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Ying L, Qiang S, Jinbo X, Binzhi R, Hua Z, Yong S, Shuaifeng Z, Mei H, Kangping Z, Jianping C, Yunting Z, Jianhua C, Qiong G, Yu J, Huanhuan L, Jichen L, Ruyi C, Tingting Y, Rui W, Yanjun Z, Tiantian S, Liheng Y, Xiaoyi W, Shuangli Z, Dongmei Y, Tianjiao J, Qian Y, Zhen Z, Yong Z. Genetic variation and evolutionary characteristics of Echovirus 11: new variant within genotype D5 associated with neonatal death found in China. Emerg Microbes Infect 2024; 13:2361814. [PMID: 38828746 PMCID: PMC11159588 DOI: 10.1080/22221751.2024.2361814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 05/26/2024] [Indexed: 06/05/2024]
Abstract
Echovirus 11 (E11) has gained attention owing to its association with severe neonatal infections. From 2018 to 2023, a surge in severe neonatal cases and fatalities linked to a novel variant of genotype D5 was documented in China, France, and Italy. However, the prevention and control of E11 variants have been hampered by limited background data on the virus circulation and genetic variance. Therefore, the present study investigated the circulating dynamics of E11 and the genetic variation and molecular evolution of genotype D5 through the collection of strains from the national acute flaccid paralysis (AFP) and hand, foot, and mouth disease (HFMD) surveillance system in China during 2000-2022 and genetic sequences published in the GenBank database. The results of this study revealed a prevalent dynamic of E11 circulation, with D5 being the predominant genotype worldwide. Further phylogenetic analysis of genotype D5 indicated that it could be subdivided into three important geographic clusters (D5-CHN1: 2014-2019, D5-CHN2: 2016-2022, and D5-EUR: 2022-2023). Additionally, variant-specific (144) amino acid mutation sites and positive-selection pressure sites (132, 262) were identified in the VP1 region. Cluster-specific recombination patterns were also identified, with CVB5, E6, and CVB4 as the major recombinant viruses. These findings provide a preliminary landscape of E11 circulation worldwide and basic scientific data for further study of the pathogenicity of E11 variants.
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Affiliation(s)
- Liu Ying
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases (NITFID), National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
- WHO WPRO Regional Polio Reference Laboratory, National Health Commission Key Laboratory for Biosafety, National Health Commission Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Sun Qiang
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases (NITFID), National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
- WHO WPRO Regional Polio Reference Laboratory, National Health Commission Key Laboratory for Biosafety, National Health Commission Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Xiao Jinbo
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases (NITFID), National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
- WHO WPRO Regional Polio Reference Laboratory, National Health Commission Key Laboratory for Biosafety, National Health Commission Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Ren Binzhi
- Pathogen Detection Laboratory, Shanxi Provincial Center for Disease Control and Prevention, Shanxi, People’s Republic of China
| | - Zhao Hua
- Pathogen Detection Laboratory, Chongqing Provincial Center for Disease Control and Prevention, Chongqing, People’s Republic of China
| | - Shi Yong
- Pathogen Detection Laboratory, Jiangxi Provincial Center for Disease Control and Prevention, Jiangxi, People’s Republic of China
| | - Zhou Shuaifeng
- Pathogen Detection Laboratory, Hunan Provincial Center for Disease Control and Prevention, Hunan, People’s Republic of China
| | - Hong Mei
- Pathogen Detection Laboratory, Xizang Provincial Center for Disease Control and Prevention, Xizang, People’s Republic of China
| | - Zhou Kangping
- Pathogen Detection Laboratory, Hubei Provincial Center for Disease Control and Prevention, Hubei, People’s Republic of China
| | - Cun Jianping
- Pathogen Detection Laboratory, Yunnan Provincial Center for Disease Control and Prevention, Yunnan, People’s Republic of China
| | - Zeng Yunting
- Pathogen Detection Laboratory, Hainan Provincial Center for Disease Control and Prevention, Hainan, People’s Republic of China
| | - Chen Jianhua
- Pathogen Detection Laboratory, Gansu Provincial Center for Disease Control and Prevention, Gansu, People’s Republic of China
| | - Ge Qiong
- Pathogen Detection Laboratory, Zhejiang Provincial Center for Disease Control and Prevention, Zhejiang, People’s Republic of China
| | - Ju Yu
- Pathogen Detection Laboratory, Guangxi Provincial Center for Disease Control and Prevention, Guangxi, People’s Republic of China
| | - Lu Huanhuan
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases (NITFID), National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
- WHO WPRO Regional Polio Reference Laboratory, National Health Commission Key Laboratory for Biosafety, National Health Commission Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Li Jichen
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases (NITFID), National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
- WHO WPRO Regional Polio Reference Laboratory, National Health Commission Key Laboratory for Biosafety, National Health Commission Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Cong Ruyi
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases (NITFID), National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
- WHO WPRO Regional Polio Reference Laboratory, National Health Commission Key Laboratory for Biosafety, National Health Commission Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Yang Tingting
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases (NITFID), National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
- WHO WPRO Regional Polio Reference Laboratory, National Health Commission Key Laboratory for Biosafety, National Health Commission Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Wang Rui
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases (NITFID), National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
- WHO WPRO Regional Polio Reference Laboratory, National Health Commission Key Laboratory for Biosafety, National Health Commission Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Zong Yanjun
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases (NITFID), National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
- WHO WPRO Regional Polio Reference Laboratory, National Health Commission Key Laboratory for Biosafety, National Health Commission Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Sun Tiantian
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases (NITFID), National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
- WHO WPRO Regional Polio Reference Laboratory, National Health Commission Key Laboratory for Biosafety, National Health Commission Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Yu Liheng
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases (NITFID), National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
- WHO WPRO Regional Polio Reference Laboratory, National Health Commission Key Laboratory for Biosafety, National Health Commission Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Wang Xiaoyi
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases (NITFID), National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
- WHO WPRO Regional Polio Reference Laboratory, National Health Commission Key Laboratory for Biosafety, National Health Commission Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Zhu Shuangli
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases (NITFID), National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
- WHO WPRO Regional Polio Reference Laboratory, National Health Commission Key Laboratory for Biosafety, National Health Commission Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Yan Dongmei
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases (NITFID), National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
- WHO WPRO Regional Polio Reference Laboratory, National Health Commission Key Laboratory for Biosafety, National Health Commission Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Ji Tianjiao
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases (NITFID), National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
- WHO WPRO Regional Polio Reference Laboratory, National Health Commission Key Laboratory for Biosafety, National Health Commission Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Yang Qian
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases (NITFID), National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
- WHO WPRO Regional Polio Reference Laboratory, National Health Commission Key Laboratory for Biosafety, National Health Commission Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Zhu Zhen
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases (NITFID), National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
- WHO WPRO Regional Polio Reference Laboratory, National Health Commission Key Laboratory for Biosafety, National Health Commission Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Zhang Yong
- National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases (NITFID), National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
- WHO WPRO Regional Polio Reference Laboratory, National Health Commission Key Laboratory for Biosafety, National Health Commission Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
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Novazzi F, Piralla A, Perniciaro S, Genoni AP, Ferrante FD, Giardina F, Ferrari G, Pellegrinelli L, Clementi N, Pariani E, Zanoni I, Baldanti F, Agosti M, Mancini N. A new case of Echovirus 11 neonatal fulminant hepatitis involving male twins in a Northern Italy Tertiary University Hospital: Insight on a possible immunological clue. IJID REGIONS 2024; 12:100411. [PMID: 39220203 PMCID: PMC11363566 DOI: 10.1016/j.ijregi.2024.100411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 09/04/2024]
Abstract
The European Center for Disease Prevention and Control has reported 19 cases of severe echovirus 11 infections in neonates since 2022, nine of which were fatal. We report a new fatal neonatal case that occurred in a male twin for which we evaluated the respiratory and intestinal mucosal innate immune response.
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Affiliation(s)
- Federica Novazzi
- University of Insubria, Department of Medicine and Technological Innovation Varese, Varese, Italy
- ASST Sette Laghi, Laboratory of Medical Microbiology and Virology, Varese, Italy
| | - Antonio Piralla
- Fondazione IRCCS Policlinico San Matteo, Microbiology and Virology Department, Pavia, Italy
| | - Simona Perniciaro
- Ospedale Filippo del Ponte Ostetricia e Ginecologia, Neonatology and NICU, Del Ponte Hospital, Varese, Italy
| | - Angelo Paolo Genoni
- University of Insubria, Department of Medicine and Technological Innovation Varese, Varese, Italy
- ASST Sette Laghi, Laboratory of Medical Microbiology and Virology, Varese, Italy
| | | | - Federica Giardina
- University of Pavia, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences Pavia, Pavia, Italy
| | - Guglielmo Ferrari
- Fondazione IRCCS Policlinico San Matteo, Microbiology and Virology Department, Pavia, Italy
| | - Laura Pellegrinelli
- University of Milan, Department of Biomedical Sciences for Health Milano, Milano, Italy
| | - Nicola Clementi
- IRCCS San Raffaele Hospital, Milan, Italy, Department of Biomedical Sciences for Health, Milano, Italy
| | - Elena Pariani
- University of Milan, Department of Biomedical Sciences for Health Milano, Milano, Italy
| | - Ivan Zanoni
- Harvard University, Boston Children's Hospital Cambridge, Cambridge, USA
| | - Fausto Baldanti
- Fondazione IRCCS Policlinico San Matteo, Microbiology and Virology Department, Pavia, Italy
- University of Pavia, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences Pavia, Pavia, Italy
| | - Massimo Agosti
- University of Insubria, Department of Medicine and Surgery, Varese, Italy
| | - Nicasio Mancini
- University of Insubria, Department of Medicine and Technological Innovation Varese, Varese, Italy
- ASST Sette Laghi, Laboratory of Medical Microbiology and Virology, Varese, Italy
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Loconsole D, Centrone F, Sallustio A, Casulli D, Zagaria R, Sacco D, Colella V, Albano N, Caselli D, Cardinale F, Giordano P, Lofù I, Laforgia N, Chironna M. Echovirus 11 lineage I and other enteroviruses in hospitalized children with acute respiratory infection in Southern Italy, 2022- 2023. Int J Infect Dis 2024; 146:107091. [PMID: 38729515 DOI: 10.1016/j.ijid.2024.107091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 04/24/2024] [Accepted: 05/07/2024] [Indexed: 05/12/2024] Open
Abstract
OBJECTIVES A new variant of echovirus 11 (E11) infection is a major health concern in neonates. Here, we describe the clinical and virological characteristics of enterovirus (EV) infections in children hospitalized with acute respiratory infection in Southern Italy. METHODS Between July 2022 and August 2023, 173 EV infections were identified. Demographic and clinical characteristics, comorbidities, and coinfections were analyzed. Genotypes were identified by sequencing of VP1. Whole-genome sequencing of five E11 strains was performed. RESULTS Case numbers peaked in July 2022, November-December 2022, and June-July 2023. Coxsackievirus A2 was identified in 36.7%, coxsackievirus B5 in 13.8%, echovirus E11 in 9.2%, and EV-D68 in 6.4% of cases. No child had critical symptoms or a severe infection. The only neonate infected by E11 recovered fully after 5 days in hospital. Phylogenetic analysis revealed that four E11 strains were closely related to divergent lineage I E11 strains identified in France and Italy. CONCLUSIONS The new variant of E11 was identified in children in Southern Italy. Although the cases were mild, the data suggest that transmission routes and host factors are likely to be main drivers for the development of potentially severe diseases. Systematic epidemiological/molecular surveillance will help us better understand the clinical impact of EV infections and develop preventive strategies.
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Affiliation(s)
- Daniela Loconsole
- Department of Interdisciplinary Medicine, Hygiene Section, "Aldo Moro" University of Bari, Bari, Italy
| | - Francesca Centrone
- Hygiene Unit, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, Bari, Italy
| | - Anna Sallustio
- Hygiene Unit, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, Bari, Italy
| | - Daniele Casulli
- Hygiene Unit, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, Bari, Italy
| | - Riccardo Zagaria
- Department of Interdisciplinary Medicine, Hygiene Section, "Aldo Moro" University of Bari, Bari, Italy
| | - Davide Sacco
- Department of Interdisciplinary Medicine, Hygiene Section, "Aldo Moro" University of Bari, Bari, Italy
| | - Vito Colella
- Department of Interdisciplinary Medicine, Hygiene Section, "Aldo Moro" University of Bari, Bari, Italy
| | - Nelhudoff Albano
- Department of Health Promotion and Animal Welfare, Apulia Region, Bari, Italy
| | - Desiree Caselli
- Infectious Diseases, Children's Hospital Giovanni XXIII, Bari, Italy
| | - Fabio Cardinale
- Pediatric and Emergency Department, Pediatric Pulmonology and Immunology section, Giovanni XXIII Pediatric Hospital, "Aldo Moro" University of Bari, Bari, Italy
| | - Paola Giordano
- Department of Interdisciplinary Medicine, Pediatric Section, "Aldo Moro" University of Bari, Bari, Italy
| | - Ignazio Lofù
- Pediatric Unit, Maternal and Child Health Department, "S. Giacomo" Hospital, ASL BA, Bari, Italy
| | - Nicola Laforgia
- Section of Neonatology and Neonatal Intensive Care Unit, Department of Interdisciplinary Medicine, "Aldo Moro" University of Bari, Bari, Italy
| | - Maria Chironna
- Department of Interdisciplinary Medicine, Hygiene Section, "Aldo Moro" University of Bari, Bari, Italy.
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Bianconi I, Battisti L, Staffler A, Giacobazzi E, Masi E, Incrocci E, Bellutti M, Fontana S, Stefanelli P, Buttinelli G, Pagani E. Disseminated Echovirus 11 infection in a newborn in the Province of Bolzano, Italy. Infection 2024:10.1007/s15010-024-02315-9. [PMID: 39150641 DOI: 10.1007/s15010-024-02315-9] [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: 04/23/2024] [Accepted: 05/31/2024] [Indexed: 08/17/2024]
Abstract
PURPOSE Recently, cases of serious illness in newborns infected with Echovirus 11 have been reported in Europe, including Italy. Here, we report the case of a newborn diagnosed with disseminated Echovirus 11 infection, which occurred in October 2023 in the Province of Bolzano, Italy. METHODS A molecular screening, by Real-Time RT-PCR, was employed to analyse the cerebrospinal fluid, blood and stool samples, and nasal swabs. The entire viral genome was sequenced using both Illumina and Nanopore technologies. RESULTS The patient was admitted to hospital due to fever. Molecular testing revealed the presence of enterovirus RNA. Typing confirmed the presence of Echovirus 11. The patient was initially treated with antibiotic therapy and, following the diagnosis of enterovirus infection, also with human immunoglobulins. Over the following days, the patient remained afebrile, with decreasing inflammation indices and in excellent general condition. Genomic and phylogenetic characterization suggested that the strain was similar to strains from severe cases reported in Europe. CONCLUSIONS Despite the low overall risk for the neonatal population in Europe, recent cases of Echovirus 11 have highlighted the importance of surveillance and complete genome sequencing is fundamental to understanding the phylogenetic relationships of Echovirus 11 variants.
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Affiliation(s)
- Irene Bianconi
- Laboratory of Microbiology and Virology, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), Bolzano-Bozen, Italy.
| | - Laura Battisti
- Division of Paediatrics, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), Bolzano-Bozen, Italy
| | - Alex Staffler
- Division of Neonatology/NICU, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), Bolzano-Bozen, Italy
| | - Elisabetta Giacobazzi
- Laboratory of Microbiology and Virology, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), Bolzano-Bozen, Italy
| | - Elisa Masi
- Laboratory of Microbiology and Virology, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), Bolzano-Bozen, Italy
| | - Elisabetta Incrocci
- Laboratory of Microbiology and Virology, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), Bolzano-Bozen, Italy
| | - Marion Bellutti
- Division of Paediatrics, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), Bolzano-Bozen, Italy
| | - Stefano Fontana
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Paola Stefanelli
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Gabriele Buttinelli
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Elisabetta Pagani
- Laboratory of Microbiology and Virology, Hospital of Bolzano (SABES-ASDAA), Teaching Hospital of Paracelsus Medical University (PMU), Bolzano-Bozen, Italy
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Jartti M, Flodström-Tullberg M, Hankaniemi MM. Enteroviruses: epidemic potential, challenges and opportunities with vaccines. J Biomed Sci 2024; 31:73. [PMID: 39010093 PMCID: PMC11247760 DOI: 10.1186/s12929-024-01058-x] [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: 03/14/2024] [Accepted: 06/23/2024] [Indexed: 07/17/2024] Open
Abstract
Enteroviruses (EVs) are the most prevalent viruses in humans. EVs can cause a range of acute symptoms, from mild common colds to severe systemic infections such as meningitis, myocarditis, and flaccid paralysis. They can also lead to chronic diseases such as cardiomyopathy. Although more than 280 human EV serotypes exist, only four serotypes have licenced vaccines. No antiviral drugs are available to treat EV infections, and global surveillance of EVs has not been effectively coordinated. Therefore, poliovirus still circulates, and there have been alarming epidemics of non-polio enteroviruses. Thus, there is a pressing need for coordinated preparedness efforts against EVs.This review provides a perspective on recent enterovirus outbreaks and global poliovirus eradication efforts with continuous vaccine development initiatives. It also provides insights into the challenges and opportunities in EV vaccine development. Given that traditional whole-virus vaccine technologies are not suitable for many clinically relevant EVs and considering the ongoing risk of enterovirus outbreaks and the potential for new emerging pathogenic strains, the need for new effective and adaptable enterovirus vaccines is emphasized.This review also explores the difficulties in translating promising vaccine candidates for clinical use and summarizes information from published literature and clinical trial databases focusing on existing enterovirus vaccines, ongoing clinical trials, the obstacles faced in vaccine development as well as the emergence of new vaccine technologies. Overall, this review contributes to the understanding of enterovirus vaccines, their role in public health, and their significance as a tool for future preparedness.
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Affiliation(s)
- Minne Jartti
- Virology and Vaccine Immunology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Malin Flodström-Tullberg
- Department of Medicine Huddinge and Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Minna M Hankaniemi
- Virology and Vaccine Immunology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
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6
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Sanchez R, Capossela E, Speziale M, O’Donnell J, Moodley A, Morales C, Wadford DA, Glaser C, Shah S, Beatty ME, Pong A. Notes from the Field: Respiratory Viral Panel as an Early Diagnostic Tool for Neonatal Enterovirus Infection - San Diego, California 2023. MMWR. MORBIDITY AND MORTALITY WEEKLY REPORT 2024; 73:607-608. [PMID: 38990763 PMCID: PMC11254348 DOI: 10.15585/mmwr.mm7327a2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/13/2024]
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7
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Luo W, Wang L, Chen Z, Liu M, Zhao Y, Wu Y, Huang B, Wang P. Pathoimmunological analyses of fatal E11 infection in premature infants. Front Cell Infect Microbiol 2024; 14:1391824. [PMID: 39045132 PMCID: PMC11263194 DOI: 10.3389/fcimb.2024.1391824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 06/27/2024] [Indexed: 07/25/2024] Open
Abstract
E11 causes acute fulminant hepatitis in newborns. We investigated the pathological changes of different tissues from premature male twins who died due to E11 infection. The E11 expression level was higher in the liver than in other tissues. IP10 was upregulated in liver tissue in the patient group, and might be regulated by IFNAR and IRF7, whereas IFNα was regulated by IFNAR or IRF5.
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Affiliation(s)
- Wei Luo
- Department of Neonatology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Lixia Wang
- College of Pediatrics, Guangzhou Medical University, Guangzhou, China
| | - Zhengrong Chen
- Department of Pathology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Ming Liu
- Guangzhou Institute of Pediatrics, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yixue Zhao
- Department of Neonatology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yucan Wu
- Department of Neonatology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Bing Huang
- Department of Gastroenterology, Guangdong Provincial Key Laboratory of Gastroenterology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ping Wang
- Department of Neonatology, Guangzhou Women and Children’s Medical Center, Guangzhou Medical University, Guangzhou, China
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8
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Kadambari S, Abdullahi F, Celma C, Ladhani S. Epidemiological trends in viral meningitis in England: Prospective national surveillance, 2013-2023. J Infect 2024; 89:106223. [PMID: 38986749 DOI: 10.1016/j.jinf.2024.106223] [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: 03/21/2024] [Accepted: 07/04/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND In the conjugate vaccine era, viruses are the most common cause of meningitis. Here, we evaluated epidemiological trends in laboratory-confirmed viral meningitis across all age-groups over an 11-year period in England. METHODS In England, hospital laboratories routinely report laboratory-confirmed infections electronically to the UK Health Security Agency. Records of positive viral detections in cerebrospinal fluid during 2013-2023 were extracted. Incidence rates with confidence intervals were calculated using mid-year resident population estimates. RESULTS There were 22,114 laboratory-confirmed viral meningitis cases, including 15,299 cases during 2013-19 (pre COVID-19), with a gradual increase in incidence from 3.5/100,00 (95%CI: 3.3-3.6) to 3.9/100,000 (95%CI: 3.6-4.1). During 2020-21 when pandemic restrictions were in place, there were 2061 cases (1.8/100,000; 1.7-1.9), which increased to 4754 (4.2/100,000; 4.0-4.3) during 2022-23 (post pandemic restrictions). Infants aged <3 months accounted for 39.4% (8702/22,048) of all cases, with a stable incidence 2013-19 (504/100,000, 95%CI: 491-517), followed by a significant decline during 2020-21 (204/100,000; 188-221) and then an increase during 2022-23 (780/100,000; 749-812), with enteroviruses being the commonest cause (84.9%, 7387/8702; 424.74/100,000; 95%CI: 415.12-434.51), followed by parechoviruses (9.1%, 792/8702; 45.54/100,000; 95%CI: 42.42-48.82) and herpes simplex virus (4.4%, 380/8702; 21.85/100,000; 95%CI: 19.71-24.16). Pandemic restrictions were associated with significant declines in the incidence of enterovirus (77.7%) and parechoviruses (64% lower), with rebounds after societal restrictions were lifted. CONCLUSIONS Rates of viral meningitis have returned to pre-pandemic levels since societal restrictions were lifted. The highest incidence of viral meningitis remains in infants aged <3 months and most commonly due to enteroviral infection.
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Affiliation(s)
- Seilesh Kadambari
- Department of Paediatric Infectious Diseases, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK; UCL Great Ormond Street Institute of Child Health, London, UK.
| | - Fariyo Abdullahi
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK
| | - Cristina Celma
- Enteric Virus Unit, UK Health Security Agency, Colindale, London, UK
| | - Shamez Ladhani
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, UK; Paediatric Infectious Diseases Research Group and Vaccine Institute, Institute of Infection and Immunity, St George's University of London, London, UK
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9
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Cottrell S, Moore C. Emerging and Re-Emerging Enterovirus Infections: The Known Unknowns. Pediatr Infect Dis J 2024:00006454-990000000-00941. [PMID: 38986004 DOI: 10.1097/inf.0000000000004472] [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: 07/12/2024]
Affiliation(s)
- Simon Cottrell
- From the Communicable Disease Surveillance Centre and Vaccine Preventable Disease Programme, Public Health Wales, Cardiff, United Kingdom
| | - Catherine Moore
- Wales Specialist Virology Centre, Public Health Wales Microbiology Cardiff, University Hospital of Wales, Cardiff, United Kingdom
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10
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Gad B, Kłosiewicz P, Oleksiak K, Krzysztoszek A, Toczyłowski K, Sulik A, Wieczorek T, Wieczorek M. Intensified Circulation of Echovirus 11 after the COVID-19 Pandemic in Poland: Detection of a Highly Pathogenic Virus Variant. Viruses 2024; 16:1011. [PMID: 39066174 PMCID: PMC11281687 DOI: 10.3390/v16071011] [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: 05/24/2024] [Revised: 06/19/2024] [Accepted: 06/20/2024] [Indexed: 07/28/2024] Open
Abstract
After the first phase of the COVID-19 pandemic in Europe, a new highly pathogenic variant of echovirus 11 (E11) was detected. The aim of this study was to analyze the genetic diversity of Polish E11 environmental and clinical strains circulating between 2017 and 2023 as well as compare them with E11 strains isolated from severe neonatal sepsis cases reported in Europe between 2022 and 2023. Additionally, the study explores the effectiveness of environmental monitoring in tracking the spread of new variants. For this purpose, the complete sequences of the VP1 capsid protein gene were determined for 266 E11 strains isolated in Poland from 2017 to 2023, and phylogenetic analysis was performed. In the years 2017-2023, a significant increase in the detection of E11 strains was observed in both environmental and clinical samples in Poland. The Polish E11 strains represented three different genotypes, C3, D5 and E, and were characterized by a high diversity. In Poland, the intensive circulation of the new variant E11, responsible for severe neonatal infections with a high mortality in Europe, was detected in the years 2022-2023. This investigation demonstrates the important role of environmental surveillance in the tracking of enteroviruses circulation, especially in settings with limited clinical surveillance.
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Affiliation(s)
- Beata Gad
- Department of Virology, National Institute of Public Health NIH—National Research Institute, Chocimska 24, 00-791 Warsaw, Poland; (B.G.); (P.K.); (K.O.); (A.K.)
| | - Paulina Kłosiewicz
- Department of Virology, National Institute of Public Health NIH—National Research Institute, Chocimska 24, 00-791 Warsaw, Poland; (B.G.); (P.K.); (K.O.); (A.K.)
| | - Kinga Oleksiak
- Department of Virology, National Institute of Public Health NIH—National Research Institute, Chocimska 24, 00-791 Warsaw, Poland; (B.G.); (P.K.); (K.O.); (A.K.)
| | - Arleta Krzysztoszek
- Department of Virology, National Institute of Public Health NIH—National Research Institute, Chocimska 24, 00-791 Warsaw, Poland; (B.G.); (P.K.); (K.O.); (A.K.)
| | - Kacper Toczyłowski
- Department of Pediatric Infectious Diseases, Medical University of Bialystok, Waszyngtona 17, 15-274 Bialystok, Poland; (K.T.); (A.S.)
| | - Artur Sulik
- Department of Pediatric Infectious Diseases, Medical University of Bialystok, Waszyngtona 17, 15-274 Bialystok, Poland; (K.T.); (A.S.)
| | - Tobiasz Wieczorek
- Faculty of Civil Engineering and Geodesy, Military University of Technology, Gen. S. Kaliskiego 2, 00-908 Warsaw, Poland;
| | - Magdalena Wieczorek
- Department of Virology, National Institute of Public Health NIH—National Research Institute, Chocimska 24, 00-791 Warsaw, Poland; (B.G.); (P.K.); (K.O.); (A.K.)
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11
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Rueca M, Vairo F, Spaziante M, Fabeni L, Forbici F, Berno G, Gruber CEM, Picone S, Ajassa C, Girardi E, Maggi F, Valli MB. Molecular Genotyping of Circulating Enterovirus in the Lazio Region from 2012 to 2023. Viruses 2024; 16:1013. [PMID: 39066176 PMCID: PMC11281471 DOI: 10.3390/v16071013] [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: 04/12/2024] [Revised: 05/31/2024] [Accepted: 06/21/2024] [Indexed: 07/28/2024] Open
Abstract
Enteroviruses (EVs) are ubiquitous viruses that circulate worldwide, causing sporadic or epidemic infections, typically during the summer and fall. They cause a broad spectrum of illnesses, ranging from an unspecified febrile clinical presentation to a severe illness. EVs are recognized to be the most frequent etiological agents of aseptic meningitis in children. However, as the infection is usually mild and self-limiting, it remains underestimated, and the epidemiology of EVs is poorly understood. To date, no vaccine or effective therapy for all types of enteroviruses is available, and EVs constitute a public health concern. Here, we investigated the molecular epidemiology of EV strains circulating in the Lazio region over a 10-year time span (2012-2023) by using a sequence-typing approach and phylogenetic analysis. The epidemiological trend of EV infection has undergone changes during the SARS-CoV-2 pandemic (2020-2021), which resulted in a modification in terms of the number of diagnosed cases and seasonality. From 2022, the circulation of EVs showed a behavior typical of the pre-pandemic period, although changes in predominantly circulating strains have been noted. Both epidemic and sporadic circulation events have been characterized in the Lazio region. Further analyses are needed to better characterize any strain with higher potential pathogenic power and to identify possible recombinant strains.
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Affiliation(s)
- Martina Rueca
- Laboratory of Virology, National Institute for Infectious Diseases “Lazzaro Spallanzani” IRCCS, 00149 Rome, Italy; (M.R.); (F.F.); (G.B.); (C.E.M.G.); (F.M.); (M.B.V.)
| | - Francesco Vairo
- Regional Service for Surveillance and Control of Infectious Diseases (SERESMI)-Lazio Region, National Institute for Infectious Diseases “Lazzaro Spallanzani” IRCCS, 00149 Rome, Italy; (F.V.); (M.S.)
| | - Martina Spaziante
- Regional Service for Surveillance and Control of Infectious Diseases (SERESMI)-Lazio Region, National Institute for Infectious Diseases “Lazzaro Spallanzani” IRCCS, 00149 Rome, Italy; (F.V.); (M.S.)
| | - Lavinia Fabeni
- Laboratory of Virology, National Institute for Infectious Diseases “Lazzaro Spallanzani” IRCCS, 00149 Rome, Italy; (M.R.); (F.F.); (G.B.); (C.E.M.G.); (F.M.); (M.B.V.)
| | - Federica Forbici
- Laboratory of Virology, National Institute for Infectious Diseases “Lazzaro Spallanzani” IRCCS, 00149 Rome, Italy; (M.R.); (F.F.); (G.B.); (C.E.M.G.); (F.M.); (M.B.V.)
| | - Giulia Berno
- Laboratory of Virology, National Institute for Infectious Diseases “Lazzaro Spallanzani” IRCCS, 00149 Rome, Italy; (M.R.); (F.F.); (G.B.); (C.E.M.G.); (F.M.); (M.B.V.)
| | - Cesare Ernesto Maria Gruber
- Laboratory of Virology, National Institute for Infectious Diseases “Lazzaro Spallanzani” IRCCS, 00149 Rome, Italy; (M.R.); (F.F.); (G.B.); (C.E.M.G.); (F.M.); (M.B.V.)
| | - Simonetta Picone
- Neonatology and Neonatal Intensive Care Unit, Policlinico Casilino, 00169 Rome, Italy;
| | - Camilla Ajassa
- Department of Public Health and Infectious Diseases, Sapienza University Hospital “Policlinico Umberto I”, 00161 Rome, Italy;
| | - Enrico Girardi
- Scientific Direction, National Institute for Infectious Diseases “Lazzaro Spallanzani” IRCCS, 00149 Rome, Italy;
| | - Fabrizio Maggi
- Laboratory of Virology, National Institute for Infectious Diseases “Lazzaro Spallanzani” IRCCS, 00149 Rome, Italy; (M.R.); (F.F.); (G.B.); (C.E.M.G.); (F.M.); (M.B.V.)
| | - Maria Beatrice Valli
- Laboratory of Virology, National Institute for Infectious Diseases “Lazzaro Spallanzani” IRCCS, 00149 Rome, Italy; (M.R.); (F.F.); (G.B.); (C.E.M.G.); (F.M.); (M.B.V.)
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12
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Amoroso MG, Pucciarelli A, Serra F, Ianiro G, Iafusco M, Fiorito F, Polverino MG, Dimatteo M, Monini M, Ferrara D, Martemucci L, Di Bartolo I, De Carlo E, Fusco G. Ten different viral agents infecting and co-infecting children with acute gastroenteritis in Southern Italy: Role of known pathogens and emerging viruses during and after COVID-19 pandemic. J Med Virol 2024; 96:e29679. [PMID: 38767190 DOI: 10.1002/jmv.29679] [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: 01/30/2024] [Revised: 04/18/2024] [Accepted: 05/08/2024] [Indexed: 05/22/2024]
Abstract
Acute gastroenteritis (AGE) represents a world public health relevant problem especially in children. Enteric viruses are the pathogens mainly involved in the episodes of AGE, causing about 70.00% of the cases. Apart from well-known rotavirus (RVA), adenovirus (AdV) and norovirus (NoV), there are various emerging viral pathogens potentially associated with AGE episodes. In this study, the presence of ten different enteric viruses was investigated in 152 fecal samples collected from children hospitalized for gastroenteritis. Real time PCR results showed that 49.3% of them were positive for viral detection with the following prevalence: norovirus GII 19.7%, AdV 15.8%, RVA 10.5%, human parechovirus (HPeV) 5.3%, enterovirus (EV) 3.3%, sapovirus (SaV) 2.6%. Salivirus (SalV), norovirus GI and astrovirus (AstV) 1.3% each, aichivirus (AiV) found in only one patient. In 38.2% of feces only one virus was detected, while co-infections were identified in 11.8% of the cases. Among young patients, 105 were ≤5 years old and 56.0% tested positive for viral detection, while 47 were >5 years old with 40.0% of them infected. Results obtained confirm a complex plethora of viruses potentially implicated in gastroenteritis in children, with some of them previously known for other etiologies but detectable in fecal samples. Subsequent studies should investigate the role of these viruses in causing gastroenteritis and explore the possibility that other symptoms may be ascribed to multiple infections.
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Affiliation(s)
- Maria Grazia Amoroso
- Department of Animal Health, Unit of Virology, Experimental Zooprophylactic Institute of Southern Italy, Portici, Italy
| | - Alessia Pucciarelli
- Department of Animal Health, Unit of Virology, Experimental Zooprophylactic Institute of Southern Italy, Portici, Italy
| | - Francesco Serra
- Department of Animal Health, Unit of Virology, Experimental Zooprophylactic Institute of Southern Italy, Portici, Italy
| | - Giovanni Ianiro
- Istituto Superiore di Sanità Department of Food Safety, Nutrition and Veterinary Public Health, Rome, Italy
| | - Michele Iafusco
- Pediatrics Department, "Pediatria 2", National Specialty Hospital Santobono Pausilipon, Napoli, Italy
| | - Filomena Fiorito
- Department of Veterinary Science and Animal Production, University of Naples Federico II, Naples, Italy
| | - Maria Grazia Polverino
- Department of Animal Health, Unit of Virology, Experimental Zooprophylactic Institute of Southern Italy, Portici, Italy
| | - Maria Dimatteo
- Department of Animal Health, Unit of Virology, Experimental Zooprophylactic Institute of Southern Italy, Portici, Italy
| | - Marina Monini
- Istituto Superiore di Sanità Department of Food Safety, Nutrition and Veterinary Public Health, Rome, Italy
| | - Daniela Ferrara
- Pediatrics Department, "Pediatria 2", National Specialty Hospital Santobono Pausilipon, Napoli, Italy
| | - Luigi Martemucci
- Pediatrics Department, "Pediatria 2", National Specialty Hospital Santobono Pausilipon, Napoli, Italy
| | - Ilaria Di Bartolo
- Istituto Superiore di Sanità Department of Food Safety, Nutrition and Veterinary Public Health, Rome, Italy
| | - Esterina De Carlo
- Department of Animal Health, Unit of Virology, Experimental Zooprophylactic Institute of Southern Italy, Portici, Italy
| | - Giovanna Fusco
- Department of Animal Health, Unit of Virology, Experimental Zooprophylactic Institute of Southern Italy, Portici, Italy
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13
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Giammanco GM, Filizzolo C, Pizzo M, Sanfilippo GL, Cacioppo F, Bonura F, Fontana S, Buttinelli G, Stefanelli P, De Grazia S. Detection of Echovirus 11 lineage 1 in wastewater samples in Sicily. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 918:170519. [PMID: 38316300 DOI: 10.1016/j.scitotenv.2024.170519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 01/16/2024] [Accepted: 01/26/2024] [Indexed: 02/07/2024]
Abstract
We report the presence of Echovirus 11 (E11) in wastewater in Sicily (Southern Italy), since August 2022. Overall, the 5.4 % of sewage samples (7/130) collected in 2022 were positives for E11 and then the percentage of E11-positive sewage samples reached the value of 27.27(18/66) in the first semester of 2023. Phylogenetic analysis of VP1 sequences showed for most E11-positive samples (16/25: 64 %) close genetic correlation (98.4-99.4 % nucleotide identity) to E11 lineage 1 strains involved in recently reported severe neonatal infections.
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Affiliation(s)
- Giovanni M Giammanco
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Palermo, Italy.
| | - Chiara Filizzolo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Mariangela Pizzo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Giuseppa L Sanfilippo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Federica Cacioppo
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Floriana Bonura
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Stefano Fontana
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Gabriele Buttinelli
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Paola Stefanelli
- Department of Infectious Diseases, Istituto Superiore di Sanità, Rome, Italy
| | - Simona De Grazia
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties "G. D'Alessandro", University of Palermo, Palermo, Italy
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14
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Giva S, Barry R, Drew RJ, Geoghegan S. Enterovirus Central Nervous System Infection in Infancy, the Value of Routine Testing. Pediatr Infect Dis J 2023; 42:1031-1034. [PMID: 37589456 DOI: 10.1097/inf.0000000000004072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Abstract
BACKGROUND Human nonpolio enterovirus (EV) is a major cause of infection in neonates and infants; however, the clinical presentation and cerebrospinal fluid findings vary significantly. Infection caused by EV in patients under 1 year of age can present with a broad clinical spectrum, from fever to severe systemic and/or neurological disease. METHODS Retrospective cohort analysis of infants with EV central nervous system (CNS) infection presenting to a tertiary center between January 2017 and December 2022. We recorded patient demographics, parent-reported symptoms at presentation, and blood and cerebrospinal fluid (CSF) testing at presentation. RESULTS Seventy-eight patients were included in the final study. Forty-one percent of infants with an EV CNS infection had a normal CSF white blood cell count. Clinical presentation was similar in infants with and without CSF pleocytosis. Median C-reactive protein was higher in cases of EV CNS infection without pleocytosis. CONCLUSION EV CNS infection commonly presents without CSF pleocytosis. Testing for EV should be considered in febrile infants with no source regardless of CSF parameters.
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Affiliation(s)
- Sheiniz Giva
- From the Department of Infectious Diseases, Children's Health Ireland at Temple Street and Crumlin, Dublin, Ireland
| | - Rachel Barry
- National Virus Reference Laboratory, University College Dublin, Ireland
| | - Richard J Drew
- Irish Meningitis and Sepsis Reference Laboratory, Children's Health Ireland at Temple St
- Clinical Innovation Unit, Rotunda Hospital
- Department of Clinical Microbiology, Royal College of Surgeons in Ireland
| | - Sarah Geoghegan
- From the Department of Infectious Diseases, Children's Health Ireland at Temple Street and Crumlin, Dublin, Ireland
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania
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15
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Singanayagam A, Moore C, Froude S, Celma C, Stowe J, Hani E, Ng KF, Muir P, Roderick M, Cottrell S, Bibby DF, Vipond B, Gillett S, Davis PJ, Gibb J, Barry M, Harris P, Rowley F, Song J, Shankar AG, McMichael D, Cohen JM, Manian A, Harvey C, Primrose LS, Wilson S, Bradley DT, Paranthaman K, Beard S, Zambon M, Ramsay M, Saliba V, Ladhani S, Williams C. Increased reports of severe myocarditis associated with enterovirus infection in neonates, United Kingdom, 27 June 2022 to 26 April 2023. Euro Surveill 2023; 28:2300313. [PMID: 37768558 PMCID: PMC10540513 DOI: 10.2807/1560-7917.es.2023.28.39.2300313] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Accepted: 08/27/2023] [Indexed: 09/29/2023] Open
Abstract
Enteroviruses are a common cause of seasonal childhood infections. The vast majority of enterovirus infections are mild and self-limiting, although neonates can sometimes develop severe disease. Myocarditis is a rare complication of enterovirus infection. Between June 2022 and April 2023, twenty cases of severe neonatal enteroviral myocarditis caused by coxsackie B viruses were reported in the United Kingdom. Sixteen required critical care support and two died. Enterovirus PCR on whole blood was the most sensitive diagnostic test. We describe the initial public health investigation into this cluster and aim to raise awareness among paediatricians, laboratories and public health specialists.
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Affiliation(s)
| | | | | | - Cristina Celma
- UK Health Security Agency, Colindale, London, United Kingdom
| | - Julia Stowe
- UK Health Security Agency, Colindale, London, United Kingdom
| | - Erjola Hani
- UK Health Security Agency, Colindale, London, United Kingdom
| | - Khuen Foong Ng
- Paediatric Infectious Diseases and Immunology, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | - Peter Muir
- UK Health Security Agency South West Regional Laboratory, Bristol, United Kingdom
| | - Marion Roderick
- Paediatric Infectious Diseases and Immunology, Bristol Royal Hospital for Children, Bristol, United Kingdom
| | | | - David F Bibby
- UK Health Security Agency, Colindale, London, United Kingdom
| | - Barry Vipond
- UK Health Security Agency South West Regional Laboratory, Bristol, United Kingdom
| | - Sophie Gillett
- UK Health Security Agency South West Regional Laboratory, Bristol, United Kingdom
| | - Peter J Davis
- Paediatric Intensive Care Unit, Bristol Royal Hospital for Children, University Hospitals Bristol & Weston Foundation Trust, Bristol, United Kingdom
| | - Jack Gibb
- Department of Paediatric Cardiology, Bristol Royal Hospital for Children, University Hospitals Bristol & Weston Foundation Trust, Bristol, United Kingdom
| | - Mai Barry
- Public Health Wales, Wales, Cardiff, United Kingdom
| | | | | | - Jiao Song
- Public Health Wales, Wales, Cardiff, United Kingdom
| | | | | | - Jonathan M Cohen
- Evelina London Children's Hospital, Guys & St Thomas National Health Service Foundation Trust, London, United Kingdom
| | - Abirami Manian
- Evelina London Children's Hospital, Guys & St Thomas National Health Service Foundation Trust, London, United Kingdom
| | | | | | | | | | | | - Stuart Beard
- UK Health Security Agency, Colindale, London, United Kingdom
| | - Maria Zambon
- UK Health Security Agency, Colindale, London, United Kingdom
| | - Mary Ramsay
- UK Health Security Agency, Colindale, London, United Kingdom
| | - Vanessa Saliba
- UK Health Security Agency, Colindale, London, United Kingdom
| | - Shamez Ladhani
- UK Health Security Agency, Colindale, London, United Kingdom
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16
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Piralla A, Borghesi A, Di Comite A, Giardina F, Ferrari G, Zanette S, Figar TA, Angelini M, Pisoni C, Pitrolo AMG, Paolucci S, Rovida F, Pellicioli I, Bonanomi E, Baldanti F, Ghirardello S. Fulminant echovirus 11 hepatitis in male non-identical twins in northern Italy, April 2023. Euro Surveill 2023; 28:2300289. [PMID: 37318763 PMCID: PMC10318938 DOI: 10.2807/1560-7917.es.2023.28.24.2300289] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 06/14/2023] [Indexed: 06/16/2023] Open
Abstract
Echovirus 11 (E11) has recently been associated with a series of nine neonatal cases of severe hepatitis in France. Here, we present severe hepatitis caused by E11 in a pair of twins. In one of the neonates, the clinical picture evolved to fulminant hepatitis. The E11 genome showed 99% nucleotide identity with E11 strains reported in the cases in France. Rapid genome characterisation using next generation sequencing is essential to identify new and more pathogenetic variants.
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Affiliation(s)
- Antonio Piralla
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- These authors contributed equally to this work and share first authorship
| | - Alessandro Borghesi
- Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- These authors contributed equally to this work and share first authorship
| | - Amelia Di Comite
- Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Federica Giardina
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - Guglielmo Ferrari
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Simona Zanette
- Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Micol Angelini
- Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Camilla Pisoni
- Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | - Stefania Paolucci
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Francesca Rovida
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
| | - Isabella Pellicioli
- Paediatric Intensive Care Unit, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Ezio Bonanomi
- Paediatric Intensive Care Unit, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Fausto Baldanti
- Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, Pavia, Italy
- These authors contributed equally to the work and share the last authorship
| | - Stefano Ghirardello
- Neonatal Intensive Care Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
- These authors contributed equally to the work and share the last authorship
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Chandran D, Chakraborty S, Ahmed SK, Chopra H, Islam MR, Dhama K. France Reports Rise in Severe Neonatal Infections Caused by a New Enterovirus (Echovirus-11) Variant. CLINICAL PATHOLOGY (THOUSAND OAKS, VENTURA COUNTY, CALIF.) 2023; 16:2632010X231213793. [PMID: 38022906 PMCID: PMC10657519 DOI: 10.1177/2632010x231213793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 10/25/2023] [Indexed: 12/01/2023]
Abstract
The surge in severe neonatal sepsis cases caused by a novel variant of Echovirus 11 (E-11) in France and several European countries has sparked concern. The affected infants, mostly premature and twins, displayed rapid clinical decline within days after birth, presenting symptoms akin to septic shock with hepatic impairment and multi-organ failure. Laboratory findings revealed profound coagulopathy, low platelet counts, and acute renal failure, indicating severe disease progression. Genetic analysis identified a distinct recombinant E-11 lineage, previously unseen in France before July 2022. Despite its novelty, the exact pathogenicity remains uncertain. Although the World Health Organization downplaying immediate public health risks, the absence of a robust global surveillance program hinders accurate prevalence assessment. To mitigate the impact of this novel E-11 variant, establishing robust surveillance, refining diagnostic capabilities, and exploring therapeutic interventions such as intravenous immunoglobulin (IVIg) and pocapavir are imperative for effective management and prevention strategies.
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Affiliation(s)
- Deepak Chandran
- Department of Animal Husbandry, Government of Kerala, Kerala, India
| | - Sandip Chakraborty
- Department of Veterinary Microbiology, College of Veterinary Sciences and Animal Husbandry, West Tripura, Tripura, India
| | - Sirwan Khalid Ahmed
- Department of Adult Nursing, College of Nursing, University of Raparin, Sulaymaniyah, Kurdistan Region, Iraq
- Ministry of Health, General Directorate of Health-Raparin, Rania, Sulaymaniyah, Kurdistan Region, Iraq
| | - Hitesh Chopra
- Department of Biosciences, Saveetha School of Engineering, Saveetha Institute of Medical and Technical Sciences, Chennai, Tamil Nadu, India
| | | | - Kuldeep Dhama
- Division of Pathology, ICAR-Indian Veterinary Research Institute, Bareilly, Izatnagar, Uttar Pradesh, India
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