Chen D, Liu H, Ding G. Effects of Floods on the Incidence of Acute Hemorrhagic Conjunctivitis in Mengshan, China, from 2005 to 2012. Am J Trop Med Hyg 2020; 102:1263-1268. [PMID: 32228794 DOI: 10.4269/ajtmh.19-0164] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
This study aimed to examine the association between floods and the morbidity of acute hemorrhagic conjunctivitis (AHC) in Mengshan, China. Relying on the longitudinal data, a generalized additive model (GAM) was applied to quantify the relationship between the morbidity of AHC and floods from 2005 to 2012, controlling for other meteorological variables. Years lived with disability (YLDs) and attributable YLDs were used as the measure of the burden of AHC because of the floods. Multivariable analysis showed that floods were significantly associated with an increased risk of the morbidity of AHC (rate ratio [RR] = 2.136, 95% CI: 2.109-2.163). The total YLDs per 1,000 in Mengshan was 0.2001, although the value in females was higher than that in males (0.2351 versus 0.1686). The YLD per 1,000 of AHC in Mengshan was highest between the ages of 5 and 14 years (0.6530), followed by the age of 0-4 years (0.3325). The attributable YLD per 1,000 of AHC due to the floods in Mengshan was 0.0434 (95% CI: 0.0425-0.0442). Our study confirms that floods have significantly increased the risks of AHC in the selected study area. Females and youngsters may be the vulnerable populations to develop the flood-related disease.
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Affiliation(s)
- Xuena Liu
- School of Public Health, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, P.R. China
| | - Shuo Qiu
- Shandong Yingcai University, Jinan, P.R. China
| | - Zhidong Liu
- School of Public Health, Shandong University, Jinan, P.R. China
| | - Dongzhen Chen
- School of Public Health, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, P.R. China
| | - Hui Liu
- Shandong Yingcai University, Jinan, P.R. China
| | - Guoyong Ding
- School of Public Health, Shandong First Medical University & Shandong Academy of Medical Sciences, Taian, P.R. China
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Transfer of Enteric Viruses Adenovirus and Coxsackievirus and Bacteriophage MS2 from Liquid to Human Skin. Appl Environ Microbiol 2018; 84:AEM.01809-18. [PMID: 30217840 PMCID: PMC6210118 DOI: 10.1128/aem.01809-18] [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: 07/25/2018] [Accepted: 09/05/2018] [Indexed: 11/23/2022] Open
Abstract
Enteric viruses (viruses that infect the gastrointestinal tract) are responsible for most water-transmitted diseases. They are shed in high concentrations in the feces of infected individuals, persist for an extended period of time in water, and are highly infective. Exposure to contaminated water directly (through ingestion) or indirectly (for example, through hand-water contacts followed by hand-to-mouth contacts) increases the risk of virus transmission. The work described herein provides a quantitative model for estimating human-pathogenic virus retention on skin following contact with contaminated water. The work will be important in refining the contribution of indirect transmission of virus to risks associated with water-related activities. Indirect exposure to waterborne viruses increases the risk of infection, especially among children with frequent hand-to-mouth contacts. Here, we quantified the transfer of one bacteriophage (MS2) and two enteric viruses (adenovirus and coxsackievirus) from liquid to skin. MS2, a commonly used enteric virus surrogate, was used to compare virus transfer rates in a volunteer trial to those obtained using human cadaver skin and synthetic skin. MS2 transfer to volunteer skin was similar to transfer to cadaver skin but significantly different from transfer to synthetic skin. The transfer of MS2, adenovirus, and coxsackievirus to cadaver skin was modeled using measurements for viruses attaching to the skin (adsorbed) and viruses in liquid residual on skin (unadsorbed). We find virus transfer per surface area is a function of the concentration of virus in the liquid and the film thickness of liquid retained on the skin and is estimable using a linear model. Notably, the amount of MS2 adsorbed on the skin was on average 5 times higher than the amount of adenovirus and 4 times higher than the amount of coxsackievirus. Quantification of pathogenic virus retention to skin would thus be overestimated using MS2 adsorption data. This study provides models of virus transfer useful for risk assessments of water-related activities, demonstrates significant differences in the transfer of pathogenic virus and MS2, and suggests cadaver skin as an alternative testing system for studying interactions between viruses and skin. IMPORTANCE Enteric viruses (viruses that infect the gastrointestinal tract) are responsible for most water-transmitted diseases. They are shed in high concentrations in the feces of infected individuals, persist for an extended period of time in water, and are highly infective. Exposure to contaminated water directly (through ingestion) or indirectly (for example, through hand-water contacts followed by hand-to-mouth contacts) increases the risk of virus transmission. The work described herein provides a quantitative model for estimating human-pathogenic virus retention on skin following contact with contaminated water. The work will be important in refining the contribution of indirect transmission of virus to risks associated with water-related activities.
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Zhang L, Zhao N, Huang X, Jin X, Geng X, Chan TC, Liu S. Molecular epidemiology of acute hemorrhagic conjunctivitis caused by coxsackie A type 24 variant in China, 2004-2014. Sci Rep 2017; 7:45202. [PMID: 28332617 PMCID: PMC5362916 DOI: 10.1038/srep45202] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 02/21/2017] [Indexed: 11/09/2022] Open
Abstract
To understand control interventions, the molecular epidemiology of acute hemorrhagic conjunctivitis (AHC) was investigated from 2004 to 2014.A total of 613,485 AHC cases (annualized cases 55,771) with two deaths were included. Our findings showed that AHC was reported in all provinces, predominantly in Southern and Eastern China. The incidence rates were highest in 2007 (5.65/100,000) and 2010 (21.78/100,000) respectively. A clear seasonal pattern was identified with a peak from August to October. AHC cases occurred in all age groups; however, five to 14 years was the predominant group [23.06%, 133, 510/578,909]. The median age was 24 years (one month~97 years). The median duration from onset to diagnosis was 1.5 days, and there was no difference between the <15, 15~60 and >60-year-old patients [p = 0.0653]. The phylogenetic analysis of 100 nonstructural proteins (3C) and 84 structural proteins (VP1) revealed that AHC outbreaks were caused by Coxsackievirus A24 variant. Genotypes G4-c5a, G4-c5b, and G4-c3 co-circulated with both temporal and geographical overlaps. In conclusion, despite the overall steady decline in the number of AHC cases since the peak in 2010, it still remains a serious public health problem in Southern and Eastern China that targets on the school aged children under 15 years old.
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Affiliation(s)
- Li Zhang
- Eye Center of the Second Affiliated Hospital, Medical School of Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Na Zhao
- National Research Center for Wildlife Borne Diseases, Key Lab of Animal Ecology and Conservation Biology, Institute of Zoology, Chinese Academy of Sciences, Beijing, China
| | - Xiaodan Huang
- Eye Center of the Second Affiliated Hospital, Medical School of Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Xiuming Jin
- Eye Center of the Second Affiliated Hospital, Medical School of Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Xingyi Geng
- Emergency Offices, Jinan Centre for Disease Control and Prevention, Jinan, Shandong Province, China
| | - Ta-Chien Chan
- Center for Geographic Information Science, Research Center for Humanities and Social Sciences, Academia Sinica, Taipei, Taiwan
| | - Shelan Liu
- Department of Infectious Diseases, Zhejiang Provincial Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, China
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Complete genome analysis of coxsackievirus A24 isolated in Yunnan, China, in 2013. Arch Virol 2016; 161:1705-9. [PMID: 26935916 DOI: 10.1007/s00705-016-2792-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 02/11/2016] [Indexed: 10/22/2022]
Abstract
Human coxsackievirus A24 (CVA24) belongs to the species Enterovirus C, and variants of this virus frequently cause acute hemorrhagic conjunctivitis (AHC). The complete genome of the K282/YN/CHN/2013 strain, isolated from a healthy child in Yunnan, China, in 2013, is reported here for the first time. The strain showed 80.0 % and 79.9 % nucleotide sequence identity to CVA24 prototype strain Joseph and CVA24 variant prototype EH24, respectively. The K282/YN/CHN/2013 strain belongs to the CVA24 serotype. Twelve amino acid differences, most of which are in structural regions, were found between the CVA24 and CVA24v strains. In the whole-length genome sequence, only the structural region of K282/YN/CHN/2013 was similar to that of the CVA24 strains; the other genome regions were more similar to those of other members of the species Enterovirus C. Recombination analysis showed evidence of recombination with other viruses of the same species.
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12
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Abstract
PURPOSE OF REVIEW There are over 100 serotypes of human enteroviruses, which cause a spectrum of illnesses, including meningitis, encephalitis, paralysis, myocarditis and rash. Increasing incidence of hand-foot-and-mouth disease in the Asia-Pacific region and recent outbreaks of enterovirus-associated disease, such as severe respiratory illness in the United States in 2014, highlight the threat of these viruses to human health. RECENT FINDINGS We describe recent outbreaks of human enteroviruses and summarize knowledge gaps regarding their burden, spectrum of diseases and epidemiology. SUMMARY Reported outbreaks of respiratory, neurological, skin and eye diseases associated with human enteroviruses have increased in frequency and size in recent years. Improved molecular diagnostics and genetic sequence analysis are beginning to reveal the complex dynamics of individual serotypes and genotypes, and their contribution to these outbreaks. However, the biological mechanisms underlying their emergence and transmission dynamics remain elusive. They are likely to involve changes in the virus, such as fitness, antigenicity, virulence or tropism, and in the human population, such as levels of sanitation and of homotypic and heterotypic immunity. Improvements in surveillance, serological surveys and detailed genetic and antigenic characterization of viral populations would help to elucidate these mechanisms. This will be important for the design of outbreak control and vaccine development strategies.
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13
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Langford MP, Anders EA, Burch MA. Acute hemorrhagic conjunctivitis: anti-coxsackievirus A24 variant secretory immunoglobulin A in acute and convalescent tear. Clin Ophthalmol 2015; 9:1665-73. [PMID: 26392747 PMCID: PMC4574852 DOI: 10.2147/opth.s85358] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose The purpose of this paper is to present the clinical course of a laboratory-acquired case of acute hemorrhagic conjunctivitis (AHC) caused by coxsackievirus A24 variant (CA24v). Also, the anti-CA24v neutralizing activity and anti-CA24v immunoglobulin (Ig) G and secretory IgA (sIgA) in acute and convalescent tears and/or sera are presented. Case A 60-year-old male presented with acute-onset left eyelid edema, tearing, conjunctival erythema, pain, foreign body sensation, and subconjunctival hemorrhage 24 hours after suspected laboratory exposure. Bilateral conjunctivitis presented 24 hours later and resolved in 10 days. Methods Tear and blood samples were collected for virus isolation and neutralizing assays. CA24v-reactive IgG and sIgA in tear and/or serum samples were detected by immunofluorescent antibody analysis of ethanol-fixed virus-infected cells. Results Peak tear neutralization titers (1,000–1,500 U/mL) against the isolated virus occurred 1 day post-onset (po) of AHC. Tear neutralization titers became undetectable by the sixth day as serum neutralization titers became detectable on the ninth day po (60 U/mL), peaked by 21 days (3,000 U/mL), declined by 1 year to 200 U/mL, and remained at 30 U/mL 5 years po. Antibody to human IgG, IgA, and secretory component (sIgA) reacted with CA24v-infected cells treated with pooled acute tears collected 1–4 days po. Predominantly, sIgA was detected in CA24v-infected cells treated with tears collected 4 years and 5 years post-AHC, while convalescent serum contained predominantly anti-CA24v IgG. Conclusion AHC was confirmed by CA24v isolation, tear anti-CA24v neutralizing activity, and seroconversion. The detection of CA24v-reactive IgG, sIgA, and neutralizing activity in tears collected 1–4 days po of AHC supports plasma extravasation of IgG and suggests a defensive role for tear anti-CA24v sIgA. The results suggest that immunofluorescent antibody analysis of tears for persistent anti-CA24v sIgA may be useful in epidemiological monitoring of AHC.
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Affiliation(s)
- Marlyn P Langford
- Department of Ophthalmology, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Edwin A Anders
- Department of Ophthalmology, Louisiana State University Health Sciences Center, Shreveport, LA, USA
| | - Maxwell A Burch
- Department of Ophthalmology, Louisiana State University Health Sciences Center, Shreveport, LA, USA
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Harada K, Fujimoto T, Asato Y, Uchio E. Virological and epidemiological analysis of coxsackievirus A24 variant epidemic of acute hemorrhagic conjunctivitis in Okinawa, Japan, in 2011. Clin Ophthalmol 2015; 9:1085-92. [PMID: 26109843 PMCID: PMC4474401 DOI: 10.2147/opth.s81386] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Acute hemorrhagic conjunctivitis (AHC) is a highly contagious enterovirus infection of the conjunctiva and cornea. Coxsackievirus A24 variant (CA24v) is one of its etiological agents. We report a clinical, epidemiological, and virological analysis of a large epidemic of AHC that occurred from May to September, 2011, in Okinawa, Japan. METHODS Clinical and epidemic aspects were evaluated for 435 AHC patients (348 bilateral and 87 unilateral, 783 eyes). Virological studies were carried out on nine isolates from ten patients. Virus isolation and direct detection of the enterovirus genome by the reverse transcription polymerase chain reaction method and complete nucleotide sequencing of the VP1 gene and phylogeny-based classification using the VP4 sequences were carried out. RESULTS The 11-15-year age group comprised the highest (62.0%) proportion of cases among all age groups. Conjunctival hyperemia was present in all patients, and subconjunctival hemorrhage, superficial punctate keratitis, and preauricular lymphadenopathy were present in 25.4%, 10.3%, and 7.8% of eyes, respectively. CA24v was isolated from the epidemic strain, and phylogenetic analysis based on a fragment of the VP1 gene showed 96%-97% identity between the current strain and the recent China/GD01/2010 strain. CONCLUSION These findings demonstrate that the clinical and epidemiological features of AHC observed in this study were similar to those of the past epidemic in the same region. It should be noted that sequential outbreaks of AHC due to CA24v might occur in the same location after a considerable period of time, and public health precautions are necessary to control this explosive epidemic.
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Affiliation(s)
- Kazuhiro Harada
- Department of Ophthalmology, Fukuoka University School of Medicine, Fukuoka, Japan
| | - Tsuguto Fujimoto
- Infectious Disease Surveillance Center, National Institute of Infectious Disease, Tokyo, Japan
| | | | - Eiichi Uchio
- Department of Ophthalmology, Fukuoka University School of Medicine, Fukuoka, Japan
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Epidemic outbreak of acute haemorrhagic conjunctivitis caused by coxsackievirus A24 in Thailand, 2014. Epidemiol Infect 2015; 143:3087-93. [PMID: 25824006 DOI: 10.1017/s0950268815000643] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Acute haemorrhagic conjunctivitis outbreaks are often attributed to viral infection. In 2014, an unprecedented nationwide outbreak of infectious conjunctivitis occurred in Thailand, which affected >300 000 individuals over 3 months. To identify and characterize the virus responsible for the epidemic, eye swab specimens from 119 patients were randomly collected from five different provinces. Conserved regions in the enteroviral 5'-UTR and adenovirus hexon gene were analysed. Enterovirus was identified in 71·43% (85/119) of the samples, while no adenovirus was detected. From enterovirus-positive samples, the coxsackievirus A24 variant (70·59%, 84/119) and echovirus (0·84%, 1/119) were identified. Additional sequencing of full-length VP1 and 3C genes and subsequent phylogenetic analysis revealed that these clinical isolates form a new lineage cluster related to genotype IV-C5. In summary, the coxsackievirus A24 variant was identified as an aetiological agent for the recent acute haemorrhagic conjunctivitis outbreak in Thailand.
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Ndiaye AK, Diop PAM, Diop OM. Environmental surveillance of poliovirus and non-polio enterovirus in urban sewage in Dakar, Senegal (2007-2013). Pan Afr Med J 2014; 19:243. [PMID: 25848458 PMCID: PMC4377292 DOI: 10.11604/pamj.2014.19.243.3538] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 07/23/2014] [Indexed: 11/16/2022] Open
Abstract
Introduction Global poliomyelitis eradication initiative relies on (i) laboratory based surveillance of acute flaccid surveillance (AFP) to monitor the circulation of wild poliovirus in a population, and (ii) vaccination to prevent its diffusion. However, as poliovirus can survive in the environment namely in sewage, environmental surveillance (ES) is of growing importance as the eradication target is close. This study aimed to assess polioviruses and non polio enteroviruses circulation in sewage drains covering a significant population of Dakar. Methods From April 2007 to May 2013, 271 specimens of raw sewage were collected using the grab method in 6 neighborhoods of Dakar. Samples were processed to extract and concentrate viruses using polyethylene glycol and Dextran (two-phase separation method). Isolation of enteroviruses was attempted in RD, L20B and Hep2 cell lines. Polioviruses were identified by RT-PCR and Elisa. Non Polio Enteroviruses (NPEVs) were identified by RT-PCR and microneutralisation tests. Results Polioviruses and NPEVs were respectively detected in 34,3% and 42,8% sewage samples. No wild poliovirus neither circulating vaccine-derived Poliovirus (cVDPV) was detected. Neutralization assays have identified 49 non polio enteroviruses that were subsequently classified in 13 serotypes belonging to HEV-A (22, 4%), HEV-B (12, 24%), HEV-C (26, 53%) and HEV-D (6, 12%) species. Conclusion This study is the first documentation of enteroviruses environmental detection in Senegal. It shows the usefulness of environmental surveillance for indirect monitoring of the circulation and distribution of enteroviruses in the community.
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Affiliation(s)
- Abdou Kader Ndiaye
- National Reference Center for Enteric Viruses, Medical Virology Unit, Institut Pasteur de Dakar, Senegal
| | - Pape Amadou Mbathio Diop
- National Reference Center for Enteric Viruses, Medical Virology Unit, Institut Pasteur de Dakar, Senegal
| | - Ousmane Madiagne Diop
- National Reference Center for Enteric Viruses, Medical Virology Unit, Institut Pasteur de Dakar, Senegal
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Wu B, Qi X, Xu K, Ji H, Zhu Y, Tang F, Zhou M. Genetic characteristics of the coxsackievirus A24 variant causing outbreaks of acute hemorrhagic conjunctivitis in Jiangsu, China, 2010. PLoS One 2014; 9:e86883. [PMID: 24475191 PMCID: PMC3901726 DOI: 10.1371/journal.pone.0086883] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 12/19/2013] [Indexed: 11/19/2022] Open
Abstract
During September 2010, an outbreak of acute hemorrhagic conjunctivitis reemerged in Jiangsu, three years after the nationwide epidemic in China in 2007. In total, 2409 cases were reported, 2118 of which were reported in September; 79.8% of those affected were students or teachers, with a median age of 16 years. To identify and demonstrate the genetic characteristics of the etiological agent, 52 conjunctival swabs were randomly collected from four different cities. After detection and isolation, 43 patients were positive for coxsackievirus A24 variant according to PCR and 20 according to culture isolation. Neither adenovirus nor EV70 was detected. A phylogenetic study of the complete 3Cpro and VP1 regions showed that the Jiangsu isolates clustered into a new lineage, GIV-C5, with two uniform amino-acid mutations that distinguished them from all previous strains. Another new cluster, GIV-C4, formed by Indian isolates from 2007 and Brazilian isolates from 2009, was also identified in this study. Interestingly, our isolates shared greatest homology with the GIV-C4 strains, not with the isolates that were responsible for the nationwide acute hemorrhagic conjunctivitis epidemic in China in 2007. Although all our isolates were closely related, they could be differentiated into two subclusters within GIV-C5. In conclusion, our study suggests that a new cluster of coxsackievirus A24 variant that had already evolved into diverse strains was associated with the acute hemorrhagic conjunctivitis outbreaks in Jiangsu in September 2010. These viruses might have originated from the virus isolated in India in 2007, rather than from the epidemic strains isolated in China in 2007.
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Affiliation(s)
- Bin Wu
- Department of Acute Infectious Disease Control and Prevention, Jiangsu Province Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Xian Qi
- Department of Acute Infectious Disease Control and Prevention, Jiangsu Province Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Ke Xu
- Department of Acute Infectious Disease Control and Prevention, Jiangsu Province Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Hong Ji
- Department of Acute Infectious Disease Control and Prevention, Jiangsu Province Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Yefei Zhu
- Department of Acute Infectious Disease Control and Prevention, Jiangsu Province Center for Disease Control and Prevention, Nanjing, Jiangsu, China
- * E-mail:
| | - Fenyang Tang
- Department of Acute Infectious Disease Control and Prevention, Jiangsu Province Center for Disease Control and Prevention, Nanjing, Jiangsu, China
| | - Minghao Zhou
- Department of Acute Infectious Disease Control and Prevention, Jiangsu Province Center for Disease Control and Prevention, Nanjing, Jiangsu, China
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