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Arslan M, Xu B, Gamal El-Din M. Transmission of SARS-CoV-2 via fecal-oral and aerosols-borne routes: Environmental dynamics and implications for wastewater management in underprivileged societies. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 743:140709. [PMID: 32652357 PMCID: PMC7332911 DOI: 10.1016/j.scitotenv.2020.140709] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 06/30/2020] [Accepted: 07/01/2020] [Indexed: 05/18/2023]
Abstract
The advent of novel human coronavirus (SARS-CoV-2) and its potential transmission via fecal-oral and aerosols-borne routes are upcoming challenges to understand the fate of the virus in the environment. In this short communication, we specifically looked at the possibilities of these transmission routes based on the available literature directly related to the SARS-CoV-2 as well as on the closer phylogenetic relatives such as SARS-CoV-1. The available data suggest that, in addition to human-to-human contact, the virus may spread via fecal-oral and aerosols-borne routes. Existing knowledge states that coronaviruses have low stability in the environment due to the natural action of oxidants that disrupt the viral envelope. Previous recommended dosage of chlorination has been found to be not sufficient to inactivate SARS-CoV-2 in places where viral load is high such as hospitals and airports. Although there is no current evidence showing that coronaviruses can be transmitted through contaminated drinking water, there is a growing concern on the impact of the current pandemic wave on underprivileged societies because of their poor wastewater treatment infrastructures, overpopulation, and outbreak management strategies. More research is encouraged to trace the actual fate of SARS-CoV-2 in the environment and to develop/revise the disinfection strategies accordingly.
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Affiliation(s)
- Muhammad Arslan
- Department of Civil and Environmental Engineering, University of Alberta, Edmonton, Alberta T6G 1H9, Canada
| | - Bin Xu
- State Key Laboratory of Pollution Control and Resource Reuse, Key Laboratory of Yangtze Water Environment, Ministry of Education, College of Environmental Science and Engineering, Tongji University, Shanghai 200092, PR China; Shanghai Institute of Pollution Control and Ecological Security, Shanghai 200092, PR China
| | - Mohamed Gamal El-Din
- Department of Civil and Environmental Engineering, University of Alberta, Edmonton, Alberta T6G 1H9, Canada.
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Li H, Deng J, Yu P, Deng L, Ren X. Gaining insight into irrational off-label use of vidarabine through analysis of a spontaneous reporting system in China. J Clin Pharm Ther 2020; 45:1301-1311. [PMID: 32614099 DOI: 10.1111/jcpt.13209] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/30/2020] [Accepted: 06/08/2020] [Indexed: 12/13/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Although superseded by other antiviral agents in many Western countries, vidarabine is still widely used in some countries, including China; hence, the extent and appropriateness of vidarabine prescriptions in children require better characterization. This study examined the rationale, extent, and health risks associated with irrational off-label vidarabine use in China. METHODS Data used in the study were extracted from a multi-provincial joint adverse drug reactions monitoring platform from 2002 to 2018. Descriptive statistics were used to analyse the characteristics of individual case safety reports (ICSRs) related to vidarabine use. RESULTS AND DISCUSSION Among 2772 individual ICSRs related to vidarabine, 2223 (80.19%) cases occurred in patients aged 0-9. In all patients, the median age and interquartile range were 2 (0-6). Although most adverse events were mild, five deaths were recorded, all in children below 7 years of age. Paediatric use is the most prominent off-label use of vidarabine. Additionally, several other irrational off-label uses were identified, including 218 (7.86%) cases of overdosing and numerous applications beyond the approved indications, dosages, routes of administration, and solvents. WHAT IS NEW AND CONCLUSION Data indicate that vidarabine was mainly prescribed for suspected common viral infections in paediatric patients, demonstrating serious inappropriate off-label uses. The problem was further complicated by the lack of sufficient information regarding safety, efficacy, and dosing regimens in children, as well as by several additional risk factors such as inappropriate solvents, routes of administration, and overdose. In the case of children, the physicians' lack of understanding of antiviral activities and compassionate prescriptions were mainly responsible for drug overuse. The health risks associated with the paediatric use of vidarabine in China require greater attention and further investigation.
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Affiliation(s)
- Haona Li
- Huaihe Hospital of Henan University, Kaifeng, China.,Institutes of Evidence-Based Medicine and Knowledge Translation, Henan University, Kaifeng, China
| | - Jianxiong Deng
- Adverse Drug Reaction Monitoring Centre of Guangdong Province, Guangzhou, China
| | - Peiming Yu
- School of Pharmacy, Henan University, Kaifeng, China
| | - Lewen Deng
- Adverse Drug Reaction Monitoring Centre of Guangdong Province, Guangzhou, China
| | - Xuequn Ren
- Huaihe Hospital of Henan University, Kaifeng, China.,Institutes of Evidence-Based Medicine and Knowledge Translation, Henan University, Kaifeng, China
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Molecular epidemiology of enterovirus from children with herpangina or hand, foot, and mouth disease in Hangzhou, 2016. Arch Virol 2019; 164:2565-2571. [DOI: 10.1007/s00705-019-04356-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 06/28/2019] [Indexed: 12/24/2022]
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Yao X, Bian LL, Lu WW, Li JX, Mao QY, Wang YP, Gao F, Wu X, Ye Q, Li XL, Zhu FC, Liang Z. Epidemiological and etiological characteristics of herpangina and hand foot mouth diseases in Jiangsu, China, 2013-2014. Hum Vaccin Immunother 2016; 13:823-830. [PMID: 27768527 DOI: 10.1080/21645515.2016.1236879] [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] [Indexed: 10/20/2022] Open
Abstract
Herpangina (HA) and hand, foot, and mouth disease (HFMD) are common infectious diseases caused by human enteroviruses and frequently occurr in young children. Previous published studies have mainly focused on HFMD, while the HA epidemiological and etiological characteristics in mainland China have not been described. From June, 2013 to March, 2014, HA and HFMD patients were monitored in participants from clinical trial of EV-A71 vaccine conducted during 2012-2013. A total of 95 HA patients and 161 HFMD patients were defined. Enteroviruses of HA samples were differentiated into 17 serotypes (EV-A71, CV-A16, CV-A24, E6, CV-B5, CV-A22, CV-A6, CV-A10, CV-B3, E9, CV-A9, CV-B4, CV-B2, E1, E7, E21 and CV-A20), the most common serotypes were EV-A71(10/95,10.5%), CV-A16(4/95,4.2%) and CV-A24(4/95,4.2%); while enteroviruses detected from HFMD samples were classfied into 21 serotypes ( EV-A71, CV-A16, CV-A10, CV-A6, E6, CV-B3, CV-B5, CV-A9, E9, CV-B2, CV-B4, E3, E11, E15, E16, CV-A1, EV-A69, E5, CA22, CA24 and EV99), the most common serotypes were EV-A71(28/161,17.4%), CV-A16(7/161,4.4%) and CV-A10(5/161,3.1%). The first HA epidemic peak occurred in summer and a second smaller peak occurred in January. In HA patients, the body temperature (P < 0.0001) and the incidence of fever (P < 0.05) were significant higher than those in HFMD patients. Between HA and HFMD patients infected with EV-A71, no significant differences were found in age, sex, circulating season, and the viral genome diversity. In summary, we firstly reported the epidemiological and etiological characteristics of HA in mainland China. Developing a multivalent vaccine will be helpful for the control of the HA/HFMD epidemic.
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Affiliation(s)
- Xin Yao
- a National Institute for Food and Drug Control , Beijing , China
| | - Lian-Lian Bian
- a National Institute for Food and Drug Control , Beijing , China
| | - Wei-Wei Lu
- b Beijing Vigoo Biological , Beijing , China
| | - Jing-Xin Li
- c Jiangsu Provincial Center for Disease Control and Prevention , Nanjing , China
| | - Qun-Ying Mao
- a National Institute for Food and Drug Control , Beijing , China
| | - Yi-Ping Wang
- a National Institute for Food and Drug Control , Beijing , China
| | - Fan Gao
- a National Institute for Food and Drug Control , Beijing , China
| | - Xing Wu
- a National Institute for Food and Drug Control , Beijing , China
| | - Qiang Ye
- a National Institute for Food and Drug Control , Beijing , China
| | - Xiu-Ling Li
- b Beijing Vigoo Biological , Beijing , China
| | - Feng-Cai Zhu
- c Jiangsu Provincial Center for Disease Control and Prevention , Nanjing , China
| | - Zhenglun Liang
- a National Institute for Food and Drug Control , Beijing , China
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5
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Li W, Gao HH, Zhang Q, Liu YJ, Tao R, Cheng YP, Shu Q, Shang SQ. Large outbreak of herpangina in children caused by enterovirus in summer of 2015 in Hangzhou, China. Sci Rep 2016; 6:35388. [PMID: 27752104 PMCID: PMC5067559 DOI: 10.1038/srep35388] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 09/28/2016] [Indexed: 12/28/2022] Open
Abstract
Herpangina, usually caused by coxsackie virus A, is prevalent in children spreading through the fecal-oral transmission and the respiratory droplets dissemination. Also, it is mostly asymptomatic and self-limiting. In our study, we found that large outbreak of herpangina in children occurred in the summer of 2015 in Hangzhou, China. From May 1th to August 31th, a total of 10 210 children were diagnosed with herpangina in Children’s Hospital of Zhejiang University School of Medicine. 2 310 throat swabs were collected and tested for enterovirus detection by real-time RT-PCR, while 1 651 cases were positive with the rate of 71.5%. Based on VP1 gene or 5′UTR region sequences, Coxsackievirus A2, A4, A6, A10, B2, B4 and echovirus 30 were detected in these cases. More importantly, Coxsackievirus A2 may be the major subtype of enterovirus resulting in children with herpangina in hangzhou, China.
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Affiliation(s)
- Wei Li
- Department of Clinical Laboratory, Children's Hospital of Zhejiang University School of Medicine, Hangzhou 310013, PR China
| | - Hui-Hui Gao
- Department of Clinical Laboratory, Children's Hospital of Zhejiang University School of Medicine, Hangzhou 310013, PR China
| | - Qiong Zhang
- Department of Clinical Laboratory, Children's Hospital of Zhejiang University School of Medicine, Hangzhou 310013, PR China
| | - Yu-Jie Liu
- Department of Clinical Laboratory, Children's Hospital of Zhejiang University School of Medicine, Hangzhou 310013, PR China
| | - Ran Tao
- Department of Clinical Laboratory, Children's Hospital of Zhejiang University School of Medicine, Hangzhou 310013, PR China
| | - Yu-Ping Cheng
- Department of Clinical Laboratory, Children's Hospital of Zhejiang University School of Medicine, Hangzhou 310013, PR China
| | - Qiang Shu
- Department of Clinical Laboratory, Children's Hospital of Zhejiang University School of Medicine, Hangzhou 310013, PR China
| | - Shi-Qiang Shang
- Department of Clinical Laboratory, Children's Hospital of Zhejiang University School of Medicine, Hangzhou 310013, PR China
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Peng Q, Xie M, Zhang Y, Liu Q, Li W, Li S, Ma Q, Lu X, Zhong B. Molecular epidemiology of the enteroviruses associated with hand, foot and mouth disease/herpangina in Dongguan, China, 2015. Arch Virol 2016; 161:3463-3471. [PMID: 27654666 DOI: 10.1007/s00705-016-3058-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 09/08/2016] [Indexed: 10/21/2022]
Abstract
Enteroviruses (EVs) are the etiological agents involved in most cases of hand, foot and mouth disease (HFMD) and herpangina (HA). Information on the epidemiology profiles of EVs in China is very limited, as the present surveillance system of China focuses on CAV16 and EV71, and no published data are available in Dongguan. The aim of this study is to determine the prevalence of EVs among patients with HFMD and HA in Dongguan, China, during 2015. A total of 271 clinical stool specimens that were clinically determined to be positive for enteroviruses were genotyped by semi-nested polymerase chain reaction (PCR) for the VP1 genes of EVs. The results showed that a total of 14 enterovirus genotypes were identified among HFMD and HA patients in this study. CVA6 was the most common genotype for HFMD, and CVA2 accounted for the majority of HA cases in this study. Sequence and phylogenetic analysis showed that all of the CVA6 and CVA2 strains identified in our study displayed a close genetic relationship to strains identified in other cities in China. This study also demonstrates that there are associations between particular causative enterovirus genotypes and some clinical symptoms, which may provide useful information for improving case prevention, diagnosis and treatment of HFMD and HA.
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Affiliation(s)
- Qi Peng
- Department of Pediatric Infectious Diseases, Children's Hospital of Dongguan, Dongguan, Guangdong, China.,Department of Medical and Molecular Genetics, Dongguan Institute of Pediatrics, Dongguan, Guangdong, China
| | - Mingyu Xie
- Department of Pediatric Infectious Diseases, Children's Hospital of Dongguan, Dongguan, Guangdong, China.,Department of Medical and Molecular Genetics, Dongguan Institute of Pediatrics, Dongguan, Guangdong, China.,Guangdong Medical University, Dongguan, Guangdong, China
| | - Yinghong Zhang
- Department of Pediatric Infectious Diseases, Children's Hospital of Dongguan, Dongguan, Guangdong, China.,Department of Medical and Molecular Genetics, Dongguan Institute of Pediatrics, Dongguan, Guangdong, China
| | - Qian Liu
- Department of Pediatric Infectious Diseases, Children's Hospital of Dongguan, Dongguan, Guangdong, China.,Department of Medical and Molecular Genetics, Dongguan Institute of Pediatrics, Dongguan, Guangdong, China
| | - Wenrui Li
- Department of Pediatric Infectious Diseases, Children's Hospital of Dongguan, Dongguan, Guangdong, China.,Department of Medical and Molecular Genetics, Dongguan Institute of Pediatrics, Dongguan, Guangdong, China
| | - Siping Li
- Department of Pediatric Infectious Diseases, Children's Hospital of Dongguan, Dongguan, Guangdong, China.,Department of Medical and Molecular Genetics, Dongguan Institute of Pediatrics, Dongguan, Guangdong, China
| | - Qiang Ma
- Department of Pediatric Infectious Diseases, Children's Hospital of Dongguan, Dongguan, Guangdong, China.,Department of Medical and Molecular Genetics, Dongguan Institute of Pediatrics, Dongguan, Guangdong, China
| | - Xiaomei Lu
- Department of Pediatric Infectious Diseases, Children's Hospital of Dongguan, Dongguan, Guangdong, China. .,Department of Medical and Molecular Genetics, Dongguan Institute of Pediatrics, Dongguan, Guangdong, China.
| | - Baimao Zhong
- Department of Pediatric Infectious Diseases, Children's Hospital of Dongguan, Dongguan, Guangdong, China. .,Department of Medical and Molecular Genetics, Dongguan Institute of Pediatrics, Dongguan, Guangdong, China. .,Guangdong Medical University, Dongguan, Guangdong, China.
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Oliveira DB, Machado G, Almeida GMF, Ferreira PCP, Bonjardim CA, de Souza Trindade G, Abrahão JS, Kroon EG. First fatal case of CNS infection caused by Enterovirus A in Brazil. New Microbes New Infect 2015; 7:94-6. [PMID: 26442151 PMCID: PMC4552807 DOI: 10.1016/j.nmni.2015.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Revised: 06/16/2015] [Accepted: 06/18/2015] [Indexed: 11/30/2022] Open
Abstract
We describe what is to our knowledge the first fatal case of central nervous system Enterovirus infection in Brazil. Molecular and phylogenetic characterization revealed that Enterovirus A was the aetiologic agent of this case.
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Affiliation(s)
- D B Oliveira
- Laboratório de Vírus, Departamento de Microbiologia, Brazil
| | - G Machado
- Hospital Risoleta Tolentino Neves, Universidade Federal de Minas Gerais, Minas Gerais, Brazil
| | - G M F Almeida
- Laboratório de Vírus, Departamento de Microbiologia, Brazil
| | - P C P Ferreira
- Laboratório de Vírus, Departamento de Microbiologia, Brazil
| | - C A Bonjardim
- Laboratório de Vírus, Departamento de Microbiologia, Brazil
| | | | - J S Abrahão
- Laboratório de Vírus, Departamento de Microbiologia, Brazil
| | - E G Kroon
- Laboratório de Vírus, Departamento de Microbiologia, Brazil
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Li W, Zhang X, Chen X, Cheng YP, Wu YD, Shu Q, Chen XJ, Shang SQ. Epidemiology of childhood enterovirus infections in Hangzhou, China. Virol J 2015; 12:58. [PMID: 25884568 PMCID: PMC4403759 DOI: 10.1186/s12985-015-0294-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 04/04/2015] [Indexed: 11/25/2022] Open
Abstract
Background There are over 100 serotypes of enterovirus species A-D, which are the common cause of various symptoms in infants, such as meningitis, encephalitis and hand foot mouth disease (HFMD). This study aims to investigate the epidemiological characteristics of enteroviruses in Hangzhou, Zhejiang province, China, and to provide relevant information to guide public health responses and interventions. Methods Systematic surveillance was conducted on enterovirus infections. Samples were collected from children admitted to the inpatient wards and outpatient departments between January 2010 and December 2012 in the Children’s Hospital, Zhejiang University School of Medicine. Enteroviruses from all specimens were detected by RT-PCR using a commercialized detection kit. Results From 13026 samples collected and examined, 2673 (21.21%) were found positive for enteroviruses. The annual enterovirus-positive rate decreased from 32.78% in 2010 to 14.23% in 2012. Positivity rate for enteroviruses was highest among children aged less than 5 years. The monthly positivity rate for enterovirus infection ranged from 2.6% to 34.83%, with a peak in June and July. Serotypes causing severe symptoms such as HFMD including EV71 and CA16 were decreasing, while the proportion of unidentified EV serotypes causing herpangina and viral encephalitis were on the rise. Conclusions EV infection is highly prevalent among young children in Hangzhou, as it is in the most other parts of the world. Further surveillance using methods that can subtype all EVs is warranted to better monitor these infections and their etiology.
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Affiliation(s)
- Wei Li
- Department of Clinical Laboratory, Children's Hospital of Zhejiang University School of Medicine, 3333 Binsheng road, Hangzhou, 310003, China.
| | - Xiao Zhang
- Department of Clinical Laboratory, Children's Hospital of Zhejiang University School of Medicine, 3333 Binsheng road, Hangzhou, 310003, China.
| | - Xi Chen
- Department of Clinical Laboratory, Children's Hospital of Zhejiang University School of Medicine, 3333 Binsheng road, Hangzhou, 310003, China.
| | - Yu-Ping Cheng
- Department of Clinical Laboratory, Children's Hospital of Zhejiang University School of Medicine, 3333 Binsheng road, Hangzhou, 310003, China.
| | - Yi-Dong Wu
- Department of Clinical Laboratory, Children's Hospital of Zhejiang University School of Medicine, 3333 Binsheng road, Hangzhou, 310003, China.
| | - Qiang Shu
- Department of Clinical Laboratory, Children's Hospital of Zhejiang University School of Medicine, 3333 Binsheng road, Hangzhou, 310003, China.
| | - Xue-Jun Chen
- Department of Clinical Laboratory, Children's Hospital of Zhejiang University School of Medicine, 3333 Binsheng road, Hangzhou, 310003, China.
| | - Shi-Qiang Shang
- Department of Clinical Laboratory, Children's Hospital of Zhejiang University School of Medicine, 3333 Binsheng road, Hangzhou, 310003, China.
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