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Kordi R, Chang AJ, Hicar MD. Seasonal Testing, Results, and Effect of the Pandemic on Coxsackievirus Serum Studies. Microorganisms 2024; 12:367. [PMID: 38399771 PMCID: PMC10893248 DOI: 10.3390/microorganisms12020367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/25/2024] Open
Abstract
Coxsackieviruses (CVs) are common causes of infections and can be life-threatening. Unfortunately, rigorous studies guiding the clinician in interpreting CV serum antibody titer testing is lacking. To explore the epidemiology of circulating CVs and the serological test utility in aiding diagnosis of CV infections in our community, we obtained results of CV immunologic diagnostic tests between 2018 and 2022 from a regional healthcare database. For CV type A, rare individuals had positive CF (complement fixation) tests whereas all 16 individuals with IFA testing showed at least one positive serotype. For CV type B CF testing, 52.2% of 222 patients had at least one serotype positive, with B5 being most common and also the most common with higher titers (14.8% with ≥1:32). We found a significant reduction in seropositivity rate during the pandemic in 2020 compared to 2018, which continued through 2022 (OR: 0.2, 95% CI: 0.08-0.49, p-value < 0.001). During the pandemic, the seasonal pattern of positive tests varied from the pre-pandemic pattern. Testing for CVs was increased after the first year of the pandemic. Overall, the variability by month and seasonal change in our data support that CF testing can be used to identify recent CVB infection.
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Affiliation(s)
- Ramesh Kordi
- Department of Pediatric Infectious Diseases, State University of New York at Buffalo, Buffalo, NY 14203, USA;
| | - Arthur J. Chang
- Division of Pediatric Infectious Diseases, University of Nebraska Medical Center, Omaha, NE 68198, USA;
| | - Mark D. Hicar
- Department of Pediatric Infectious Diseases, State University of New York at Buffalo, Buffalo, NY 14203, USA;
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Wan Y, Song P, Liu J, Xu X, Lei X. A hybrid model for hand-foot-mouth disease prediction based on ARIMA-EEMD-LSTM. BMC Infect Dis 2023; 23:879. [PMID: 38102558 PMCID: PMC10722819 DOI: 10.1186/s12879-023-08864-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 12/04/2023] [Indexed: 12/17/2023] Open
Abstract
BACKGROUND Hand, foot, and mouth disease (HFMD) is a common infectious disease that poses a serious threat to children all over the world. However, the current prediction models for HFMD still require improvement in accuracy. In this study, we proposed a hybrid model based on autoregressive integrated moving average (ARIMA), ensemble empirical mode decomposition (EEMD) and long short-term memory (LSTM) to predict the trend of HFMD. METHODS The data used in this study was sourced from the National Clinical Research Center for Child Health and Disorders, Chongqing, China. The daily reported incidence of HFMD from 1 January 2015 to 27 July 2023 was collected to develop an ARIMA-EEMD-LSTM hybrid model. ARIMA, LSTM, ARIMA-LSTM and EEMD-LSTM models were developed to compare with the proposed hybrid model. Root mean square error (RMSE), mean absolute error (MAE) and coefficient of determination (R2) were adopted to evaluate the performances of the prediction models. RESULTS Overall, ARIMA-EEMD-LSTM model achieved the most accurate prediction for HFMD, with RMSE, MAPE and R2 of 4.37, 2.94 and 0.996, respectively. Performing EEMD on the residual sequence yields 11 intrinsic mode functions. EEMD-LSTM model is the second best, with RMSE, MAPE and R2 of 6.20, 3.98 and 0.996. CONCLUSION Results showed the advantage of ARIMA-EEMD-LSTM model over the ARIMA model, the LSTM model, the ARIMA-LSTM model and the EEMD-LSTM model. For the prevention and control of epidemics, the proposed hybrid model may provide a more powerful help. Compared with other three models, the two integrated with EEMD method showed significant improvement in predictive capability, offering novel insights for modeling of disease time series.
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Affiliation(s)
- Yiran Wan
- School of Public Health, Chongqing Medical University, Chongqing, China
- Research Center for Medicine and Social Development, Chongqing, China
- Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing, China
- Research Center for Public Health Security, Chongqing Medical University, No1 Medical College Rd, Yuzhong District, Chongqing, 400016, People's Republic of China
| | - Ping Song
- Big Data Center for Children's Medical Care, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, No 136. Zhongshan 2Nd Rd, Yuzhong District, Chongqing, 400014, People's Republic of China
| | - Jiangchen Liu
- School of Mathematical Science, Chongqing Normal University, Chongqing, China
| | - Ximing Xu
- Big Data Center for Children's Medical Care, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, No 136. Zhongshan 2Nd Rd, Yuzhong District, Chongqing, 400014, People's Republic of China.
| | - Xun Lei
- School of Public Health, Chongqing Medical University, Chongqing, China.
- Research Center for Medicine and Social Development, Chongqing, China.
- Collaborative Innovation Center of Social Risks Governance in Health, Chongqing Medical University, Chongqing, China.
- Research Center for Public Health Security, Chongqing Medical University, No1 Medical College Rd, Yuzhong District, Chongqing, 400016, People's Republic of China.
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Wang Y, Ji W, Li D, Sun T, Zhu P, Li J, Zhang L, Zhang Y, Yang H, Chen S, Jin Y, Duan G. Active inoculation with an inactivated Coxsackievirus A2 vaccine induces neutralizing antibodies and protects mice against lethal infection. Vaccine 2023; 41:6470-6482. [PMID: 37718187 DOI: 10.1016/j.vaccine.2023.08.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 08/29/2023] [Accepted: 08/29/2023] [Indexed: 09/19/2023]
Abstract
Coxsackievirus A2 (CVA2) is one of the causative agents of hand-foot-and-mouth disease (HFMD), which poses a great challenge for global public health. However, presently, there are no available commercial vaccines or antivirals to prevent CVA2 infection. Here, we present an inactivated Vero cell-based whole CVA2 vaccine candidate and evaluate its safety and efficacy in this study. Neonatal BALB/c mice were vaccinated at 5 and 7 days old, respectively, and then challenged with either homologous or heterologous strain of CVA2 at a lethal dose at 10 days old. The inactivated whole CVA2 vaccine candidate showed a high protective efficacy. Additionally, our inactivated vaccine stimulated the production of CVA2-specific IgG1 and IgG2a antibodies in vivo and high titers of neutralization antibodies (NtAbs) in the serum of immunized mice. Maternal immunization with the inactivated CVA2 vaccine provided full protection to pups against lethal infection. Compared with mice inoculated with only alum, the viral loads were decreased, and pathological changes were relieved in tissue samples of immunized mice. Moreover, the transcription levels of some genes related to cytokines (IFN-γ and TNF-α, MCP-1, IL-6, CXCL-10 etc.) were significantly reduced. The number of immune cells and levels of cytokines in peripheral blood of mice inoculated with only alum were higher than that of immunized mice. It is noteworthy that this vaccine showed a good cross-immunity efficacy against Enterovirus A71 (EVA71) challenge. In conclusion, our findings suggest that this experimental inactivated CVA2 vaccine is a promising component of polyvalent vaccines related to HFMD in the near future.
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Affiliation(s)
- Yuexia Wang
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou 450001, Henan, China; Academy of Medical Science, Zhengzhou University, Zhengzhou 450001, Henan, China; Department of Infectious Disease Control and Prevention, Jiangshan Center for Disease Control and Prevention, Jiangshan 324100, Zhejiang, China
| | - Wangquan Ji
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou 450001, Henan, China; Academy of Medical Science, Zhengzhou University, Zhengzhou 450001, Henan, China
| | - Dong Li
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou 450001, Henan, China; Academy of Medical Science, Zhengzhou University, Zhengzhou 450001, Henan, China
| | - Tiantian Sun
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou 450001, Henan, China; Academy of Medical Science, Zhengzhou University, Zhengzhou 450001, Henan, China
| | - Peiyu Zhu
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou 450001, Henan, China; Academy of Medical Science, Zhengzhou University, Zhengzhou 450001, Henan, China
| | - Junwei Li
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou 450001, Henan, China; Department of Infectious Disease Control and Prevention, Jiangshan Center for Disease Control and Prevention, Jiangshan 324100, Zhejiang, China
| | - Liang Zhang
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou 450001, Henan, China; Academy of Medical Science, Zhengzhou University, Zhengzhou 450001, Henan, China
| | - Yu Zhang
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou 450001, Henan, China
| | - Haiyan Yang
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou 450001, Henan, China
| | - Shuaiyin Chen
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou 450001, Henan, China
| | - Yuefei Jin
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou 450001, Henan, China.
| | - Guangcai Duan
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou 450001, Henan, China; Academy of Medical Science, Zhengzhou University, Zhengzhou 450001, Henan, China.
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Wu Z, Zhu S, Qian J, Hu Y, Ji W, Li D, Zhu P, Liang R, Jin Y. Analysis of miRNAs Involved in Mouse Heart Injury Upon Coxsackievirus A2 Infection. Front Cell Infect Microbiol 2022; 12:765445. [PMID: 35155276 PMCID: PMC8831793 DOI: 10.3389/fcimb.2022.765445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 01/03/2022] [Indexed: 12/03/2022] Open
Abstract
Coxsackievirus A2 (CVA2) has recently been constantly detected, and is associated with viral myocarditis in children. Our previous study demonstrated that CVA2 led to heart damage in a neonatal murine model. However, the molecular mechanism of heart injury caused by CVA2 remains largely unknown. Emerging evidence suggests the significant functions of miRNAs in Coxsackievirus infection. To investigate potential miRNAs involved in heart injury caused by CVA2, our study, for the first time, conducted a RNA-seq in vivo employing infected mice hearts. In total, 87, 101 and 76 differentially expressed miRNAs were identified at 3 days post infection (dpi), 7 dpi and 7 dpi vs 3 dpi. Importantly, above 3 comparison strategies shared 34 differentially expressed miRNAs. These results were confirmed by quantitative PCR (qPCR). Next, we did GO, KEGG, and miRNA-mRNA integrated analysis of differential miRNAs. The dual-luciferase reporter assay confirmed the miRNA-mRNA pairs. To further confirm the above enriched pathways and processes, we did Western blotting and immunofluorescence staining. Our results suggest that inflammatory responses, T cell activation, apoptosis, autophagy, antiviral immunity, NK cell infiltration, and the disruption of tight junctions are involved in the pathogenesis of heart injury caused by CVA2. The dysregulated miRNAs and pathways recognized in the current study can improve the understanding of the intricate interactions between CVA2 and the heart injury, opening a novel avenue for the future study of CVA2 pathogenesis.
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Affiliation(s)
- Zhaoke Wu
- Department of Gerontology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shenshen Zhu
- Department of Gerontology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Juanfeng Qian
- Department of Gerontology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanmin Hu
- Department of Gerontology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wangquan Ji
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Dong Li
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Peiyu Zhu
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Ruonan Liang
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yuefei Jin
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
- *Correspondence: Yuefei Jin,
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Yu Y, Luo Z, Jin W, Mai J, Qian S, Lu J, Wei Z, Meng S, Wang Z, Guan X, Tong Y, Shen S. Emergence of a novel recombinant of CV-A5 in HFMD epidemics in Xiangyang, China. BMC Med Genomics 2021; 14:279. [PMID: 34819054 PMCID: PMC8611921 DOI: 10.1186/s12920-021-01107-6] [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: 01/19/2021] [Accepted: 10/21/2021] [Indexed: 11/19/2022] Open
Abstract
Background Hand, foot and mouth disease (HFMD) is caused by a variety of enterovirus serotypes and the etiological spectrum worldwide has changed since a large scale of outbreaks occurred in 1997. Methods A large number of clinical specimens of HFMD patients were collected in Xiangyang and genotyping was performed by qRT-PCR, conventional PCR amplification and sequencing. Among the 146 CV-A5 detected cases, the complete genome sequences of representative strains were determined for genotyping and for recombination analysis. Results It was found that CV-A5 was one of the six major serotypes that caused the epidemic from October 2016 to December 2017. Phylogenetic analyses based on the VP1 sequences showed that these CV-A5 belonged to the genotype D which dominantly circulated in China. Recombination occurred between the CV-A5 and CV-A2 strains with a breakpoint in the 2A region at the nucleotide 3791. Conclusions The result may explain the emergence of CV-A5 as one of the major pathogens of HFMD. A multivalent vaccine against HFMD is urgently needed to control the disease and to prevent emerging and spreading of new recombinants.
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Affiliation(s)
- Yuting Yu
- Wuhan Institute of Biological Products, Co. Ltd, Wuhan, 430207, People's Republic of China
| | - Zhiyu Luo
- Wuhan Institute of Biological Products, Co. Ltd, Wuhan, 430207, People's Republic of China
| | - Weiping Jin
- Wuhan Institute of Biological Products, Co. Ltd, Wuhan, 430207, People's Republic of China
| | - Jianyi Mai
- Wuhan Institute of Biological Products, Co. Ltd, Wuhan, 430207, People's Republic of China
| | - Shasha Qian
- Wuhan Institute of Biological Products, Co. Ltd, Wuhan, 430207, People's Republic of China
| | - Jia Lu
- Wuhan Institute of Biological Products, Co. Ltd, Wuhan, 430207, People's Republic of China
| | - Zhenni Wei
- Wuhan Institute of Biological Products, Co. Ltd, Wuhan, 430207, People's Republic of China
| | - Shengli Meng
- Wuhan Institute of Biological Products, Co. Ltd, Wuhan, 430207, People's Republic of China
| | - Zejun Wang
- Wuhan Institute of Biological Products, Co. Ltd, Wuhan, 430207, People's Republic of China
| | - Xuhua Guan
- Xiangyang Center for Disease Control and Prevention, Hubei, People's Republic of China.
| | - Yeqing Tong
- Xiangyang Center for Disease Control and Prevention, Hubei, People's Republic of China.
| | - Shuo Shen
- Wuhan Institute of Biological Products, Co. Ltd, Wuhan, 430207, People's Republic of China.
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The Disruption of the Endothelial Barrier Contributes to Acute Lung Injury Induced by Coxsackievirus A2 Infection in Mice. Int J Mol Sci 2021; 22:ijms22189895. [PMID: 34576058 PMCID: PMC8467819 DOI: 10.3390/ijms22189895] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/15/2021] [Accepted: 09/10/2021] [Indexed: 01/10/2023] Open
Abstract
Sporadic occurrences and outbreaks of hand, foot, and mouth disease (HFMD) caused by Coxsackievirus A2 (CVA2) have frequently reported worldwide recently, which pose a great challenge to public health. Epidemiological studies have suggested that the main cause of death in critical patients is pulmonary edema. However, the pathogenesis of this underlying comorbidity remains unclear. In this study, we utilized the 5-day-old BALB/c mouse model of lethal CVA2 infection to evaluate lung damage. We found that the permeability of lung microvascular was significantly increased after CVA2 infection. We also observed the direct infection and apoptosis of lung endothelial cells as well as the destruction of tight junctions between endothelial cells. CVA2 infection led to the degradation of tight junction proteins (e.g., ZO-1, claudin-5, and occludin). The gene transcription levels of von Willebrand factor (vWF), endothelin (ET), thrombomodulin (THBD), granular membrane protein 140 (GMP140), and intercellular cell adhesion molecule-1 (ICAM-1) related to endothelial dysfunction were all significantly increased. Additionally, CVA2 infection induced the increased expression of inflammatory cytokines (IL-6, IL-1β, and MCP-1) and the activation of p38 mitogen-activated protein kinase (MAPK). In conclusion, the disruption of the endothelial barrier contributes to acute lung injury induced by CVA2 infection; targeting p38-MAPK signaling may provide a therapeutic approach for pulmonary edema in critical infections of HFMD.
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Ji W, Zhu P, Liang R, Zhang L, Zhang Y, Wang Y, Zhang W, Tao L, Chen S, Yang H, Jin Y, Duan G. Coxsackievirus A2 Leads to Heart Injury in a Neonatal Mouse Model. Viruses 2021; 13:v13081588. [PMID: 34452454 PMCID: PMC8402683 DOI: 10.3390/v13081588] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 07/30/2021] [Accepted: 08/02/2021] [Indexed: 12/12/2022] Open
Abstract
Coxsackievirus A2 (CVA2) has emerged as an active pathogen that has been implicated in hand, foot, and mouth disease (HFMD) and herpangina outbreaks worldwide. It has been reported that severe cases with CVA2 infection develop into heart injury, which may be one of the causes of death. However, the mechanisms of CVA2-induced heart injury have not been well understood. In this study, we used a neonatal mouse model of CVA2 to investigate the possible mechanisms of heart injury. We detected CVA2 replication and apoptosis in heart tissues from infected mice. The activity of total aspartate transaminase (AST) and lactate dehydrogenase (LDH) was notably increased in heart tissues from infected mice. CVA2 infection also led to the disruption of cell-matrix interactions in heart tissues, including the increases of matrix metalloproteinase (MMP)3, MMP8, MMP9, connective tissue growth factor (CTGF) and tissue inhibitors of metalloproteinases (TIMP)4. Infiltrating leukocytes (CD45+ and CD11b+ cells) were observed in heart tissues of infected mice. Correspondingly, the expression levels of inflammatory cytokines in tissue lysates of hearts, including tumor necrosis factor alpha (TNF-α), interleukin-1beta (IL-1β), IL6 and monocyte chemoattractant protein-1 (MCP-1) were significantly elevated in CVA2 infected mice. Inflammatory signal pathways in heart tissues, including phosphatidylinositol 3-kinase (PI3K)-AKT, mitogen-activated protein kinases (MAPK) and nuclear factor kappa B (NF-κB), were also activated after infection. In summary, CVA2 infection leads to heart injury in a neonatal mouse model, which might be related to viral replication, increased expression levels of MMP-related enzymes and excessive inflammatory responses.
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Affiliation(s)
- Wangquan Ji
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou 450001, China; (W.J.); (P.Z.); (R.L.); (L.Z.); (Y.Z.); (Y.W.); (S.C.); (H.Y.)
| | - Peiyu Zhu
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou 450001, China; (W.J.); (P.Z.); (R.L.); (L.Z.); (Y.Z.); (Y.W.); (S.C.); (H.Y.)
| | - Ruonan Liang
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou 450001, China; (W.J.); (P.Z.); (R.L.); (L.Z.); (Y.Z.); (Y.W.); (S.C.); (H.Y.)
| | - Liang Zhang
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou 450001, China; (W.J.); (P.Z.); (R.L.); (L.Z.); (Y.Z.); (Y.W.); (S.C.); (H.Y.)
| | - Yu Zhang
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou 450001, China; (W.J.); (P.Z.); (R.L.); (L.Z.); (Y.Z.); (Y.W.); (S.C.); (H.Y.)
| | - Yuexia Wang
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou 450001, China; (W.J.); (P.Z.); (R.L.); (L.Z.); (Y.Z.); (Y.W.); (S.C.); (H.Y.)
| | - Weiguo Zhang
- Department of Immunology, Duke University Medical Center, Durham, NC 27710, USA;
| | - Ling Tao
- School of Public Health, Xinxiang Medical University, Xinxiang 453003, China;
| | - Shuaiyin Chen
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou 450001, China; (W.J.); (P.Z.); (R.L.); (L.Z.); (Y.Z.); (Y.W.); (S.C.); (H.Y.)
| | - Haiyan Yang
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou 450001, China; (W.J.); (P.Z.); (R.L.); (L.Z.); (Y.Z.); (Y.W.); (S.C.); (H.Y.)
| | - Yuefei Jin
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou 450001, China; (W.J.); (P.Z.); (R.L.); (L.Z.); (Y.Z.); (Y.W.); (S.C.); (H.Y.)
- Correspondence: (Y.J.); (G.D.)
| | - Guangcai Duan
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou 450001, China; (W.J.); (P.Z.); (R.L.); (L.Z.); (Y.Z.); (Y.W.); (S.C.); (H.Y.)
- Henan Key Laboratory of Molecular Medicine, Zhengzhou University, Zhengzhou 450001, China
- Correspondence: (Y.J.); (G.D.)
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Ji W, Qin L, Tao L, Zhu P, Liang R, Zhou G, Chen S, Zhang W, Yang H, Duan G, Jin Y. Neonatal Murine Model of Coxsackievirus A2 Infection for the Evaluation of Antiviral Therapeutics and Vaccination. Front Microbiol 2021; 12:658093. [PMID: 34122374 PMCID: PMC8192712 DOI: 10.3389/fmicb.2021.658093] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/30/2021] [Indexed: 01/08/2023] Open
Abstract
Coxsackievirus (CV) A2 has emerged as an important etiological agent in the pathogen spectrum of hand, foot, and mouth disease (HFMD). The symptoms of CVA2 infections are generally mild, but worsen rapidly in some people, posing a serious threat to children’s health. However, compared with enterovirus 71 detected frequently in fatal cases, limited attention has been paid to CVA2 infections because of its benign clinical course. In the present study, we identified three CVA2 strains from HFMD infections and used the cell-adapted CVA2 strain HN202009 to inoculate 5-day-old BALB/c mice intramuscularly. These mice developed remarkably neurological symptoms such as ataxia, hind-limb paralysis, and death. Histopathological determination showed neuronophagia, pulmonary hemorrhage, myofiberlysis and viral myocarditis. Viral replication was detected in multiple organs and tissues, and CVA2 exhibited strong tropism to muscle tissue. The severity of illness was associated with abnormally high levels of inflammatory cytokines, including interleukin (IL)-6, IL-10, tumor necrosis factor α, and monocyte chemotactic protein 1, although the blockade of these proinflammatory cytokines had no obvious protection. We also tested whether an experimental formaldehyde-inactivated CVA2 vaccine could induce protective immune response in adult mice. The CVA2 antisera from the vaccinated mice were effective against CVA2 infection. Moreover, the inactivated CVA2 vaccine could successfully generate immune protection in neonatal mice. Our results indicated that the neonatal mouse model could be a useful tool to study CVA2 infection and to develop CVA2 vaccines.
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Affiliation(s)
- Wangquan Ji
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Luwei Qin
- Henan Province Center for Disease Control and Prevention, Zhengzhou, China
| | - Ling Tao
- School of Public Health, Xinxiang Medical University, Xinxiang, China
| | - Peiyu Zhu
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Ruonan Liang
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Guangyuan Zhou
- School of Public Health, Xinxiang Medical University, Xinxiang, China
| | - Shuaiyin Chen
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Weiguo Zhang
- Department of Immunology, Duke University Medical Center, Durham, NC, United States
| | - Haiyan Yang
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Guangcai Duan
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yuefei Jin
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
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Ai Y, Zhang W, Wu J, Zhang J, Shen M, Yao S, Deng C, Li X, Wu D, Tian P, Cheng X, Zha H, Wu K. Molecular Epidemiology and Clinical Features of Enteroviruses-Associated Hand, Foot, and Mouth Disease and Herpangina Outbreak in Zunyi, China, 2019. Front Med (Lausanne) 2021; 8:656699. [PMID: 33981716 PMCID: PMC8109248 DOI: 10.3389/fmed.2021.656699] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/31/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Hand, foot and mouth disease (HFMD) and herpangina (HA), two of the most common childhood infectious diseases, are associated with enteroviruses (EVs) infection. The aim of this study was to identify the molecular epidemiology of enterovirus causing HFMD/HA in Zunyi, China, during 2019, and to describe the clinical features of the cases. Methods: We collected the information on demographic and clinical characteristics, laboratory data of laboratory-confirmed EVs associated HFMD/HA cases in Zunyi Medical University Third Affiliated Hospital between March 1 and July 31, 2019. EV types were determined by either one-step real time RT-PCR or partial VP1 gene sequencing and sequence alignment. Phylogenetic analysis of CVA6, CVA2, and CVA5 were established based on the partial VP1 gene sequences by neighbor-joining method. Differences in clinical characteristics and laboratory results of the cases were compared among patients infected with the most prevalent EV types. Results: From 1 March to 31 July 2019, 1,377 EVs associated HFMD/HA inpatients were confirmed. Of them, 4 (0.3%, 4/1,377) were EV-A71-associated cases, 84 (6.1%, 84/1,377) were CVA16-associated cases, and 1,289 (93.6%, 1,289/1,377) were non-EV-A71/CVA16-associated cases. Of the randomly selected 372 non-EV-A71/CVA16 cases, EV types have been successfully determined in 273 cases including 166 HFMD and 107 HA cases. For HFMD cases, the three most common types were CVA6 (80.7%, 134/166), CVA2 (5.4%, 9/166) and CVA5 (3.0%, 5/166); similarly, for HA cases, the three most prevalent serotypes were CVA6 (36.5%, 39/107), CVA2 (21.5%, 23/107) and CVA5 (18.7%, 20/107). Phylogenetic analysis showed that subclade D of CVA5, and subclade E of CVA6 and CVA2 were predominant in Zunyi during the outbreak in 2019. Compared with the cases caused by CVA16, the incidence of high fever and severe infection associated with CVA2, CVA5, and CVA6 was higher. Conclusions: The recent HFMD/HA outbreak in Zunyi is due to a larger incidence of CVA6, CVA2, and CVA5. Novel diagnostic reagents and vaccines against these types would be important to monitor and control EV infections.
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Affiliation(s)
- Yuanhang Ai
- Department of Clinical Laboratory, Zunyi Medical University Third Affiliated Hospital, Zunyi, China
| | - Weiwei Zhang
- Department of Pediatrics and Child Health, Zunyi Medical University Third Affiliated Hospital, Zunyi, China
| | - Jie Wu
- Department of Scientific Research Laboratory, Zunyi Medical University Third Affiliated Hospital, Zunyi, China
| | - Jingzhi Zhang
- Department of Clinical Laboratory, Zunyi Medical University Third Affiliated Hospital, Zunyi, China
| | - Meijing Shen
- Department of Clinical Laboratory, Zunyi Medical University Third Affiliated Hospital, Zunyi, China
| | - Shifei Yao
- Department of Clinical Laboratory, Zunyi Medical University Third Affiliated Hospital, Zunyi, China
| | - Chengmin Deng
- Department of Scientific Research Laboratory, Zunyi Medical University Third Affiliated Hospital, Zunyi, China
| | - Xiaoqian Li
- Department of Scientific Research Laboratory, Zunyi Medical University Third Affiliated Hospital, Zunyi, China
| | - Dejing Wu
- Department of Scientific Research Laboratory, Zunyi Medical University Third Affiliated Hospital, Zunyi, China
| | - Peng Tian
- Department of Scientific Research Laboratory, Zunyi Medical University Third Affiliated Hospital, Zunyi, China
| | - Xiaoju Cheng
- Department of Scientific Research Laboratory, Zunyi Medical University Third Affiliated Hospital, Zunyi, China
| | - He Zha
- Department of Clinical Laboratory, Zunyi Medical University Third Affiliated Hospital, Zunyi, China
| | - Kaifeng Wu
- Department of Clinical Laboratory, Zunyi Medical University Third Affiliated Hospital, Zunyi, China.,Department of Scientific Research Laboratory, Zunyi Medical University Third Affiliated Hospital, Zunyi, China
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Zhao TS, Du J, Li HJ, Cui Y, Liu Y, Yang Y, Cui F, Lu QB. Molecular epidemiology and clinical characteristics of herpangina children in Beijing, China: a surveillance study. PeerJ 2020; 8:e9991. [PMID: 33088614 PMCID: PMC7568857 DOI: 10.7717/peerj.9991] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 08/28/2020] [Indexed: 11/20/2022] Open
Abstract
Background Herpangina is a highly infectious disease, which is usually prevalent in preschool children. Methods This study analyzed the clinical and pathogenic characteristics of herpangina children to demonstrate the epidemiology of herpangina. Clinical manifestations, laboratory indicators and pharyngeal swabs were collected from children with herpangina who were monitored by Tongzhou Center for Disease Control and Prevention in Beijing, 2008. Utilizing pharyngeal swabs, virus extraction and amplification were performed for nucleotide identification and sequencing. The phylogenetic analysis was conducted based on all sequences amplified in this study and strains retrieved from GenBank. Results Among 190 children with herpangina, 69.0% (131/190) were positive for enterovirus. Eight genotypes were identified, mainly including CV-A6 (39/131), CV-A4 (25/131), CV-A10 (24/131). The phylogenetic analysis showed one CV-A6 strain of Tongzhou was imported from Japan. CV-A10 strains were clustered into five groups (A-E). The dominant cluster of CV-A10 was Group E6 between 2009 and 2013, and converted to Group E5 after 2013. CV-A6 was the predominant pathogen causing herpangina in Tongzhou in 2018, followed by CV-A4 and CV-A10. Conclusions The circulation of coxsackievirus had spatiotemporal cluster. In controlling the transmission of herpangina, the surveillance and reporting system should be enhanced.
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Affiliation(s)
- Tian-Shuo Zhao
- Department of Laboratorial Science and Technology, School of Public Health, Peking University, Beijing, China.,Vaccine Research Center, School of Public Health, Peking University, Beijing, China
| | - Juan Du
- Department of Laboratorial Science and Technology, School of Public Health, Peking University, Beijing, China.,Vaccine Research Center, School of Public Health, Peking University, Beijing, China
| | - Hong-Jun Li
- Institute for Infectious Diseases and Endemic Diseases Prevention and Control, Beijing Tongzhou Center for Diseases Control and Prevention, Beijing, China
| | - Yan Cui
- Institute for Infectious Diseases and Endemic Diseases Prevention and Control, Beijing Tongzhou Center for Diseases Control and Prevention, Beijing, China
| | - Yaqiong Liu
- Department of Laboratorial Science and Technology, School of Public Health, Peking University, Beijing, China.,Vaccine Research Center, School of Public Health, Peking University, Beijing, China
| | - Yanna Yang
- Institute for Infectious Diseases and Endemic Diseases Prevention and Control, Beijing Tongzhou Center for Diseases Control and Prevention, Beijing, China
| | - Fuqiang Cui
- Department of Laboratorial Science and Technology, School of Public Health, Peking University, Beijing, China.,Vaccine Research Center, School of Public Health, Peking University, Beijing, China
| | - Qing-Bin Lu
- Department of Laboratorial Science and Technology, School of Public Health, Peking University, Beijing, China.,Vaccine Research Center, School of Public Health, Peking University, Beijing, China
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11
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Xu S, Li H, Qiao P, Xu G, Zhao D, Lin X, Qin Y, Yu H, Zhang X, Zhang W, Huang L. Neonatal hand, foot, and mouth disease due to coxsackievirus A6 in Shanghai. BMC Pediatr 2020; 20:364. [PMID: 32741368 PMCID: PMC7397588 DOI: 10.1186/s12887-020-02262-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 07/28/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Evidence of hand, foot, and mouth disease (HFMD) in neonates is limited. The aim of this study was to evaluate the clinical symptoms, pathogens, possible transmission routes, and prognosis of neonatal HFMD in Shanghai. METHODS This was a case-control study based on the HFMD registry surveillance system. All neonates and infected family members were enrolled between 2016 and 2017 in Shanghai. Neonates with HFMD were followed for at least half a year. Detailed questionnaires, medical history, and physical examination were recorded. Routine blood examination, liver and renal function, immunophenotypes of peripheral blood lymphocytes (CD3, CD4, and CD8 T-cells; NK cells), immunoglobulin (Ig) M, IgG, and IgA, and cytokine interleukin (IL-1β, IL-2R, IL-6, IL-8, IL-10, and TNF-α) levels were measured. All rectal swab specimens were collected and genotyped for enterovirus, and phylogenetic analysis based on the VP1 sequences of coxsackievirus A6 (CV-A6) was performed to investigate molecular and evolutionary characteristics. T-test or nonparametric test was used to evaluate the differences. Logistic analysis was applied to calculate the risk of clinical manifestations in the group of HFMD neonates and their paired siblings. RESULTS There were 16 neonates among the 12,608 diagnosed patients with HFMD, accounting for 0.13%. All neonatal infections were transmitted by other members of the family, mainly the elder siblings, and were caused by CV-A6. CV-A6 was the emerging and predominant causative agent of HFMD in Shanghai. None of the neonates with HFMD experienced fever, onychomadesis, or severe complications. However, two elder sibling patients showed lethargy, and one developed hypoperfusion. In the elder siblings with HFMD, the proportion of white blood cells was generally higher than in neonates with HFMD. The immunologic function of the neonates with HFMD was basically normal. The levels of inflammatory markers were higher in both neonates and elder siblings with HFMD compared to age-matched controls. The clinical symptoms receded about 1 week after onset. None of the neonates had sequelae. CONCLUSIONS In our study, CV-A6 infection in neonates was benign, but had the character of family clustering. Due to the two-child policy in China, elder siblings may be the main route of HFMD transmission.
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Affiliation(s)
- Shanshan Xu
- Department of Pediatric Infectious Diseases, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Huajun Li
- Department of Pediatric Infectious Diseases, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Peng Qiao
- Department of Infectious Disease Control, Yangpu District Centers for Disease Control and Prevention, Shanghai, 200093, China
| | - Guofeng Xu
- Department of Pediatric Surgery, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Dongying Zhao
- Department of Neonatology, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Xiaoyan Lin
- Department of Pediatric Internal Medicine, Hangzhou Children's Hospital, Hangzhou, 310000, Zhejiang Province, China
| | - Yu Qin
- Department of Pediatric Internal Medicine, Xingtai People's Hospital, Xingtai, 054001, Hebei Province, China
| | - Huiju Yu
- Department of Pediatric Infectious Diseases, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Xi Zhang
- Clinical Research Unit, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China
| | - Wanju Zhang
- Pathogen Diagnosis and Biosafety Department, Shanghai Public Health Clinical Center, Fudan University, Shanghai, 201508, China.
| | - Lisu Huang
- Department of Pediatric Infectious Diseases, Xinhua Hospital, Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, 200092, China.
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12
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Yang TO, Arthur Huang KY, Chen MH, Chen PC, Huang WT. Comparison of Nonpolio Enteroviruses in Children With Herpangina and Hand, Foot and Mouth Disease in Taiwan. Pediatr Infect Dis J 2019; 38:887-893. [PMID: 31033911 DOI: 10.1097/inf.0000000000002351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nonpolio enterovirus (NPEV) infections are often present with herpangina (HA) and hand, foot and mouth disease (HFMD). Most countries sample NPEVs in HFMD cases, targeting enterovirus A71 (EV-A71) and coxsackievirus A16 (CV-A16) that are associated with outbreaks and severe complications. HA is also monitored in Taiwan and several other countries, but its viral characteristics are underreported. METHODS Through Taiwan's National Virologic Surveillance, information regarding ~100,000 child respiratory samples (2002-2015) was linked to concurrent (0-6 days before the sampling date) outpatient records from the National Health Insurance databases, including ~15,000 HA-related and ~7000 HFMD-related samples. We assessed sample representation and NPEV positive rates, and estimated total numbers of EV-A71 and CV-A16. RESULTS There were more HA events (4.0 millions) than HFMD events (1.2 millions) in Taiwan. In every 1000 events with HFMD and HA, 6.0 and 4.1, respectively, respiratory samples were collected. The NPEV positive rate in HFMD-related samples was 48%, consistent across most sampling seasons, and predominantly EV-A71 or CV-A16 (74%). By comparison, the HA-related samples had a lower positive rate overall (43%), occasionally EV-A71 or CV-A16 (13%), and the positive rate depended strongly on HA incidence (P < 10). Compared with sampling HFMD alone, inclusion of HA-related information predicted an earlier onset of EV-A71 outbreak in 2011, and predicted 30% more EV-A71 cases. CONCLUSIONS This is the first representative report on viral characteristics of HA. Our findings confirm that HFMD monitoring is a reliable strategy, but there is a measurable additional benefit when HA is also monitored.
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Affiliation(s)
- TienYu Owen Yang
- From the Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Kuan-Ying Arthur Huang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan
| | - Mei-Huei Chen
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli
| | - Pau-Chung Chen
- Department of Public Health and Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health
- Department of Environmental and Occupational Medicine, National Taiwan University College of Medicine and Hospital
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13
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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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14
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Zhao Y, Zhang H, Liu H, Zhang J, He L, Sun H, Huang X, Yang Z, Ma S. Molecular characteristics of hand, foot, and mouth disease for hospitalized pediatric patients in Yunnan, China. Medicine (Baltimore) 2018; 97:e11610. [PMID: 30075535 PMCID: PMC6081097 DOI: 10.1097/md.0000000000011610] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 06/28/2018] [Indexed: 12/29/2022] Open
Abstract
Hand, foot, and mouth disease (HFMD) is a common infectious disease caused by multiple enteroviruses (EVs) in China. To better define the etiologic agents and clinical characteristics of HFMD, we conducted this study in Yunnan, China.In this study, 1280 stool specimens were collected from pediatric patients hospitalized for treatment of HFMD in 2010. EV was detected with nested reverse transcription polymerase chain reaction and directly genotyped by gene sequencing of the viral protein 1 (VP1) region. Phylogenetic analysis was performed based on the VP1 partial gene and the clinical characteristics were analyzed using SPSS Software.Of 1280 specimens, 1115 (87.1%) tested positive for EV. Seventeen different EV serotypes were detected. Coxsackievirus A16 (CA16) was the most frequently detected serotype (615/1115 cases, 55.1%), followed by enterovirus 71 (EV71; 392/1115, 35.2%), CA10 (45/1115, 4.0%), and CA4 (23/1115, 2.1%). Among the 709 severe cases, CA16, EV71, CA10, and CA4 accounted for 48.0%, 42.0%, 3.5%, and 2.3%, respectively. Of the 26 critical cases, 13 were caused by EV71, 9 by CA16, 2 by CA4, and 1 each were the result of CA10 and E9, respectively. All EV71, CA16, CA10, and CA4 isolates were highly homologous to the strains isolated from mainland China, and belonged to the C4a, B1a, G, and C genotypes, respectively.Our study showed that EV71 and CA16 were the main causative agents for severe and critical HFMD, but other serotypes can also cause severe and critical cases.
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Affiliation(s)
- Yilin Zhao
- Institute of Medical Biology, Chinese Academy of Medical Sciences, Peking Union Medical College
- Yunnan Key Laboratory of Vaccine Research Development on Severe Infectious Disease, Kunming, Yunnan, PR China
| | - Haihao Zhang
- Institute of Medical Biology, Chinese Academy of Medical Sciences, Peking Union Medical College
- Yunnan Key Laboratory of Vaccine Research Development on Severe Infectious Disease, Kunming, Yunnan, PR China
| | - Hongbo Liu
- Institute of Medical Biology, Chinese Academy of Medical Sciences, Peking Union Medical College
- Yunnan Key Laboratory of Vaccine Research Development on Severe Infectious Disease, Kunming, Yunnan, PR China
| | - Jie Zhang
- Institute of Medical Biology, Chinese Academy of Medical Sciences, Peking Union Medical College
- Yunnan Key Laboratory of Vaccine Research Development on Severe Infectious Disease, Kunming, Yunnan, PR China
| | - Licun He
- Institute of Medical Biology, Chinese Academy of Medical Sciences, Peking Union Medical College
- Yunnan Key Laboratory of Vaccine Research Development on Severe Infectious Disease, Kunming, Yunnan, PR China
| | - Hao Sun
- Institute of Medical Biology, Chinese Academy of Medical Sciences, Peking Union Medical College
- Yunnan Key Laboratory of Vaccine Research Development on Severe Infectious Disease, Kunming, Yunnan, PR China
| | - Xiaoqin Huang
- Institute of Medical Biology, Chinese Academy of Medical Sciences, Peking Union Medical College
- Yunnan Key Laboratory of Vaccine Research Development on Severe Infectious Disease, Kunming, Yunnan, PR China
| | - Zhaoqing Yang
- Institute of Medical Biology, Chinese Academy of Medical Sciences, Peking Union Medical College
- Yunnan Key Laboratory of Vaccine Research Development on Severe Infectious Disease, Kunming, Yunnan, PR China
| | - Shaohui Ma
- Institute of Medical Biology, Chinese Academy of Medical Sciences, Peking Union Medical College
- Yunnan Key Laboratory of Vaccine Research Development on Severe Infectious Disease, Kunming, Yunnan, PR China
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15
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Kraus CN, Sodha P, Kirkorian AY. A Child With a Blistering Rash. JAMA Pediatr 2018; 172:592-593. [PMID: 29610826 DOI: 10.1001/jamapediatrics.2017.5218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - Pooja Sodha
- Department of Dermatology, Georgetown University-Washington Hospital Center, Washington, DC
| | - A Yasmine Kirkorian
- Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC
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16
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Floods Increase the Risks of Hand-Foot-Mouth Disease in Qingdao, China, 2009-2013: A Quantitative Analysis. Disaster Med Public Health Prep 2018; 12:723-729. [PMID: 29734967 DOI: 10.1017/dmp.2017.154] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND We aimed to quantify the impact of few times floods on hand-foot-mouth disease (HFMD) in Qingdao during 2009-2013. METHODS The Spearman correlation test was applied to examine the lagged effects of floods on monthly morbidity of HFMD during study period in Qingdao. We further quantified the effects of 5 flood events on the morbidity of HFMD using the time-series Poisson regression controlling for climatic factors, seasonality, and lagged effects among different populations. RESULTS A total of 55,920 cases of HFMD were reported in the study region over the study period. The relative risks of floods on the morbidity of HFMD among the total population, males, females, under 1-2 years old, and 3-5 years old were 1.178, 1.165, 1.198, 1.338, and 1.245, respectively. CONCLUSIONS This study has, for the first time, provided the positive evidence of the impact of floods on HFMD. It demonstrates that floods can significantly increase the risk of HFMD during study period. Additionally, among the different populations, the risks were higher among children under 1-5 years old. (Disaster Med Public Health Preparedness. 2018;12:723-729).
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17
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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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18
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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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19
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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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Yan G, Jun L, Kangchen Z, Yiyue G, Yang Y, Xiaoyu Z, Zhiyang S, Lunbiao C. Rapid and visual detection of human enterovirus coxsackievirus A16 by reverse transcription loop-mediated isothermal amplification combined with lateral flow device. Lett Appl Microbiol 2015; 61:531-7. [PMID: 26399963 DOI: 10.1111/lam.12499] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Revised: 09/13/2015] [Accepted: 09/15/2015] [Indexed: 11/25/2022]
Abstract
UNLABELLED In this study, a reverse transcription loop-mediated isothermal amplification (RT-LAMP) combined with lateral flow device (LFD) technology to rapidly detect CVA16 was developed and evaluated. RT-LAMP assay was optimized to amplify VP1 gene of CVA16. Amplified products were analysed by LFD and capillary electrophoresis. The RT-LAMP-LFD assay showed 100% specificity in detecting CVA16, and showed analytical sensitivity of 0·55 TCID50 per reaction mixture. Comparison of the RT-LAMP-LFD assay with real-time RT-PCR developed previously in clinical specimens showed 93·3% agreement. The RT-LAMP-LFD assay is more sensitive in detecting CVA16 RNA. The RT-LAMP-LFD assay presented here might offer a rapid and simple alternative in clinical diagnosis of CVA16. SIGNIFICANCE AND IMPACT OF THE STUDY Coxsackievirus A16 (CVA16) is one of the major causative agents of hand, foot and mouth disease (HFMD). Rapid and reliable detection and typing of it can limit the spread. We developed a reverse transcription loop-mediated isothermal amplification (RT-LAMP) combined with lateral flow device (LFD) technology to rapidly detect CVA16. The high sensitivity and specificity and its ease of use make this assay ideal for use in resource-limited settings such as primary care facilities and clinical laboratories in developing countries.
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Affiliation(s)
- G Yan
- Department of Neonatology, Nanjing Children's Hospital, Nanjing Medical University, Nanjing, China
| | - L Jun
- Department of Emergency, Nanjing Children's Hospital, Nanjing Medical University, Nanjing, China
| | - Z Kangchen
- Key Laboratories of Enteric Pathogenic Microbiology (Ministry of Health), Institute of Pathogenic Microbiology, Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, China
| | - G Yiyue
- Key Laboratories of Enteric Pathogenic Microbiology (Ministry of Health), Institute of Pathogenic Microbiology, Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, China
| | - Y Yang
- Department of Neonatology, Nanjing Children's Hospital, Nanjing Medical University, Nanjing, China
| | - Z Xiaoyu
- Department of Neonatology, Nanjing Children's Hospital, Nanjing Medical University, Nanjing, China
| | - S Zhiyang
- Key Laboratories of Enteric Pathogenic Microbiology (Ministry of Health), Institute of Pathogenic Microbiology, Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, China
| | - C Lunbiao
- Key Laboratories of Enteric Pathogenic Microbiology (Ministry of Health), Institute of Pathogenic Microbiology, Jiangsu Provincial Center for Disease Prevention and Control, Nanjing, China
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Effect of Meteorological and Geographical Factors on the Epidemics of Hand, Foot, and Mouth Disease in Island-Type Territory, East Asia. BIOMED RESEARCH INTERNATIONAL 2015; 2015:805039. [PMID: 26290875 PMCID: PMC4531172 DOI: 10.1155/2015/805039] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 09/16/2014] [Accepted: 09/17/2014] [Indexed: 11/18/2022]
Abstract
Hand, foot, and mouth disease (HFMD) has threatened East Asia for more than three decades and has become an important public health issue owing to its severe sequelae and mortality among children. The lack of effective treatment and vaccine for HFMD highlights the urgent need for efficiently integrated early warning surveillance systems in the region. In this study, we try to integrate the available surveillance and weather data in East Asia to elucidate possible spatiotemporal correlations and weather conditions among different areas from low to high latitude. The general additive model (GAM) was applied to understand the association between HFMD and latitude, as well as meteorological factors for islands in East Asia, namely, Japan, Taiwan, Hong Kong, and Singapore, from 2012 to 2014. The results revealed that latitude was the most important explanatory factor associated with the timing and amplitude of HFMD epidemics (P < 0.0001). Meteorological factors including higher dew point, lower visibility, and lower wind speed were significantly associated with the rise of epidemics (P < 0.01). In summary, weather conditions and geographic location could play some role in affecting HFMD epidemics. Regional integrated surveillance of HFMD in East Asia is needed for mitigating the disease risk.
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Klein M, Chong P. Is a multivalent hand, foot, and mouth disease vaccine feasible? Hum Vaccin Immunother 2015; 11:2688-704. [PMID: 26009802 DOI: 10.1080/21645515.2015.1049780] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Enterovirus A infections are the primary cause of hand, foot and mouth disease (HFMD) in infants and young children. Although enterovirus 71 (EV-A71) and coxsackievirus A16 (CV-A16) are the predominant causes of HFMD epidemics worldwide, EV-A71 has emerged as a major neurovirulent virus responsible for severe neurological complications and fatal outcomes. HFMD is a serious health threat and economic burden across the Asia-Pacific region. Inactivated EV-A71 vaccines have elicited protection against EV-A71 but not against CV-A16 infections in large efficacy trials. The current development of a bivalent inactivated EV-A71/CV-A16 vaccine is the next step toward that of multivalent HFMD vaccines. These vaccines should ultimately include other prevalent pathogenic coxsackieviruses A (CV-A6 and CV-A10), coxsackieviruses B (B3 and B5) and echovirus 30 that often co-circulate during HFMD epidemics and can cause severe HFMD, aseptic meningitis and acute viral myocarditis. The prospect and challenges for the development of such multivalent vaccines are discussed.
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Affiliation(s)
| | - Pele Chong
- b Vaccine R&D Center; National Health Research Institutes ; Zhunan Town, Miaoli County , Taiwan.,c Graduate Institute of Immunology; China Medical University ; Taichung , Taiwan
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Complete sequence analysis and antiviral screening of medicinal plants for human coxsackievirus a16 isolated in Korea. Osong Public Health Res Perspect 2015; 6:52-8. [PMID: 25737832 PMCID: PMC4346589 DOI: 10.1016/j.phrp.2014.12.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 12/15/2014] [Accepted: 12/16/2014] [Indexed: 01/01/2023] Open
Abstract
Objectives Coxsackievirus A group 16 strain (CVA16) is one of the predominant causative agents of hand, foot, and mouth disease (HFMD). Methods Using a specimen from a male patient with HFMD, we isolated and performed sequencing of the Korean CVA16 strain and compared it with a G10 reference strain. Also, we were investigated the effects of medicinal plant extract on the cytopathic effects (CPE) by CPE reduction assay against Korean CVA16. Results Phylogenetic analysis showed that the Korean CVA16 isolate belonged to cluster B-1 and was closely related to the strain PM-15765-00 isolated in Malaysia in 2000. The Korean CVA16 isolate showed 73.2% nucleotide identity to the G10 prototype strain and 98.7% nucleotide identity to PM-15765-00. Next, we assessed whether the Korean CVA16 isolate could be used for in vitro screening of antiviral agents to treat HFMD infection. Vero cells infected with the Korean CVA16 isolate showed a cytopathic effect 2 days after the infection, and the treatment of cells with Cornus officinalis, Acer triflorum, Pulsatilla koreana, and Clematis heracleifolia var. davidiana Hemsl extracts exhibited strong antiviral activity against CVA16. Conclusion Collectively, our work provides potential candidates for the development of vaccine and novel drugs to treat the CVA16 strain isolated from a Korean patient.
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Huaman JL, Carrion G, Ampuero JS, Gomez J, Ocaña V, Paz I, Gomez E, Chavez E, Sarmiento F, Pozo E, Laguna-Torres VA, Halsey ES. Non-rhinovirus enteroviruses associated with respiratory infections in Peru (2005-2010). Virol J 2014; 11:169. [PMID: 25244984 PMCID: PMC4192742 DOI: 10.1186/1743-422x-11-169] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2014] [Accepted: 09/15/2014] [Indexed: 11/10/2022] Open
Abstract
Background Enteroviruses (EVs) are a common cause of respiratory tract infections and are classified into seven species (EVA-D and rhinoviruses [RHVs] A-C) with more than 200 different serotypes. Little is known about the role of non-RHV EVs in respiratory infections in South America. The aim of this study was to describe the epidemiology of non-RHV EVs detected in patients with influenza-like illness enrolled in a passive surveillance network in Peru. Methods Throat swabs and epidemiological data were collected from participants after obtaining verbal consent. Viral isolation was performed in cell culture and identified by immunofluorescence assay. Serotype identification of EV isolates was performed using commercial monoclonal antibodies. Identification of non-serotypeable isolations was carried out by reverse transcriptase-PCR, followed by sequencing. Results Between 2005 and 2010, 24,239 samples were analyzed, and 9,973 (41.1%) possessed at least one respiratory virus. EVs were found in 175 samples (0.7%). Our results revealed a clear predominance of EVB species, 90.9% (159/175). No EVDs were isolated. The mean and median ages of EV-positive subjects were 9.1 and 4.0 years, respectively, much younger than the population sampled, 17.6 and 12.0 years. Sixteen serotypes were identified, four EVA, 11 EVB, and one EVC species. The most common serotypes were coxsackievirus B1, coxsackievirus B2, coxsackievirus B5, and coxsackievirus B3. Conclusion This study provides data about the serotypes of EVs circulating in Peru and sets the need for further studies.
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Puenpa J, Mauleekoonphairoj J, Linsuwanon P, Suwannakarn K, Chieochansin T, Korkong S, Theamboonlers A, Poovorawan Y. Prevalence and characterization of enterovirus infections among pediatric patients with hand foot mouth disease, herpangina and influenza like illness in Thailand, 2012. PLoS One 2014; 9:e98888. [PMID: 24887237 PMCID: PMC4041783 DOI: 10.1371/journal.pone.0098888] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2013] [Accepted: 05/07/2014] [Indexed: 12/18/2022] Open
Abstract
Hand, foot, and mouth disease (HFMD) and herpangina are common infectious diseases caused by several genotypes of human enterovirus species A and frequently occurring in young children. This study was aimed at analyzing enteroviruses from patients with these diseases in Thailand in 2012. Detection and genotype determination of enteroviruses were accomplished by reverse transcription-polymerase chain reaction and sequencing of the VP1 region. Enterovirus-positive samples were differentiated into 17 genotypes (coxsackievirus A4 (CAV4), A5, A6, A8, A9, A10, A12, A16, A21, B1, B2, B4, B5, echovirus 7, 16, 25 and Enterovirus 71). The result showed CAV6 (33.5%), followed by CAV16 (9.4%) and EV71 (8.8%) as the most frequent genotypes in HFMD, CAV8 (19.3%) in herpangina and CAV6 (1.5%) in influenza like illness. Enterovirus infections were most prevalent during July with 34.4% in HFMD, 39.8% in herpangina and 1.6% in ILI. The higher enterovirus infection associated with HFMD and herpangina occurred in infants over one year-old. This represents the first report describing the circulation of multiple enteroviruses in Thailand.
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Affiliation(s)
- Jiratchaya Puenpa
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - John Mauleekoonphairoj
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Piyada Linsuwanon
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Kamol Suwannakarn
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Thaweesak Chieochansin
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sumeth Korkong
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Apiradee Theamboonlers
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Yong Poovorawan
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- * E-mail:
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Outbreak of herpangina in the Brazilian Amazon in 2009 caused by Enterovirus B. Arch Virol 2013; 159:1155-7. [PMID: 24197788 DOI: 10.1007/s00705-013-1858-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Accepted: 09/24/2013] [Indexed: 10/26/2022]
Abstract
In October 2009, our laboratory was contacted by a Brazilian Public Health organization regarding a severe community outbreak of an acute exanthematic and febrile disease in the Brazilian Amazon that primarily affected children. A total of 44 patients with febrile disease were identified by the local public health system, 37 of whom were children between 1 and 9 years of age. Molecular virological and phylogenetic characterization revealed that enterovirus B was the etiological agent of this outbreak, which was characterized by a clinical presentation known as herpangina.
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