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Chien YS, Chen FJ, Wu HC, Lin CH, Chang WC, Perera D, Yang JY, Lee MS, Liao YC. Cost-effective complete genome sequencing using the MinION platform for identification of recombinant enteroviruses. Microbiol Spectr 2023; 11:e0250723. [PMID: 37831475 PMCID: PMC10715163 DOI: 10.1128/spectrum.02507-23] [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: 06/14/2023] [Accepted: 08/30/2023] [Indexed: 10/14/2023] Open
Abstract
IMPORTANCE By employing a cost-effective approach for complete genome sequencing, the study has enabled the identification of novel enterovirus strains and shed light on the genetic exchange events during outbreaks. The success rate of genome sequencing and the scalability of the protocol demonstrate its practical utility for routine enterovirus surveillance. Moreover, the study's findings of recombinant strains of EVA71 and CVA2 contributing to epidemics in Malaysia and Taiwan emphasize the need for accurate detection and characterization of enteroviruses. The investigation of the whole genome and upstream ORF sequences has provided insights into the evolution and spread of enterovirus subgenogroups. These findings have important implications for the prevention, control, and surveillance of enteroviruses, ultimately contributing to the understanding and management of enterovirus-related illnesses.
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Affiliation(s)
- Yeh-Sheng Chien
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan
| | - Feng-Jui Chen
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan
- Department of Biological Science and Technology, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Han-Chieh Wu
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan
| | - Chieh-Hua Lin
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
| | - Wen-Chiung Chang
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan
| | - David Perera
- Institute of Health and Community Medicine, Universiti Malaysia Sarawak, Sarawak, Malaysia
| | - Jyh-Yuan Yang
- Research and Diagnosis Center, Centers for Disease Control, Taipei, Taiwan
| | - Min-Shi Lee
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan
| | - Yu-Chieh Liao
- Institute of Population Health Sciences, National Health Research Institutes, Zhunan, Taiwan
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Shi Y, Liu Y, Wu Y, Hu S, Sun B. Molecular epidemiology and recombination of enterovirus D68 in China. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2023; 115:105512. [PMID: 37827347 DOI: 10.1016/j.meegid.2023.105512] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Revised: 10/05/2023] [Accepted: 10/09/2023] [Indexed: 10/14/2023]
Abstract
Enterovirus D68 (EV-D68), a member of Enterovirus genus of the Picornaviridae family, mainly causes respiratory system-related diseases as well as neurological complications in some patients. At present, there is no effective vaccine or treatment for the virus. The aim of this research was to systematically analyse the molecular epidemiology, recombination and changes in the epitope of EV-D68 in China from 2008 to 2022. Through phylogenetic analysis based on VP1 sequences, it was found that there was limited information about EV-D68 infection before 2011 and that EV-D68 infection was dominated by the A2 gene subtype from 2011 to 2013 and the B3 genotype from 2014 to 2018, during which A2 and B3 were coprevalent and alternately prevalent. We also constructed a phylogenetic tree using the EV-D68 full-length genome sequences, and the genotype of each sequence was consistent with that of the VP1 sequence evolutionary tree. Recombination analysis showed that MH341715 underwent intertypic recombination with the A2 genotype MH341729 at the 5' untranslated region (5'UTR) and that P1-P3 underwent recombination with the B3 genotype MH341712. The capsid protein VP1 is one of the most important structural proteins. In VP1, the BC-loop (89-105 amino acids) and DE-loop (140-152 amino acids) are the most variable domains on the surface of the virus and are associated with epitopes. In this study, it was found that the dominant amino acid composition of the BC-loop and DE-loop continued to change with the epidemic of the virus; the amino acid composition also differed in different regions of the same genotypes. The ongoing genomic and molecular epidemiology of EV-D68 remains important for predicting emergence of new viruses and preventing major outbreaks of respiratory diseases.
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Affiliation(s)
- Yingying Shi
- Department of Immunology, School of Medicine, Jianghan University, Wuhan, Hubei 430056, China
| | - Yongjuan Liu
- Department of Central Laboratory, the Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, Jiangsu 222002, China
| | - Yanli Wu
- Department of Immunology, School of Medicine, Jianghan University, Wuhan, Hubei 430056, China
| | - Song Hu
- Wuhan Institute of Biomedical Sciences, School of Medicine, Jianghan University, Wuhan, China
| | - Binlian Sun
- Wuhan Institute of Biomedical Sciences, School of Medicine, Jianghan University, Wuhan, China.
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Gummersheimer S, Hayes A, Harrison C, Lee B, Schuster J, Dhar M, Sasidharan A, Banerjee D, Selvarangan R. Prevalence and clinical presentation of EV-D68 infections in Kansas City children during the 2022 season. Diagn Microbiol Infect Dis 2023; 107:115992. [PMID: 37385072 DOI: 10.1016/j.diagmicrobio.2023.115992] [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: 01/29/2023] [Revised: 05/03/2023] [Accepted: 05/18/2023] [Indexed: 07/01/2023]
Abstract
Seasonal EV-D68 infections can strain medical care resources due to increased pediatric hospitalizations for respiratory illness. In this study, we examine Kansas City's 2022 EV-D68 season. Rhinovirus/enterovirus (RV/EV) positive respiratory specimens from standard of care testing were salvaged and tested by EV-D68 specific PCR. Of the 1412 respiratory specimens tested from July 1 to September 15, 2022, 346 (23%) were positive for RV/EV and EV-D68 was detected in 134/319 (42%) salvaged RV/EV positive specimens. The median age of children with EV-D68 infections was 35.2 months (IQR 16.1, 67.3), which was older than children with non-EV-D68 RV/EV infections (16 months, IQR 5, 47.8), but younger than children infected during the 2014 EV-D68 outbreak. EV-D68 infection was more likely to cause severe disease in children with asthma compared to those without asthma. Real-time EV-D68 monitoring for outbreaks could potentially improve resource utilization by hospitals and help prepare for surges of respiratory disease.
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Affiliation(s)
- Stephanie Gummersheimer
- Department of Pathology and Laboratory Medicine, Division of Infectious Disease, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Amanda Hayes
- Department of Pathology and Laboratory Medicine, Division of Infectious Disease, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Christopher Harrison
- Department of Pathology and Laboratory Medicine, University of Missouri-School of Medicine, Kansas City, MO, USA
| | - Brian Lee
- Department of Pathology and Laboratory Medicine, Division of Infectious Disease, Children's Mercy Kansas City, Kansas City, MO, USA; Department of Pathology and Laboratory Medicine, University of Missouri-School of Medicine, Kansas City, MO, USA
| | - Jennifer Schuster
- Department of Pathology and Laboratory Medicine, Division of Infectious Disease, Children's Mercy Kansas City, Kansas City, MO, USA; Department of Pathology and Laboratory Medicine, University of Missouri-School of Medicine, Kansas City, MO, USA
| | - Minati Dhar
- Department of Pathology and Laboratory Medicine, Division of Infectious Disease, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Anjana Sasidharan
- Department of Pathology and Laboratory Medicine, Division of Infectious Disease, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Dithi Banerjee
- Department of Pathology and Laboratory Medicine, Division of Infectious Disease, Children's Mercy Kansas City, Kansas City, MO, USA; Department of Pathology and Laboratory Medicine, University of Missouri-School of Medicine, Kansas City, MO, USA
| | - Rangaraj Selvarangan
- Department of Pathology and Laboratory Medicine, Division of Infectious Disease, Children's Mercy Kansas City, Kansas City, MO, USA; Department of Pathology and Laboratory Medicine, University of Missouri-School of Medicine, Kansas City, MO, USA.
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Fall A, Kenmoe S, Ebogo-Belobo JT, Mbaga DS, Bowo-Ngandji A, Foe-Essomba JR, Tchatchouang S, Amougou Atsama M, Yéngué JF, Kenfack-Momo R, Feudjio AF, Nka AD, Mbongue Mikangue CA, Taya-Fokou JB, Magoudjou-Pekam JN, Noura EA, Zemnou-Tepap C, Meta-Djomsi D, Maïdadi-Foudi M, Kame-Ngasse GI, Nyebe I, Djukouo LG, Kengne Gounmadje L, Tchami Ngongang D, Oyono MG, Demeni Emoh CP, Tazokong HR, Mahamat G, Kengne-Ndé C, Sadeuh-Mba SA, Dia N, La Rosa G, Ndip L, Njouom R. Global prevalence and case fatality rate of Enterovirus D68 infections, a systematic review and meta-analysis. PLoS Negl Trop Dis 2022; 16:e0010073. [PMID: 35134062 PMCID: PMC8824346 DOI: 10.1371/journal.pntd.0010073] [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: 06/24/2021] [Accepted: 12/08/2021] [Indexed: 11/23/2022] Open
Abstract
A substantial amount of epidemiological data has been reported on Enterovirus D68 (EV-D68) infections after the 2014 outbreak. Our goal was to map the case fatality rate (CFR) and prevalence of current and past EV-D68 infections. We conducted a systematic review (PROSPERO, CRD42021229255) with published articles on EV-68 infections in PubMed, Embase, Web of Science and Global Index Medicus up to January 2021. We determined prevalences using a model random effect. Of the 4,329 articles retrieved from the databases, 89 studies that met the inclusion criteria were from 39 different countries with apparently healthy individuals and patients with acute respiratory infections, acute flaccid myelitis and asthma-related diseases. The CFR estimate revealed occasional deaths (7/1353) related to EV-D68 infections in patients with severe acute respiratory infections. Analyses showed that the combined prevalence of current and past EV-D68 infections was 4% (95% CI = 3.1-5.0) and 66.3% (95% CI = 40.0-88.2), respectively. The highest prevalences were in hospital outbreaks, developed countries, children under 5, after 2014, and in patients with acute flaccid myelitis and asthma-related diseases. The present study shows sporadic deaths linked to severe respiratory EV-D68 infections. The study also highlights a low prevalence of current EV-D68 infections as opposed to the existence of EV-D68 antibodies in almost all participants of the included studies. These findings therefore highlight the need to implement and/or strengthen continuous surveillance of EV-D68 infections in hospitals and in the community for the anticipation of the response to future epidemics.
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Affiliation(s)
- Amary Fall
- Virology Department, Institute Pasteur of Dakar, Dakar, Senegal
| | - Sebastien Kenmoe
- Virology Department, Centre Pasteur of Cameroon, Yaounde, Cameroon
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
| | - Jean Thierry Ebogo-Belobo
- Medical Research Centre, Institute of Medical Research and Medicinal Plants Studies, Yaounde, Cameroon
| | | | - Arnol Bowo-Ngandji
- Department of Microbiology, The University of Yaounde I, Yaounde, Cameroon
| | | | | | - Marie Amougou Atsama
- Centre de Recherche sur les Maladies Émergentes et Re-Emergentes, Institut de Recherches Médicales et d’Etudes des Plantes Médicinales, Yaounde, Cameroon
| | | | - Raoul Kenfack-Momo
- Department of Biochemistry, The University of Yaounde I, Yaounde, Cameroon
| | | | - Alex Durand Nka
- Virology Laboratory, Chantal Biya International Reference Center for Research on HIV/AIDS Prevention and Management, Yaounde, Cameroon
| | | | | | | | - Efietngab Atembeh Noura
- Medical Research Centre, Institute of Medical Research and Medicinal Plants Studies, Yaounde, Cameroon
| | | | - Dowbiss Meta-Djomsi
- Centre de Recherche sur les Maladies Émergentes et Re-Emergentes, Institut de Recherches Médicales et d’Etudes des Plantes Médicinales, Yaounde, Cameroon
| | - Martin Maïdadi-Foudi
- Centre de Recherche sur les Maladies Émergentes et Re-Emergentes, Institut de Recherches Médicales et d’Etudes des Plantes Médicinales, Yaounde, Cameroon
| | - Ginette Irma Kame-Ngasse
- Medical Research Centre, Institute of Medical Research and Medicinal Plants Studies, Yaounde, Cameroon
| | - Inès Nyebe
- Department of Microbiology, The University of Yaounde I, Yaounde, Cameroon
| | | | | | | | - Martin Gael Oyono
- Department of Animals Biology and Physiology, The University of Yaounde I, Yaounde, Cameroon
| | | | | | - Gadji Mahamat
- Department of Microbiology, The University of Yaounde I, Yaounde, Cameroon
| | - Cyprien Kengne-Ndé
- Research Monitoring and Planning Unit, National Aids Control Committee, Douala, Cameroon
| | | | - Ndongo Dia
- Virology Department, Institute Pasteur of Dakar, Dakar, Senegal
| | - Giuseppina La Rosa
- Department of Environment and Health, Istituto Superiore di Sanità, Rome, Italy
| | - Lucy Ndip
- Department of Microbiology and Parasitology, University of Buea, Buea, Cameroon
| | - Richard Njouom
- Virology Department, Centre Pasteur of Cameroon, Yaounde, Cameroon
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The role of conformational epitopes in the evolutionary divergence of enterovirus D68 clades: A bioinformatics-based study. INFECTION GENETICS AND EVOLUTION 2021; 93:104992. [PMID: 34242773 DOI: 10.1016/j.meegid.2021.104992] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Revised: 06/14/2021] [Accepted: 07/02/2021] [Indexed: 11/23/2022]
Abstract
Enterovirus D68 (EV-D68), as one of the major pathogens of paediatric respiratory disease, has been widely spread in the population in recent years. As the basis of virus antigenicity, antigenic epitopes are essential to monitoring the transformation of virus antigenicity. However, there is a lack of systematic studies on the antigenic epitopes of EV-D68. In this study, a bioinformatics-based prediction algorithm for human enteroviruses was used to predict the conformational epitopes of EV-D68. The prediction results showed that the conformational epitopes of EV-D68 were clustered into three sites: site 1, site 2, and site 3. Site 1 was located in the "north rim" region of the canyon near the fivefold axis; site 2 was located in the "puff" region near the twofold axis; and site 3 consisted of two parts, one in the "knob" region on the south rim of the canyon and the other in the threefold axis region. The predicted epitopes overlapped highly with the binding regions of four reported monoclonal antibodies (mAbs), indicating that the predictions were highly reliable. Phylogenetic analysis showed that amino acid mutations in the epitopes of the VP1 BC loop, DE loop, C-terminus, and VP2 EF loop played a crucial role in the evolutionary divergence of EV-D68 clades/subclades and epidemics. This finding indicated that the VP1 BC loop, DE loop, C-terminus, and VP2 EF loop were the most important epitopes of EV-D68. Research on the epitopes of EV-D68 will contribute to outbreak surveillance and to the development of diagnostic reagents and recombinant vaccines.
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6
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Liu Y, Gong C, Luo M, Zhang T, Li M, Shen L, Zhang H, Huang F. Seroepidemiology of enterovirus D68 in a healthy population in Beijing, China, between 2012 and 2017: A retrospective study. J Med Virol 2021; 93:3524-3531. [PMID: 32492201 DOI: 10.1002/jmv.26132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 05/19/2020] [Accepted: 05/21/2020] [Indexed: 11/06/2022]
Abstract
To investigate the seroepidemiological features of enterovirus D68 (EV-D68) in the healthy population from 2012 to 2017 in Beijing, China. A retrospective cross-sectional investigation was conducted using serum specimens collected from healthy individuals in Beijing from 2012 to 2017. These samples were tested for neutralization antibodies (NtAbs) against EV-D68. The sera from six EV-D68 infected patients in the acute or convalescent phase were used to determine the protection level of NtAbs against EV-D68. The geometric means of the titers (GMT) of EV-D68 NtAbs in 2012 and 2017 were 92.82 and 242.91, respectively; the seroprevalences of EV-D68 were 89.43% and 98.43%, respectively. The GMT reached its peak in the 11 to 15 age group in 2012, while in 16 to 20 age group in 2017. We also observed that EV-D68 NtAbs titers of six sera from the acute phase were all less than equal to 1:64 and that of three sera from the convalescent phase were all more than 1:64. Anti-EV-D68 NtAbs in the population remained low from 2012 to 2016 but increased significantly in 2017. Although most of the EV-D68 infections remain undetected in Beijing, the risk of a large outbreak of EV-D68 exists and should be taken seriously.
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Affiliation(s)
- Yang Liu
- College of Public Health, Capital Medical University, Beijing, China
| | - Cheng Gong
- Planned Immunity Inoculation Institute, Beijing Center for Disease Prevention and Control, Beijing, China
| | - Ming Luo
- Planned Immunity Inoculation Institute, Beijing Center for Disease Prevention and Control, Beijing, China
| | - Tiegang Zhang
- Planned Immunity Inoculation Institute, Beijing Center for Disease Prevention and Control, Beijing, China
| | - Maozhong Li
- Planned Immunity Inoculation Institute, Beijing Center for Disease Prevention and Control, Beijing, China
| | - Lingyu Shen
- Planned Immunity Inoculation Institute, Beijing Center for Disease Prevention and Control, Beijing, China
| | - Herun Zhang
- Planned Immunity Inoculation Institute, Beijing Center for Disease Prevention and Control, Beijing, China
| | - Fang Huang
- College of Public Health, Capital Medical University, Beijing, China
- Planned Immunity Inoculation Institute, Beijing Center for Disease Prevention and Control, Beijing, China
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7
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Huo W, Yu J, Liu C, Wu T, Wang Y, Meng X, Song F, Zhang S, Su Y, Liu Y, Liu J, Yu X, Hua S. Caspase-3 inhibitor inhibits enterovirus D68 production. J Microbiol 2020; 58:812-820. [PMID: 32870487 PMCID: PMC7459088 DOI: 10.1007/s12275-020-0241-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 12/20/2022]
Abstract
Enterovirus D68 (EVD68) is an emerging pathogen that recently caused a large worldwide outbreak of severe respiratory disease in children. However, the relationship between EVD68 and host cells remains unclear. Caspases are involved in cell death, immune response, and even viral production. We found that caspase-3 was activated during EVD68 replication to induce apoptosis. Caspase-3 inhibitor (Z-DEVD-FMK) inhibited viral production, protected host cells from the cytopathic effects of EVD68 infection, and prevented EVD68 from regulating the host cell cycle at G0/G1. Meanwhile, caspase-3 activator (PAC-1) increased EVD68 production. EVD68 infection therefore activates caspase-3 for virus production. This knowledge provides a potential direction for the prevention and treatment of disease related to EVD68.
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Affiliation(s)
- Wenbo Huo
- Institute of Virology and AIDS Research, The First Hospital of Jilin University, Jilin University, Changchun, 130000, P. R. China.,Department of Experimental Pharmacology and Toxicology, School of Pharmaceutical Science, Jilin University, Changhun, 130000, P. R. China
| | - Jinghua Yu
- Institute of Virology and AIDS Research, The First Hospital of Jilin University, Jilin University, Changchun, 130000, P. R. China
| | - Chunyu Liu
- Acupuncture Department, The Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, 130000, P. R. China
| | - Ting Wu
- Neonatal Intensive Care Unit, The First Hospital of Jilin University, Jilin University, Changchun, 130000, P. R. China
| | - Yue Wang
- Department of Chemistry of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, 130000, P. R. China
| | - Xiangling Meng
- Department of Experimental Pharmacology and Toxicology, School of Pharmaceutical Science, Jilin University, Changhun, 130000, P. R. China
| | - Fengmei Song
- Department of Experimental Pharmacology and Toxicology, School of Pharmaceutical Science, Jilin University, Changhun, 130000, P. R. China
| | - Shuxia Zhang
- Department of Experimental Pharmacology and Toxicology, School of Pharmaceutical Science, Jilin University, Changhun, 130000, P. R. China
| | - Ying Su
- Department of Experimental Pharmacology and Toxicology, School of Pharmaceutical Science, Jilin University, Changhun, 130000, P. R. China
| | - Yumeng Liu
- Department of Experimental Pharmacology and Toxicology, School of Pharmaceutical Science, Jilin University, Changhun, 130000, P. R. China
| | - Jinming Liu
- Department of Experimental Pharmacology and Toxicology, School of Pharmaceutical Science, Jilin University, Changhun, 130000, P. R. China
| | - Xiaoyan Yu
- Department of Experimental Pharmacology and Toxicology, School of Pharmaceutical Science, Jilin University, Changhun, 130000, P. R. China
| | - Shucheng Hua
- Department of Internal Medicine, The First Hospital of Jilin University, Jilin University, Changchun, 130000, P. R. China.
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Jiang Y, Liu S, Shen S, Guo H, Huang H, Wei W. Methyl-β-cyclodextrin inhibits EV-D68 virus entry by perturbing the accumulation of virus particles and ICAM-5 in lipid rafts. Antiviral Res 2020; 176:104752. [PMID: 32101770 DOI: 10.1016/j.antiviral.2020.104752] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2019] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 11/27/2022]
Abstract
Enterovirus D68 (EV-D68) is a member of the Picornavirus family and a causative agent of respiratory diseases in children. The incidence of EV-D68 infection has increased worldwide in recent years. Thus far, there are no approved antiviral agents or vaccines for EV-D68. Here, we show that methyl-β-cyclodextrin (MβCD), a common drug that disrupts lipid rafts, specifically inhibits EV-D68 infection without producing significant cytotoxicity at virucidal concentrations. The addition of exogenous cholesterol attenuated the anti-EV-D68 activity of MβCD. MβCD treatment had a weak influence on the attachment of viral particles to the cell membrane but significantly inhibited EV-D68 entry into host cells. We demonstrated that EV-D68 facilitated the translocation of the viral receptor ICAM-5 to membrane rafts in infected cells. The colocalization of viral particles with ICAM-5 in lipid rafts was thoroughly abolished in cells after treatment with MβCD. Finally, we showed that MβCD inhibited the replication of isolated circulating EV-D68 strains. In summary, our results demonstrate that MβCD suppresses EV-D68 replication by perturbing the accumulation of virus particles and ICAM-5 in lipid rafts. This mechanism represents a promising strategy for drug development.
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Affiliation(s)
- Yunhe Jiang
- Institute of Virology and AIDS Research, The First Hospital of Jilin University, Changchun, Jilin Province, 130021, China; Department of Pathogenobiology, College of Basic Medical Science, Jilin University, Changchun, Jilin, 130021, China
| | - Shunan Liu
- Institute of Virology and AIDS Research, The First Hospital of Jilin University, Changchun, Jilin Province, 130021, China
| | - Siyu Shen
- Institute of Virology and AIDS Research, The First Hospital of Jilin University, Changchun, Jilin Province, 130021, China
| | - Haoran Guo
- Institute of Virology and AIDS Research, The First Hospital of Jilin University, Changchun, Jilin Province, 130021, China
| | - Honglan Huang
- Department of Pathogenobiology, College of Basic Medical Science, Jilin University, Changchun, Jilin, 130021, China.
| | - Wei Wei
- Institute of Virology and AIDS Research, The First Hospital of Jilin University, Changchun, Jilin Province, 130021, China; Key Laboratory of Organ Regeneration and Transplantation of Ministry of Education, Institute of Translational Medicine, The First Hospital of Jilin University, Changchun, Jilin Province, 130021, China.
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9
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Wang X, Zhang P, Li J, Chu Y, Li Z, Yang Y, Li F, Cui S, Huo D, Wang Y, Wang Q. Enterovirus D68 in a 6-year-old acute flaccid myelitis case in China, 2018: a case report. BMC Infect Dis 2020; 20:125. [PMID: 32046658 PMCID: PMC7014760 DOI: 10.1186/s12879-020-4829-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 01/28/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute flaccid myelitis (AFM) are reported to be associated with enterovirus D68 infection. Though an increasing number of AFM cases were reported with EV-D68 infection in the US, few such cases have been found in China. CASE PRESENTATION A 6-year-old boy presented with acute flaccid myelitis (AFM) involving left arm after fever and respiratory symptoms for 6 days. Computed Tomography (CT) revealed inflammation in both lungs and magnetic resonance imaging (MRI) of the brain and spine showed swelling in the left frontal lobe and brain stem. The patient was diagnosed with meningomyelitis. EV-D68 was detected from pharyngeal samples 36 days after the onset of the disease. CONCLUSION We report the first EV-D68 infection in case of AFM in mainland China. AFM surveillance systems is recommended to be established in China to guide diagnosis, case reporting, and specimen collection and testing for better understanding its etiologies.
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Affiliation(s)
- Xiaoli Wang
- Beijing Center for Disease Prevention and Control, Beijing Research Center for Preventive Medicine, No.16 Hepingli Middle Street, Dongcheng District, Beijing, 100013, China
| | - Pengfei Zhang
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Jie Li
- Beijing Center for Disease Prevention and Control, Beijing Research Center for Preventive Medicine, No.16 Hepingli Middle Street, Dongcheng District, Beijing, 100013, China
| | - Yanhui Chu
- Xicheng District Center for Disease Control and Prevention, No.38 De Shengmenwai Street, Xicheng District, Beijing, 100120, China
| | - Zheng Li
- Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, No.56 Nanlishi Road, Xicheng District, Beijing, 100045, China
| | - Yang Yang
- Beijing Center for Disease Prevention and Control, Beijing Research Center for Preventive Medicine, No.16 Hepingli Middle Street, Dongcheng District, Beijing, 100013, China
| | - Fu Li
- Beijing Center for Disease Prevention and Control, Beijing Research Center for Preventive Medicine, No.16 Hepingli Middle Street, Dongcheng District, Beijing, 100013, China
| | - Shujuan Cui
- Beijing Center for Disease Prevention and Control, Beijing Research Center for Preventive Medicine, No.16 Hepingli Middle Street, Dongcheng District, Beijing, 100013, China
| | - Da Huo
- Beijing Center for Disease Prevention and Control, Beijing Research Center for Preventive Medicine, No.16 Hepingli Middle Street, Dongcheng District, Beijing, 100013, China
| | - Yu Wang
- Beijing Center for Disease Prevention and Control, Beijing Research Center for Preventive Medicine, No.16 Hepingli Middle Street, Dongcheng District, Beijing, 100013, China
| | - Quanyi Wang
- Beijing Center for Disease Prevention and Control, Beijing Research Center for Preventive Medicine, No.16 Hepingli Middle Street, Dongcheng District, Beijing, 100013, China. .,Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, No.16 Hepingli Middle Street, Dongcheng District, Beijing, 100013, China.
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10
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Meyers L, Dien Bard J, Galvin B, Nawrocki J, Niesters HGM, Stellrecht KA, St George K, Daly JA, Blaschke AJ, Robinson C, Wang H, Cook CV, Hassan F, Dominguez SR, Pretty K, Naccache S, Olin KE, Althouse BM, Jones JD, Ginocchio CC, Poritz MA, Leber A, Selvarangan R. Enterovirus D68 outbreak detection through a syndromic disease epidemiology network. J Clin Virol 2020; 124:104262. [PMID: 32007841 DOI: 10.1016/j.jcv.2020.104262] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 01/08/2020] [Accepted: 01/14/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND In 2014, enterovirus D68 (EV-D68) was responsible for an outbreak of severe respiratory illness in children, with 1,153 EV-D68 cases reported across 49 states. Despite this, there is no commercial assay for its detection in routine clinical care. BioFire® Syndromic Trends (Trend) is an epidemiological network that collects, in near real-time, deidentified. BioFire test results worldwide, including data from the BioFire® Respiratory Panel (RP). OBJECTIVES Using the RP version 1.7 (which was not explicitly designed to differentiate EV-D68 from other picornaviruses), we formulate a model, Pathogen Extended Resolution (PER), to distinguish EV-D68 from other human rhinoviruses/enteroviruses (RV/EV) tested for in the panel. Using PER in conjunction with Trend, we survey for historical evidence of EVD68 positivity and demonstrate a method for prospective real-time outbreak monitoring within the network. STUDY DESIGN PER incorporates real-time polymerase chain reaction metrics from the RPRV/EV assays. Six institutions in the United States and Europe contributed to the model creation, providing data from 1,619 samples spanning two years, confirmed by EV-D68 gold-standard molecular methods. We estimate outbreak periods by applying PER to over 600,000 historical Trend RP tests since 2014. Additionally, we used PER as a prospective monitoring tool during the 2018 outbreak. RESULTS The final PER algorithm demonstrated an overall sensitivity and specificity of 87.1% and 86.1%, respectively, among the gold-standard dataset. During the 2018 outbreak monitoring period, PER alerted the research network of EV-D68 emergence in July. One of the first sites to experience a significant increase, Nationwide Children's Hospital, confirmed the outbreak and implemented EV-D68 testing at the institution in response. Applying PER to the historical Trend dataset to determine rates among RP tests, we find three potential outbreaks with predicted regional EV-D68 rates as high as 37% in 2014, 16% in 2016, and 29% in 2018. CONCLUSIONS Using PER within the Trend network was shown to both accurately predict outbreaks of EV-D68 and to provide timely notifications of its circulation to participating clinical laboratories.
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Affiliation(s)
- Lindsay Meyers
- BioFire Diagnostics, Salt Lake City, UT, 84103, United States.
| | - Jennifer Dien Bard
- Department of Pathology and Laboratory Medicine, Children's Hospital of Los Angeles, Los Angeles, CA 90027, United States; Keck School of Medicine, University of Southern California, Los Angeles, CA 90039, United States.
| | - Ben Galvin
- BioFire Diagnostics, Salt Lake City, UT, 84103, United States.
| | - Jeff Nawrocki
- BioFire Diagnostics, Salt Lake City, UT, 84103, United States.
| | - Hubert G M Niesters
- The University of Groningen, University Medical Center Groningen, Department of Medical Microbiology, Division of Clinical Virology, Groningen, The Netherlands.
| | - Kathleen A Stellrecht
- Department of Pathology and Laboratory Medicine, Albany Medical Center, Albany, NY 12208, United States.
| | - Kirsten St George
- New York State Department of Health, Albany, NY, 12202, United States.
| | - Judy A Daly
- Department of Pathology, University of Utah, Salt Lake City, UT 84132, United States; Division of Inpatient Medicine, Primary Children's Hospital, Salt Lake City, UT 84132, United States.
| | - Anne J Blaschke
- Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT 84132, United States.
| | - Christine Robinson
- Department of Pathology and Laboratory Medicine, Children's Colorado, Aurora, CO 80045, United States.
| | - Huanyu Wang
- Department of Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH 43205, United States.
| | - Camille V Cook
- BioFire Diagnostics, Salt Lake City, UT, 84103, United States.
| | - Ferdaus Hassan
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, MO 64108, United States.
| | - Sam R Dominguez
- Department of Pathology and Laboratory Medicine, Children's Colorado, Aurora, CO 80045, United States.
| | - Kristin Pretty
- Department of Pathology and Laboratory Medicine, Children's Colorado, Aurora, CO 80045, United States.
| | - Samia Naccache
- Department of Pathology and Laboratory Medicine, Children's Hospital of Los Angeles, Los Angeles, CA 90027, United States.
| | | | - Benjamin M Althouse
- Information School, University of Washington, Seattle, WA, 98105, United States; Department of Biology, New Mexico State University, Las Cruces, NM, 88003, United States.
| | - Jay D Jones
- BioFire Diagnostics, Salt Lake City, UT, 84103, United States.
| | - Christine C Ginocchio
- BioFire Diagnostics, Salt Lake City, UT, 84103, United States; Global Medical Affairs, bioMérieux, Durham, NC 27712, United States; Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY 11549, United States.
| | - Mark A Poritz
- BioFire Defense, Salt Lake City, UT 84107, United States.
| | - Amy Leber
- Department of Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH 43205, United States.
| | - Rangaraj Selvarangan
- Department of Pathology and Laboratory Medicine, Children's Mercy Hospital, Kansas City, MO 64108, United States.
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11
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Manifestations of enterovirus D68 and high seroconversion among children attending a kindergarten. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2019; 52:858-864. [DOI: 10.1016/j.jmii.2019.04.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Revised: 04/16/2019] [Accepted: 04/26/2019] [Indexed: 01/28/2023]
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12
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Abstract
We report a case of enterovirus C105 infection in an 11-year-old girl with lower respiratory tract symptoms that was identified through the Respiratory Virus Surveillance System, which covers 30 sentinel hospitals in all 16 districts of Beijing, China. The presence of this virus strain in China confirmed its geographically wide distribution.
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13
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Kubi JA, Mutocheluh M, Bonney JHK, Ampofo WK, Odoom JK. Molecular detection of enterovirus D68 among children with acute respiratory tract infection in Ghana. Afr J Lab Med 2019; 8:732. [PMID: 31309045 PMCID: PMC6620485 DOI: 10.4102/ajlm.v8i1.732] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 11/02/2018] [Indexed: 01/08/2023] Open
Abstract
Background Acute respiratory tract infections of viral origin remain a leading cause of morbidity, mortality and economic loss regardless of age or gender. A small number of acute respiratory tract infection cases caused by enterovirus D68 (EV-D68) have been reported regularly to Centers for Disease Control and Prevention since 1987 by countries in North America, Europe and Asia. However, in 2014 and 2015, the number of reported confirmed EV-D68 infections was much greater than in previous years. The National Influenza Centre (NIC), Ghana carries out surveillance of respiratory infections, focusing on those caused by influenza virus; however, there is inadequate information on other viruses causing respiratory infections in Ghana, including EV-D68. Objectives To investigate the association of EV-D68 with Severe Acute Respiratory Infections (SARI) and Influenza-Like Illness (ILI) in Ghana. Methods This was a retrospective cross-sectional study which involved archived human respiratory specimens stored at –80 °C at the NIC from 2014 to 2015. Using a random sampling method, oropharyngeal and nasopharyngeal swabs from patients with SARI and ILI that were negative by real-time PCR for human influenza viruses were screened for EV-D68 using real-time reverse transcription-polymerase chain reaction (rRT-PCR). Results Enterovirus D68 was detected in 4 (2.2%) out of 182 SARI samples tested. EV-D68 was detected in children younger than 5 years (4 – 100% of positives) and was not detected in children older than 5 years. Enterovirus D68 was detected more frequently in SARI cases (3%) than in ILI cases (1.2%). Conclusion This study has shown for the first time the presence of EV-D68 in acute respiratory infections in Ghana. The results confirmed minimal EV-D68 circulation in the Ghanaian population.
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Affiliation(s)
- Joyce A Kubi
- Department of Clinical Microbiology, School of Medical Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana.,Virology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - Mohamed Mutocheluh
- Department of Clinical Microbiology, School of Medical Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Joseph H K Bonney
- Virology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - William K Ampofo
- Virology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
| | - John K Odoom
- Virology Department, Noguchi Memorial Institute for Medical Research, University of Ghana, Accra, Ghana
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14
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Shen L, Gong C, Xiang Z, Zhang T, Li M, Li A, Luo M, Huang F. Upsurge of Enterovirus D68 and Circulation of the New Subclade D3 and Subclade B3 in Beijing, China, 2016. Sci Rep 2019; 9:6073. [PMID: 30988475 PMCID: PMC6465342 DOI: 10.1038/s41598-019-42651-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 03/25/2019] [Indexed: 12/14/2022] Open
Abstract
We conducted a surveillance among acute respiratory tract infection (ARTI) cases to define the epidemiology, clinical characteristics and genetic variations of enterovirus D68 (EV-D68) in Beijing, China from 2015 to 2017. Nasopharyngeal swabs and sputum were collected from 30 sentinel hospitals in Beijing and subjected to EV and EV-D68 detection by real-time PCR. The VP1 gene region and complete genome sequences of EV-D68 positive cases were analyzed. Of 21816 ARTI cases, 619 (2.84%) were EV positive and 42 cases were EV-D68 positive. The detection rates of EV-D68 were 0 (0/6644) in 2015, 0.53% (40/7522) in 2016 and 0.03% (2/7650) in 2017, respectively. Two peaks of EV-D68 infections occurred in late summer and early-winter. Ten cases (23.81%) with upper respiratory tract infection and 32 cases (76.19%) presented with pneumonia, including 3 cases with severe pneumonia. The phylogenetic analysis suggested 15 subclade D3 strains and 27 subclade B3 strains of EV-D68 were circulated in China from 2016 to 2017. A total of 52 amino acid polymorphisms were identified between subclades D1 and D3. These data suggest an upsurge of EV-D68 occurred in Beijing in 2016, the new subclade D3 emerged in 2016 and co-circulated with subclade B3 between 2016 and 2017.
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Affiliation(s)
- Lingyu Shen
- School of Public Health, Capital Medical University, Beijing, 100069, P.R. China
- Institute for immunization and prevention, Beijing Municipal Center for Disease Prevention and Control, Beijing, 100013, P.R. China
| | - Cheng Gong
- Institute for immunization and prevention, Beijing Municipal Center for Disease Prevention and Control, Beijing, 100013, P.R. China
| | - Zichun Xiang
- MOH Key Laboratory of Systems Biology of Pathogens and Christophe Mérieux Laboratory, IPB, CAMS-Foundation Mérieux, Institute of Pathogen Biology (IPB), Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College, Beijing, 100730, P.R. China
| | - Tiegang Zhang
- Institute for immunization and prevention, Beijing Municipal Center for Disease Prevention and Control, Beijing, 100013, P.R. China
| | - Maozhong Li
- Institute for immunization and prevention, Beijing Municipal Center for Disease Prevention and Control, Beijing, 100013, P.R. China
| | - Aihua Li
- Institute for immunization and prevention, Beijing Municipal Center for Disease Prevention and Control, Beijing, 100013, P.R. China
| | - Ming Luo
- School of Public Health, Capital Medical University, Beijing, 100069, P.R. China
| | - Fang Huang
- School of Public Health, Capital Medical University, Beijing, 100069, P.R. China.
- Institute for immunization and prevention, Beijing Municipal Center for Disease Prevention and Control, Beijing, 100013, P.R. China.
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15
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Sun S, Bian L, Gao F, Du R, Hu Y, Fu Y, Su Y, Wu X, Mao Q, Liang Z. A neonatal mouse model of Enterovirus D68 infection induces both interstitial pneumonia and acute flaccid myelitis. Antiviral Res 2018; 161:108-115. [PMID: 30503887 DOI: 10.1016/j.antiviral.2018.11.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 11/01/2018] [Accepted: 11/26/2018] [Indexed: 02/08/2023]
Abstract
Enterovirus D68 (EV-D68) is a causative agent of recent outbreaks of severe respiratory illness, pneumonia and acute flaccid myelitis (AFM) worldwide. The study of the pathogenesis, vaccines and anti-viral drugs for EV-D68 infection has been reported. Given the previously described mouse model of EV-D68, we sought to establish a neonatal mice model inducing both pneumonia and AFM. The neonatal BALB/c mice were inoculated intraperitoneally with the EV-D68 strain (named15296-virus) which was produced by the reverse genetics method. The infected mice displayed limb paralysis, tachypnea and even death, which were similar to the clinical symptoms of human infections. Moreover, the results of histopathologic examination and immunohistochemical staining showed acidophilic necrosis in the muscle, the spinal cord and alveolar wall thickening in the lung, indicating that EV-D68 exhibited strong tropism to the muscles, spinal cord and lung. Furthermore, the results of real-time PCR also suggested that the viral loads in the blood, spinal cord, muscles and lung were higher than those in other tissues at different time points post-infection. Additionally, the neonatal mouse model was used for evaluating the EV-D68 infection. The results of the anti-serum passive and maternal antibody protection indicated that the neonatal mice could be protected against the EV-D68 challenge, and displayed that both the serum of 15296-virus and prototype-virus (Fermon) were performing a certain cross-protective activity against the 15296-virus challenge. In summary, the above results proved that our neonatal mouse model possessed not only the interstitial pneumonia and AFM simultaneously but also a potentiality to evaluate the protective effects of EV-D68 vaccines and anti-viral drugs in the future.
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Affiliation(s)
- Shiyang Sun
- Institute of Medicinal Biotechnology Chinese Academy of Medical Sciences, Peking Union Medical College (PUMC), Beijing, China; National Institute for Food and Drug Control, Beijing, China.
| | - Lianlian Bian
- National Institute for Food and Drug Control, Beijing, China.
| | - Fan Gao
- National Institute for Food and Drug Control, Beijing, China.
| | - Ruixiao Du
- National Institute for Food and Drug Control, Beijing, China.
| | - Yalin Hu
- Hualan Biological Engineering Inc, Xinxiang, China.
| | - Ying Fu
- National Institute for Food and Drug Control, Beijing, China.
| | - Yao Su
- National Institute for Food and Drug Control, Beijing, China.
| | - Xing Wu
- National Institute for Food and Drug Control, Beijing, China.
| | - Qunying Mao
- National Institute for Food and Drug Control, Beijing, China.
| | - Zhenglun Liang
- National Institute for Food and Drug Control, Beijing, China.
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16
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Meng X, Yu X, Liu C, Wang Y, Song F, Huan C, Huo W, Zhang S, Li Z, Zhang J, Zhang W, Yu J. Effect of ingredients from Chinese herbs on enterovirus D68 production. Phytother Res 2018; 33:174-186. [PMID: 30346067 DOI: 10.1002/ptr.6214] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 08/20/2018] [Accepted: 09/25/2018] [Indexed: 01/08/2023]
Affiliation(s)
- Xiangling Meng
- Institute of Virology and AIDS Research, The First Hospital of Jilin University Jilin University Changchun China
- Department of Experimental Pharmacology and Toxicology, School of Pharmacy Jilin University Changchun China
| | - Xiaoyan Yu
- Department of Experimental Pharmacology and Toxicology, School of Pharmacy Jilin University Changchun China
| | - Chunyu Liu
- Acupuncture Department The Affiliated Hospital to Changchun University of Chinese Medicine Changchun China
| | - Ying Wang
- Department of Gastroenterology, The First Hospital of Jilin University Jilin University Changchun China
| | - Fengmei Song
- Department of Experimental Pharmacology and Toxicology, School of Pharmacy Jilin University Changchun China
| | - Chen Huan
- Institute of Virology and AIDS Research, The First Hospital of Jilin University Jilin University Changchun China
| | - Wenbo Huo
- Department of Experimental Pharmacology and Toxicology, School of Pharmacy Jilin University Changchun China
| | - Shuxia Zhang
- Department of Experimental Pharmacology and Toxicology, School of Pharmacy Jilin University Changchun China
| | - Zhaolong Li
- Institute of Virology and AIDS Research, The First Hospital of Jilin University Jilin University Changchun China
| | - Jun Zhang
- Institute of Virology and AIDS Research, The First Hospital of Jilin University Jilin University Changchun China
| | - Wenyan Zhang
- Institute of Virology and AIDS Research, The First Hospital of Jilin University Jilin University Changchun China
| | - Jinghua Yu
- Institute of Virology and AIDS Research, The First Hospital of Jilin University Jilin University Changchun China
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17
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Sun S, Gao F, Hu Y, Bian L, Wu X, Su Y, Du R, Fu Y, Zhu F, Mao Q, Liang Z. A cross-sectional seroepidemiology study of EV-D68 in China. Emerg Microbes Infect 2018; 7:99. [PMID: 29872035 PMCID: PMC5988671 DOI: 10.1038/s41426-018-0103-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 04/08/2018] [Accepted: 04/29/2018] [Indexed: 02/02/2023]
Abstract
Enterovirus 68 (EV-D68) is associated with respiratory diseases, such as acute upper respiratory tract infections (URTIs), lower respiratory tract infections (LRTIs), pneumonia, neurological diseases, and acute flaccid myelitis (AFM). In recent years, there have been global outbreaks of EV-D68 epidemics. However, there is no effective vaccine against EV-D68, and the understanding of the seroprevalence characteristics of EV-D68 is limited. To evaluate the epidemiological features of this emerging infection in mainland China, serum samples from 20 pairs of pregnant women and their neonates, 405 infants and children (ages 1 month-15 years), and 50 adults were collected to measure EV-D68 neutralizing antibodies (NtAbs). The results showed that the geometric mean titers (GMTs) of pregnant women and their neonates were 168 (95%CI: 93.6-301.7) and 162.3 (95%CI: 89.9-293.1), respectively. The seroprevalence rate of EV-D68 antibodies was negatively correlated with age in 1-month-old to 12-month-old infants (84% for 1-month-old infants vs 10% for 1-year-old infants), whereas it was positively correlated with age for 1-year-old to 15-year-old children (10% for 1-year-old children vs 92% for 15-year-old children). This study evaluated maternal antibodies against EV-D68 in neonates. Our results showed that if mothers had high levels of anti-EV-D68 NtAbs, the NtAbs titers in their neonates were also high. The GMTs and seroprevalence rates of each age group indicated that EV-D68 infection was very common in China. Periodical EV-D68 seroprevalence surveys and vaccination campaigns should be the top priority for preventing EV-D68 infection.
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Affiliation(s)
- Shiyang Sun
- National Institute for Food and Drug Control, Beijing, China
| | - Fan Gao
- National Institute for Food and Drug Control, Beijing, China
| | - Yalin Hu
- Hualan Biological Engineering Inc, Xinxiang, China
| | - Lianlian Bian
- National Institute for Food and Drug Control, Beijing, China
| | - Xing Wu
- National Institute for Food and Drug Control, Beijing, China
| | - Yao Su
- National Institute for Food and Drug Control, Beijing, China
| | - Ruixiao Du
- National Institute for Food and Drug Control, Beijing, China
| | - Ying Fu
- National Institute for Food and Drug Control, Beijing, China
| | - Fengcai Zhu
- Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Qunying Mao
- National Institute for Food and Drug Control, Beijing, China.
| | - Zhenglun Liang
- National Institute for Food and Drug Control, Beijing, China.
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18
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Piralla A, Principi N, Ruggiero L, Girello A, Giardina F, De Sando E, Caimmi S, Bianchini S, Marseglia GL, Lunghi G, Baldanti F, Esposito S. Enterovirus-D68 (EV-D68) in pediatric patients with respiratory infection: The circulation of a new B3 clade in Italy. J Clin Virol 2018; 99-100:91-96. [PMID: 29396353 PMCID: PMC7185653 DOI: 10.1016/j.jcv.2018.01.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 01/03/2018] [Accepted: 01/11/2018] [Indexed: 11/01/2022]
Abstract
BACKGROUND In recent years, several outbreaks due to Enterovirus D-68 (EV-D68) have been reported, and it was confirmed that the virus can cause upper and lower respiratory tract diseases and be associated with the development of neurological problems. OBJECTIVES The main aim of this research was to study the genetic characteristics of EV-D68 strains that were circulating in Italy identified during an outbreak of an EV-D68 infection that occurred in Italy during the period March-October 2016. STUDY DESIGN A retrospective study of the circulation of different types and subtypes of EV-D68 was performed. Nasopharyngeal swabs were collected from March 2016 through October 2016 in children admitted to the Emergency Room with respiratory diseases. RESULTS Among 390 children, 22 (59.1% males; mean age 47 months) were found to be infected by EV-D68 and most of them were immunocompetent (72.7%). Pneumonia was diagnosed in 12 (54.5%) children. Phylogenetic analysis of the VP1 region showed that all the strains identified in this study belonged to clade B3. Within B3 subclade, the Italian EV-D68 strains were most closely related to strains detected in Southern China in 2015 as well as to strains detected in US and the Netherlands in 2016. CONCLUSIONS These results showed that EV-D68 infections are a common cause of lower respiratory illness in pediatric age. The circulation of one EV-D68 lineage has been proven in Italy and in the European region during 2016. However, further studies are required to investigate whether some strains or lineages may possess a higher affinity for the lower airway or central nervous system.
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Affiliation(s)
- Antonio Piralla
- Molecular Virology Unit, Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Nicola Principi
- Pediatric Highly Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano, Italy
| | - Luca Ruggiero
- Pediatric Highly Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano, Italy
| | - Alessia Girello
- Molecular Virology Unit, Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Federica Giardina
- Molecular Virology Unit, Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Elisabetta De Sando
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Pavia, Italy
| | - Silvia Caimmi
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Pavia, Italy
| | - Sonia Bianchini
- Pediatric Highly Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milano, Italy
| | - Gian Luigi Marseglia
- Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Università degli Studi di Pavia, Pavia, Italy
| | - Giovanna Lunghi
- Virology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Pavia, Italy
| | - Fausto Baldanti
- Molecular Virology Unit, Microbiology and Virology Department, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Clinical Surgical, Diagnostic and Pediatric Sciences, Università degli Studi di Pavia, Pavia, Italy
| | - Susanna Esposito
- Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Piazza Menghini 1, 06129, Perugia, Italy.
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19
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Ny NTH, Anh NT, Hang VTT, Nguyet LA, Thanh TT, Ha DQ, Minh NNQ, Ha DLA, McBride A, Tuan HM, Baker S, Tam PTT, Phuc TM, Huong DT, Loi TQ, Vu NTA, Hung NV, Minh TTT, Xang NV, Dong N, Nghia HDT, Chau NVV, Thwaites G, van Doorn HR, Anscombe C, Le Van T. Enterovirus D68 in Viet Nam (2009-2015). Wellcome Open Res 2017. [PMID: 28852711 DOI: 10.12688/wellcomeopenres.11558.1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Since 1962, enterovirus D68 (EV-D68) has been implicated in multiple outbreaks and sporadic cases of respiratory infection worldwide, but especially in the USA and Europe with an increasing frequency between 2010 and 2014. We describe the detection, associated clinical features and molecular characterization of EV-D68 in central and southern Viet Nam between 2009 and 2015. METHODS Enterovirus/rhinovirus PCR positive respiratory or CSF samples taken from children and adults with respiratory/central nervous system infections in Viet Nam were tested by an EV-D68 specific PCR. The included samples were derived from 3 different observational studies conducted at referral hospitals across central and southern Viet Nam between 2009 and 2015. Whole-genome sequencing was carried out using a MiSeq based approach. Phylogenetic reconstruction and estimation of evolutionary rate and recombination were carried out in BEAST and Recombination Detection Program, respectively. RESULTS EV-D68 was detected in 21/625 (3.4%) enterovirus/rhinovirus PCR positive respiratory samples but in none of the 15 CSF. All the EV-D68 patients were young children (age range: 11.8 - 24.5 months) and had moderate respiratory infections. Phylogenetic analysis suggested that the Vietnamese sequences clustered with those from Asian countries, of which 9 fell in the B1 clade, and the remaining sequence was identified within the A2 clade. One intra sub-clade recombination event was detected, representing the second reported recombination within EV-D68. The evolutionary rate of EV-D68 was estimated to be 5.12E -3 substitutions/site/year. Phylogenetic analysis indicated that the virus was imported into Viet Nam in 2008. CONCLUSIONS We have demonstrated for the first time EV-D68 has been circulating at low levels in Viet Nam since 2008, associated with moderate acute respiratory infection in children. EV-D68 in Viet Nam is most closely related to Asian viruses, and clusters separately from recent US and European viruses that were suggested to be associated with acute flaccid paralysis.
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Affiliation(s)
- Nguyen Thi Han Ny
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Ho Chi Minh City University of Science, Ho Chi Minh City, Vietnam
| | - Nguyen To Anh
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Vu Thi Ty Hang
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Lam Anh Nguyet
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Tran Tan Thanh
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Do Quang Ha
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | - Do Lien Anh Ha
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Angela McBride
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Ha Manh Tuan
- Children's Hospital 2, Ho Chi Minh City, Vietnam
| | - Stephen Baker
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Tran My Phuc
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Dang Thao Huong
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Tran Quoc Loi
- Dong Thap General Hospital, Ban Me Thuot City, Vietnam
| | | | | | | | | | - Nguyen Dong
- Khanh Hoa General Hospital, Nha Trang City, Vietnam
| | - Ho Dang Trung Nghia
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Pham Ngoc Thach University, Ho Chi Minh City, Vietnam
| | | | - Guy Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - H Rogier van Doorn
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Tan Le Van
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
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20
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Ny NTH, Anh NT, Hang VTT, Nguyet LA, Thanh TT, Ha DQ, Minh NNQ, Ha DLA, McBride A, Tuan HM, Baker S, Tam PTT, Phuc TM, Huong DT, Loi TQ, Vu NTA, Hung NV, Minh TTT, Xang NV, Dong N, Nghia HDT, Chau NVV, Thwaites G, van Doorn HR, Anscombe C, Le Van T. Enterovirus D68 in Viet Nam (2009-2015). Wellcome Open Res 2017; 2:41. [PMID: 28852711 PMCID: PMC5553084 DOI: 10.12688/wellcomeopenres.11558.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2017] [Indexed: 11/30/2022] Open
Abstract
Background: Since 1962, enterovirus D68 (EV-D68) has been implicated in multiple outbreaks and sporadic cases of respiratory infection worldwide, especially in the USA and Europe with an increasing frequency between 2010 and 2014. We describe the detection, associated clinical features and molecular characterization of EV-D68 in central and southern Viet Nam between 2009 and 2015. Methods: Enterovirus/rhinovirus PCR positive respiratory or CSF samples taken from children and adults with respiratory/central nervous system infections in Viet Nam were tested by an EV-D68 specific PCR. The included samples were derived from 3 different observational studies conducted at referral hospitals across central and southern Viet Nam 2009 2015. Whole-genome sequencing was carried out using a MiSeq based approach. Phylogenetic reconstruction and estimation of evolutionary rate and recombination were carried out in BEAST and Recombination Detection Program, respectively. Results: EV-D68 was detected in 21/625 (3.4%) enterovirus/rhinovirus PCR positive respiratory samples but in none of the 15 CSF. All the EV-D68 patients were young children (age range: 11.8 – 24.5 months) and had moderate respiratory infections. Phylogenetic analysis suggested that the Vietnamese sequences clustered with those from Asian countries, of which 9 fell in the B1 clade, and the remaining sequence was identified within the A2 clade. One intra sub-clade recombination event was detected, representing the second reported recombination within EV-D68. The evolutionary rate of EV-D68 was estimated to be 5.12E
-3 substitutions/site/year. Phylogenetic analysis indicated that the virus was imported into Viet Nam in 2008. Conclusions: We have demonstrated for the first time EV-D68 has been circulating at low levels in Viet Nam since 2008, associated with moderate acute respiratory infection in children. EV-D68 in Viet Nam is most closely related to Asian viruses, and clusters separately from recent US and European viruses that were suggested to be associated with acute flaccid paralysis.
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Affiliation(s)
- Nguyen Thi Han Ny
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Ho Chi Minh City University of Science, Ho Chi Minh City, Vietnam
| | - Nguyen To Anh
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Vu Thi Ty Hang
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Lam Anh Nguyet
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Tran Tan Thanh
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Do Quang Ha
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | - Do Lien Anh Ha
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Angela McBride
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Ha Manh Tuan
- Children's Hospital 2, Ho Chi Minh City, Vietnam
| | - Stephen Baker
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Tran My Phuc
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Dang Thao Huong
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Tran Quoc Loi
- Dong Thap General Hospital, Ban Me Thuot City, Vietnam
| | | | | | | | | | - Nguyen Dong
- Khanh Hoa General Hospital, Nha Trang City, Vietnam
| | - Ho Dang Trung Nghia
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Pham Ngoc Thach University, Ho Chi Minh City, Vietnam
| | | | - Guy Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - H Rogier van Doorn
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | | | - Tan Le Van
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
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21
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Xiang Z, Li L, Ren L, Guo L, Xie Z, Liu C, Li T, Luo M, Paranhos-Baccalà G, Xu W, Wang J. Seroepidemiology of enterovirus D68 infection in China. Emerg Microbes Infect 2017; 6:e32. [PMID: 28487560 PMCID: PMC5520479 DOI: 10.1038/emi.2017.14] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 02/13/2017] [Accepted: 02/13/2017] [Indexed: 11/21/2022]
Abstract
Human enterovirus 68 (EV-D68) is a rarely reported virus that has been linked to
respiratory disease. In recent years, reports about EV-D68 infection have markedly
increased worldwide. However, the epidemiological features of this emerging infection
are not well understood. To evaluate the emerging EV-D68 epidemic, we isolated the
circulating viral strain and investigated the seroprevalence of neutralizing
antibodies (NAbs) in Beijing between 2004 and 2011. We found that the titers of
EV-D68 NAbs were generally low in all age groups in sampled populations in 2004 but
significantly higher in 2009. From 2007 to 2011, the NAbs against EV-D68
significantly increased over time. These findings indicate that EV-D68 has spread
widely in the Chinese population in recent years, although only a limited number of
cases were reported.
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Affiliation(s)
- Zichun Xiang
- MOH Key Laboratory of Systems Biology of Pathogens and Christophe Mérieux Laboratory, IPB, CAMS-Fondation Mérieux, Institute of Pathogen Biology (IPB), Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College, Beijing 100730, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou 310003, China
| | - Linlin Li
- MOH Key Laboratory of Systems Biology of Pathogens and Christophe Mérieux Laboratory, IPB, CAMS-Fondation Mérieux, Institute of Pathogen Biology (IPB), Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College, Beijing 100730, China
| | - Lili Ren
- MOH Key Laboratory of Systems Biology of Pathogens and Christophe Mérieux Laboratory, IPB, CAMS-Fondation Mérieux, Institute of Pathogen Biology (IPB), Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College, Beijing 100730, China
| | - Li Guo
- MOH Key Laboratory of Systems Biology of Pathogens and Christophe Mérieux Laboratory, IPB, CAMS-Fondation Mérieux, Institute of Pathogen Biology (IPB), Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College, Beijing 100730, China
| | - Zhengde Xie
- Beijing Children's Hospital Affiliated to Capital University of Medical Sciences, Beijing 100045, China
| | - Chunyan Liu
- Beijing Children's Hospital Affiliated to Capital University of Medical Sciences, Beijing 100045, China
| | - Taisheng Li
- Peking Union Medical College Hospital, Beijing 100005, China
| | - Ming Luo
- Beijing Center for Diseases Control and Prevention, Beijing 100013, China
| | | | - Wenbo Xu
- WHO WPRO Regional Polio Reference Laboratory and Ministry of Health Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 102206, China
| | - Jianwei Wang
- MOH Key Laboratory of Systems Biology of Pathogens and Christophe Mérieux Laboratory, IPB, CAMS-Fondation Mérieux, Institute of Pathogen Biology (IPB), Chinese Academy of Medical Sciences (CAMS) & Peking Union Medical College, Beijing 100730, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou 310003, China
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22
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Wang G, Zhuge J, Huang W, Nolan SM, Gilrane VL, Yin C, Dimitrova N, Fallon JT. Enterovirus D68 Subclade B3 Strain Circulating and Causing an Outbreak in the United States in 2016. Sci Rep 2017; 7:1242. [PMID: 28455514 PMCID: PMC5430842 DOI: 10.1038/s41598-017-01349-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 03/24/2017] [Indexed: 11/09/2022] Open
Abstract
In 2014 the United States experienced a nationwide outbreak of Enterovirus D68 (EV-D68) infection. There were no confirmed cases of EV-D68 in 2015 and CDC was only aware of limited sporadic EV-D68 detection in the US in 2016. In this report, we analyzed 749 nasopharyngeal (NP) specimens collected in 2015 and 2016 from patients in the Lower Hudson Valley, New York using a previously validated EV-D68-specific rRT-PCR assay. EV-D68 was detected in none of 199 NP specimens collected in 2015, and in one of 108 (0.9%) samples from January to May and 159 of 442 (36.0%) samples from July to October 2016. Complete EV-D68 genome sequences from 22 patients in 2016 were obtained using a metagenomic next-generation sequencing assay. Comparative genome analysis confirmed that a new EV-D68 strain belonging to subclade B3, with 3.2-4.8% divergence in nucleotide from subclade B1 strains identified during the 2014 US outbreak, was circulating in the US in 2016 and caused an outbreak in the Lower Hudson Valley, New York with 160 laboratory-confirmed cases. Our data highlight the genetic variability and capacity in causing outbreak by diverse EV-D68 strains, and the necessity of awareness and more surveillance on their active circulation worldwide.
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Affiliation(s)
- Guiqing Wang
- Department of Pathology, New York Medical College, Valhalla, New York, USA. .,Department of Pathology and Clinical Laboratories, Westchester Medical Center, Valhalla, New York, USA.
| | - Jian Zhuge
- Department of Pathology and Clinical Laboratories, Westchester Medical Center, Valhalla, New York, USA
| | - Weihua Huang
- Department of Pathology, New York Medical College, Valhalla, New York, USA
| | - Sheila M Nolan
- Department of Pediatrics, Division of Infectious Disease, New York Medical College and Maria Fareri Children's Hospital at Westchester Medical Center, Valhalla, New York, USA
| | - Victoria L Gilrane
- Department of Pathology, New York Medical College, Valhalla, New York, USA
| | - Changhong Yin
- Department of Pathology, New York Medical College, Valhalla, New York, USA
| | | | - John T Fallon
- Department of Pathology, New York Medical College, Valhalla, New York, USA.,Department of Pathology and Clinical Laboratories, Westchester Medical Center, Valhalla, New York, USA
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23
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The emergence of enterovirus D68 in England in autumn 2014 and the necessity for reinforcing enterovirus respiratory screening. Epidemiol Infect 2017; 145:1855-1864. [PMID: 28367789 DOI: 10.1017/s0950268817000590] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
In autumn 2014, enterovirus D68 (EV-D68) cases presenting with severe respiratory or neurological disease were described in countries worldwide. To describe the epidemiology and virological characteristics of EV-D68 in England, we collected clinical information on laboratory-confirmed EV-D68 cases detected in secondary care (hospitals), between September 2014 and January 2015. In primary care (general practitioners), respiratory swabs collected (September 2013-January 2015) from patients presenting with influenza-like illness were tested for EV-D68. In secondary care 55 EV-D68 cases were detected. Among those, 45 cases had clinical information available and 89% (40/45) presented with severe respiratory symptoms. Detection of EV-D68 among patients in primary care increased from 0.4% (4/1074; 95% CI 0.1-1.0) (September 2013-January 2014) to 0.8% (11/1359; 95% CI 0.4-1.5) (September 2014-January 2015). Characterization of EV-D68 strains circulating in England since 2012 and up to winter 2014/2015 indicated that those strains were genetically similar to those detected in 2014 in USA. We recommend reinforcing enterovirus surveillance through screening respiratory samples of suspected cases.
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24
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Bosis S, Esposito S. Enterovirus D68-Associated Community-Acquired Pneumonia in the Pediatric Age Group. Curr Infect Dis Rep 2017; 19:12. [PMID: 28251508 DOI: 10.1007/s11908-017-0567-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE OF REVIEW This review summarizes the current knowledge regarding the role of Enterovirus D68 (EV-D68) in community-acquired pneumonia (CAP) in children. RECENT FINDINGS EV-D68 is an emergent viral pathogen. Since its first isolation in 1962 in California in four children suffering from CAP and bronchiolitis, EV-D68 has been rarely detected from respiratory specimens. However, recently, EV-D68 infection has raised concerns in the international community because of outbreaks in 2014 in the USA and the increased number of children with EV-D68-associated severe respiratory illnesses, including pneumonia, that have been reported in many other countries around the world. EV-D68 causes severe and life-threatening respiratory diseases in the pediatric population, particularly in children with underlying conditions such as prematurity or chronic diseases. Since no specific treatment or vaccinations are available for EV-D68 infections, greater surveillance as well as the use of sensitive and rapid diagnostic methods are essential to prevent and manage new outbreaks.
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Affiliation(s)
- Samantha Bosis
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy
| | - Susanna Esposito
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy. .,Pediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Piazza Menghini 1, 06129, Perugia, Italy.
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25
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Nathaniel S, Ahmed S, Wilson J, Gutierrez C, Chadee DD, Olowokure B, de Salazar PM. First reported enterovirus D68 infection in pediatric patients from the Caribbean region: evidence of spread from the U.S. outbreak. Rev Panam Salud Publica 2017; 41:e11. [PMID: 28443999 PMCID: PMC6660861 DOI: 10.26633/rpsp.2017.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The 2014 enterovirus D68 (EV-D68) outbreak in the United States raised concerns about the introduction of the virus in the Caribbean region. The objective of this study was to provide rapid evidence of the introduction of EV-D68 strains in the Caribbean region during the 2014 outbreak in the United States, using a relatively simple phylogenetic approach. From October 2014 to May 2015, four EV-D68 cases from two countries (Bermuda and Dominica) were detected at the regional referral laboratory at the Caribbean Public Health Agency (Port of Spain, Trinidad and Tobago) based on molecular testing of respiratory specimens. All cases were children presenting to hospitals with moderate respiratory distress. No cases of acute flaccid paralysis were detected. Phylogenetic analysis of the Caribbean strains showed more than 99% similarity with the 2014 U.S.-outbreak strain, providing evidence of the introduction and circulation of the virus in the region.
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Affiliation(s)
- SueMin Nathaniel
- Caribbean Public Health AgencyPort of SpainTrinidad and TobagoCaribbean Public Health Agency, Port of Spain, Trinidad and Tobago.,Send correspondence to: Pablo Martínez de Salazar,
| | - Shalauddin Ahmed
- Ministry of Health and the EnvironmentRoseauCommonwealth of DominicaMinistry of Health and the Environment, Roseau, Commonwealth of Dominica.
| | - Jennifer Wilson
- Ministry of HealthSeniors and EnvironmentHamiltonBermudaMinistry of Health, Seniors and Environment, Hamilton, Bermuda.
| | - Cristina Gutierrez
- Caribbean Public Health AgencyPort of SpainTrinidad and TobagoCaribbean Public Health Agency, Port of Spain, Trinidad and Tobago.
| | - Dave D. Chadee
- University of the West IndiesSt. AugustineTrinidad and TobagoUniversity of the West Indies, St. Augustine, Trinidad and Tobago.
| | - Babatunde Olowokure
- Caribbean Public Health AgencyPort of SpainTrinidad and TobagoCaribbean Public Health Agency, Port of Spain, Trinidad and Tobago.
| | - Pablo M. de Salazar
- Caribbean Public Health AgencyPort of SpainTrinidad and TobagoCaribbean Public Health Agency, Port of Spain, Trinidad and Tobago.
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26
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Wang ZY, Zhong T, Wang Y, Song FM, Yu XF, Xing LP, Zhang WY, Yu JH, Hua SC, Yu XF. Human Enterovirus 68 Interferes with the Host Cell Cycle to Facilitate Viral Production. Front Cell Infect Microbiol 2017; 7:29. [PMID: 28229049 PMCID: PMC5296350 DOI: 10.3389/fcimb.2017.00029] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 01/20/2017] [Indexed: 12/18/2022] Open
Abstract
Enterovirus D68 (EV-D68) is an emerging pathogen that recently caused a large outbreak of severe respiratory disease in the United States and other countries. Little is known about the relationship between EV-D68 virus and host cells. In this study, we assessed the effect of the host cell cycle on EV-D68 viral production, as well as the ability of EV-D68 to manipulate host cell cycle progression. The results suggest that synchronization in G0/G1 phase, but not S phase, promotes viral production, while synchronization in G2/M inhibits viral production. Both an early EV-D68 isolate and currently circulating strains of EV-D68 can manipulate the host cell cycle to arrest cells in the G0/G1 phase, thus providing favorable conditions for virus production. Cell cycle regulation by EV-D68 was associated with corresponding effects on the expression of cyclins and CDKs, which were observed at the level of the protein and/or mRNA. Furthermore, the viral non-structural protein 3D of EV-D68 prevents progression from G0/G1 to S. Interestingly, another member of the Picornaviridae family, EV-A71, differs from EV-D68 in that G0/G1 synchronization inhibits, rather than promotes, EV-A71 viral replication. However, these viruses are similar in that G2/M synchronization inhibits the production and activity of both viruses, which is suggestive of a common therapeutic target for both types of enterovirus. These results further clarify the pathogenic mechanisms of enteroviruses and provide a potential strategy for the treatment and prevention of EV-D68-related disease.
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Affiliation(s)
- Zeng-Yan Wang
- Department of Internal Medicine, The First Hospital of Jilin University, Jilin University Changchun, China
| | - Ting Zhong
- Medicinal Chemistry, College of Pharmacy, Changchun University of Chinese Medicine Changchun, China
| | - Yue Wang
- Chemistry of Traditional Chinese Medicine, College of Pharmacy, Changchun University of Chinese Medicine Changchun, China
| | - Feng-Mei Song
- Department of Experimental Pharmacology and Toxicology, School of Pharmacy, Jilin Univrsity Changchun, China
| | - Xiao-Feng Yu
- Institute of Virology and AIDS Research, The First Hospital of Jilin University, Jilin University Changchun, China
| | - Li-Ping Xing
- Department of Internal Medicine, The First Hospital of Jilin University, Jilin University Changchun, China
| | - Wen-Yan Zhang
- Institute of Virology and AIDS Research, The First Hospital of Jilin University, Jilin University Changchun, China
| | - Jing-Hua Yu
- Institute of Virology and AIDS Research, The First Hospital of Jilin University, Jilin University Changchun, China
| | - Shu-Cheng Hua
- Department of Internal Medicine, The First Hospital of Jilin University, Jilin University Changchun, China
| | - Xiao-Fang Yu
- Institute of Virology and AIDS Research, The First Hospital of Jilin University, Jilin University Changchun, China
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27
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Fowler III AA, Kim C, Lepler L, Malhotra R, Debesa O, Natarajan R, Fisher BJ, Syed A, DeWilde C, Priday A, Kasirajan V. Intravenous vitamin C as adjunctive therapy for enterovirus/rhinovirus induced acute respiratory distress syndrome. World J Crit Care Med 2017; 6:85-90. [PMID: 28224112 PMCID: PMC5295174 DOI: 10.5492/wjccm.v6.i1.85] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 09/20/2016] [Accepted: 11/17/2016] [Indexed: 02/06/2023] Open
Abstract
We report a case of virus-induced acute respiratory distress syndrome (ARDS) treated with parenteral vitamin C in a patient testing positive for enterovirus/rhinovirus on viral screening. This report outlines the first use of high dose intravenous vitamin C as an interventional therapy for ARDS, resulting from enterovirus/rhinovirus respiratory infection. From very significant preclinical research performed at Virginia Commonwealth University with vitamin C and with the very positive results of a previously performed phase I safety trial infusing high dose vitamin C intravenously into patients with severe sepsis, we reasoned that infusing identical dosing to a patient with ARDS from viral infection would be therapeutic. We report here the case of a 20-year-old, previously healthy, female who contracted respiratory enterovirus/rhinovirus infection that led to acute lung injury and rapidly to ARDS. She contracted the infection in central Italy while on an 8-d spring break from college. During a return flight to the United States, she developed increasing dyspnea and hypoxemia that rapidly developed into acute lung injury that led to ARDS. When support with mechanical ventilation failed, extracorporeal membrane oxygenation (ECMO) was initiated. Twelve hours following ECMO initiation, high dose intravenous vitamin C was begun. The patient’s recovery was rapid. ECMO and mechanical ventilation were discontinued by day-7 and the patient recovered with no long-term ARDS sequelae. Infusing high dose intravenous vitamin C into this patient with virus-induced ARDS was associated with rapid resolution of lung injury with no evidence of post-ARDS fibroproliferative sequelae. Intravenous vitamin C as a treatment for ARDS may open a new era of therapy for ARDS from many causes.
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28
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Zhang T, Li A, Chen M, Wu J, Huang F. Respiratory infections associated with enterovirus D68 from 2011 to 2015 in Beijing, China. J Med Virol 2016; 88:1529-34. [PMID: 26896830 PMCID: PMC7166988 DOI: 10.1002/jmv.24505] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2016] [Indexed: 11/24/2022]
Abstract
Enterovirus D68 (EV-D68) is an emergent viral pathogen associated with mild to severe respiratory infections. In this study, we describe respiratory infections associated with EV-D68 in Beijing over a 4 year period. Total nucleic acid was extracted from 7,945 clinical specimens collected between January 5, 2011 and July 30, 2015 in Beijing and used for detecting EV-D68 and other enteroviruses by real-time PCR. Overall, 555/7,945 (6.99%) specimens were enterovirus positive: 12/7,945 (0.2%) specimens were EV-D68 positive. Of these patients, 11 were pediatric patients and 1 was a 76-year-old man. The main symptoms for the 12 EV-D68 positive patients were fever (10/12, 83.3%) and cough (6/12, 50%). Ten EV-D68 infection cases were identified in autumn or winter season. The phylogenetic relationships of the 12 EV-D68 viral strains with other strains were analyzed based on the sequences of viral protein 1(VP1). The EV-D68 strains from 2011 to 2013 belonged to groups 1 or 3, while all strains in 2014 were clustered into group 1 together with the strains circulating in the USA. In conclusion, EV-D68 played a role in respiratory infections in Beijing during this period. In addition, the most common EV-D68 strain detected was similar to that circulating in the USA in 2014. J. Med. Virol. 88:1529-1534, 2016. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Tiegang Zhang
- Beijing Center for Disease Prevention and ControlBeijingP. R. China
| | - Aihua Li
- Beijing Center for Disease Prevention and ControlBeijingP. R. China
| | - Meng Chen
- Beijing Center for Disease Prevention and ControlBeijingP. R. China
| | - Jiang Wu
- Beijing Center for Disease Prevention and ControlBeijingP. R. China
| | - Fang Huang
- Beijing Center for Disease Prevention and ControlBeijingP. R. China
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29
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Abstract
Enterovirus D68 (EV-D68) is a member of the species Enterovirus D in the genus Enterovirus of the Picornaviridae family. EV-D68 was first isolated in the United States in 1962 and is primarily an agent of respiratory disease. Infections with EV-D68 have been rarely reported until recently, when reports of EV-D68 associated with respiratory disease increased notably worldwide. An outbreak in 2014 in the United States, for example, involved more than 1,000 cases of severe respiratory disease that occurred across almost all states. Phylogenetic analysis of all EV-D68 sequences indicates that the circulating strains of EV-D68 can be classified into two lineages, lineage 1 and lineage 2. In contrast to the prototype Fermon strain, all circulating strains have deletions in their genomes. Respiratory illness associated with EV-D68 infection ranges from mild illness that just needs outpatient service to severe illness requiring intensive care and mechanical ventilation. To date, there are no specific medicines and vaccines to treat or prevent EV-D68 infection. This review provides a detailed overview about our current understanding of EV-D68-related virology, epidemiology and clinical syndromes, pathogenesis, and laboratory diagnostics.
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Affiliation(s)
- Zichun Xiang
- MOH Key Laboratory of Systems Biology of Pathogens, and Christophe Mérieux Laboratory, IPB, CAMS-Fondation Mérieux, Institute of Pathogen Biology (IPB), Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College, Beijing, P.R. China
| | - Jianwei Wang
- MOH Key Laboratory of Systems Biology of Pathogens, and Christophe Mérieux Laboratory, IPB, CAMS-Fondation Mérieux, Institute of Pathogen Biology (IPB), Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College, Beijing, P.R. China
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30
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Gong YN, Yang SL, Shih SR, Huang YC, Chang PY, Huang CG, Kao KC, Hu HC, Liu YC, Tsao KC. Molecular evolution and the global reemergence of enterovirus D68 by genome-wide analysis. Medicine (Baltimore) 2016; 95:e4416. [PMID: 27495059 PMCID: PMC4979813 DOI: 10.1097/md.0000000000004416] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Human enterovirus D68 (EV-D68) was first reported in the United States in 1962; thereafter, a few cases were reported from 1970 to 2005, but 2 outbreaks occurred in the Philippines (2008) and the United States (2014). However, little is known regarding the molecular evolution of this globally reemerging virus due to a lack of whole-genome sequences and analyses. Here, all publically available sequences including 147 full and 1248 partial genomes from GenBank were collected and compared at the clade and subclade level; 11 whole genomes isolated in Taiwan (TW) in 2014 were also added to the database. Phylogenetic trees were constructed to identify a new subclade, B3, and represent clade circulations among strains. Nucleotide sequence identities of the VP1 gene were 94% to 95% based on a comparison of subclade B3 to B1 and B2 and 87% to 91% when comparing A, C, and D. The patterns of clade circulation need to be clarified to improve global monitoring of EV-D68, even though this virus showed lower diversity among clades compared with the common enterovirus EV-71. Notably, severe cases isolated from Taiwan and China in 2014 were found in subclade B3. One severe case from Taiwan occurred in a female patient with underlying angioimmunoblastic T-cell lymphoma, from whom a bronchoalveolar lavage specimen was obtained. Although host factors play a key role in disease severity, we cannot exclude the possibility that EV-D68 may trigger clinical symptoms or death. To further investigate the genetic diversity of EV-D68, we reported 34 amino acid (aa) polymorphisms identified by comparing subclade B3 to B1 and B2. Clade D strains had a 1-aa deletion and a 2-aa insertion in the VP1 gene, and 1 of our TW/2014 strains had a shorter deletion in the 5' untranslated region than a previously reported deletion. In summary, a new subclade, genetic indels, and polymorphisms in global strains were discovered elucidating evolutionary and epidemiological trends of EV-D68, and 11 genomes were added to the database. Virus variants may contribute to disease severity and clinical manifestations, and further studies are needed to investigate the associations between genetic diversity and clinical outcomes.
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Affiliation(s)
- Yu-Nong Gong
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital
| | - Shu-Li Yang
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital
- Department of Medical Biotechnology and Laboratory Science
| | - Shin-Ru Shih
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital
- Department of Medical Biotechnology and Laboratory Science
- Research Center for Emerging Viral Infections, Chang Gung University
| | - Yhu-Chering Huang
- Department of Pediatrics, Linkou Chang Gung Memorial Hospital
- College of Medicine, Chang Gung University
| | - Pi-Yueh Chang
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital
- Department of Medical Biotechnology and Laboratory Science
| | - Chung-Guei Huang
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital
- Department of Medical Biotechnology and Laboratory Science
- Research Center for Emerging Viral Infections, Chang Gung University
| | - Kuo-Chin Kao
- Department of Respiratory Therapy
- Department of Pulmonary and Critical Care Medicine, Linkou Chang Gung Memorial Hospital
- Department of Respiratory Therapy
- Department of Pulmonary and Critical Care Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Han-Chung Hu
- Department of Respiratory Therapy
- Department of Pulmonary and Critical Care Medicine, Linkou Chang Gung Memorial Hospital
- Department of Respiratory Therapy
- Department of Pulmonary and Critical Care Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Yi-Chun Liu
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital
| | - Kuo-Chien Tsao
- Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital
- Department of Medical Biotechnology and Laboratory Science
- Research Center for Emerging Viral Infections, Chang Gung University
- Correspondence: Kuo-ChienTsao, Department of Laboratory Medicine, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan; Department of Medical Biotechnology and Laboratory Science, Research Center for Emerging Viral Infections, College of Medicine, Chang Gung University, Taoyuan, Taiwan (e-mail: )
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31
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Genetic divergence of enterovirus D68 in China and the United States. Sci Rep 2016; 6:27800. [PMID: 27278628 PMCID: PMC4899779 DOI: 10.1038/srep27800] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 05/25/2016] [Indexed: 02/08/2023] Open
Abstract
The largest outbreak of human enterovirus 68 (EV-D68) infections associated with severe respiratory illness and neurological complications emerged from the United States in 2014. China reported the circulation of EV-D68 since 2006, but these cases were sporadic and did not display neurological symptoms. Yet viral determinants responsible for the difference in prevalence between China and the U.S. were not clear. We analyzed the genome of 64 reported Chinese EV-D68 strains and found that genogroup replacement has occurred in China since 2006. The six coding mutations (M291T, V341A, T860N, D927N, S1108G and R2005K) associated with neurovirulence reported in American strains were not found in Chinese strains. Moreover, 2014 Chinese strains had a unique R220A mutation in the puff region of VP2 while R220E mutation occurred in other strains. Like other enteroviruses, the loop sequences of the domain X and Y in the 3'-UTR of the Chinese strains are complementary. However, the X loop sequences of the 2014 American strains were not complementary but identical to Y loop sequences. These results indicate that different EV-D68 strains circulated in China and America and the mutations might be responsible for different prevalence. Our findings also provide new evidence for the sequence diversity of EV-D68.
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32
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Holm-Hansen CC, Midgley SE, Fischer TK. Global emergence of enterovirus D68: a systematic review. THE LANCET. INFECTIOUS DISEASES 2016; 16:e64-e75. [PMID: 26929196 DOI: 10.1016/s1473-3099(15)00543-5] [Citation(s) in RCA: 228] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Received: 08/20/2015] [Revised: 12/09/2015] [Accepted: 12/15/2015] [Indexed: 01/15/2023]
Abstract
Since its discovery in California in 1962, reports of enterovirus D68 have been infrequent. Before 2014, infections were confirmed in only 699 people worldwide. In August, 2014, two paediatric hospitals in the USA reported increases in the number of patients with severe respiratory illness, with an over-representation in children with asthma. Shortly after, the authorities recognised a nationwide outbreak, which then spread to Canada, Europe, and Asia. In 2014, more than 2000 cases of enterovirus D68 were reported in 20 countries. Concurrently, clusters of children with acute flaccid paralysis of unknown cause were reported in several US states and in Europe. Enterovirus D68 infection was confirmed in some of the paralysed children, but not all. Complications in patients who were severely neurologically affected resemble those caused by poliomyelitis. In this paper we systematically review reports on enterovirus D68 to estimate its global epidemiology and its ability to cause respiratory infections and neurological damage in children. We extracted data from 70 papers to report on prevalence, symptoms, hospitalisation and mortality, and complications of enterovirus D68, both before and during the large outbreak of 2014. The magnitude and severity of the enterovirus D68 outbreak underscores a need for improved diagnostic work-up of paediatric respiratory illness, not only to prevent unnecessary use of antibiotics, but also to ensure better surveillance of diseases. Existing surveillance systems should be assessed in terms of capacity and ability to detect and report any upsurge of respiratory viruses such as enterovirus D68 in a timely manner, and focus should be paid to development of preventive measures against these emerging enteroviruses that have potential for severe disease.
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Affiliation(s)
- Charlotte Carina Holm-Hansen
- Virology Surveillance and Research Section, Department of Microbiological Diagnostics and Virology, Statens Serum Institut, Copenhagen, Denmark
| | - Sofie Elisabeth Midgley
- Virology Surveillance and Research Section, Department of Microbiological Diagnostics and Virology, Statens Serum Institut, Copenhagen, Denmark
| | - Thea Kølsen Fischer
- Virology Surveillance and Research Section, Department of Microbiological Diagnostics and Virology, Statens Serum Institut, Copenhagen, Denmark; Center for Global Health and Department of Infectious Diseases, Clinical Institute, University of Southern Denmark, Odense, Denmark.
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Molecular Evolution and Intraclade Recombination of Enterovirus D68 during the 2014 Outbreak in the United States. J Virol 2015; 90:1997-2007. [PMID: 26656685 DOI: 10.1128/jvi.02418-15] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 11/30/2015] [Indexed: 12/12/2022] Open
Abstract
UNLABELLED In August 2014, an outbreak of enterovirus D68 (EV-D68) occurred in North America, causing severe respiratory disease in children. Due to a lack of complete genome sequence data, there is only a limited understanding of the molecular evolution and epidemiology of EV-D68 during this outbreak, and it is uncertain whether the differing clinical manifestations of EV-D68 infection are associated with specific viral lineages. We developed a high-throughput complete genome sequencing pipeline for EV-D68 that produced a total of 59 complete genomes from respiratory samples with a 95% success rate, including 57 genomes from Kansas City, MO, collected during the 2014 outbreak. With these data in hand, we performed phylogenetic analyses of complete genome and VP1 capsid protein sequences. Notably, we observed considerable genetic diversity among EV-D68 isolates in Kansas City, manifest as phylogenetically distinct lineages, indicative of multiple introductions of this virus into the city. In addition, we identified an intersubclade recombination event within EV-D68, the first recombinant in this virus reported to date. Finally, we found no significant association between EV-D68 genetic variation, either lineages or individual mutations, and a variety of demographic and clinical variables, suggesting that host factors likely play a major role in determining disease severity. Overall, our study revealed the complex pattern of viral evolution within a single geographic locality during a single outbreak, which has implications for the design of effective intervention and prevention strategies. IMPORTANCE Until recently, EV-D68 was considered to be an uncommon human pathogen, associated with mild respiratory illness. However, in 2014 EV-D68 was responsible for more than 1,000 disease cases in North America, including severe respiratory illness in children and acute flaccid myelitis, raising concerns about its potential impact on public health. Despite the emergence of EV-D68, a lack of full-length genome sequences means that little is known about the molecular evolution of this virus within a single geographic locality during a single outbreak. Here, we doubled the number of publicly available complete genome sequences of EV-D68 by performing high-throughput next-generation sequencing, characterized the evolutionary history of this outbreak in detail, identified a recombination event, and investigated whether there was any correlation between the demographic and clinical characteristics of the patients and the viral variant that infected them. Overall, these results will help inform the design of intervention strategies for EV-D68.
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Esposito S, Bosis S, Niesters H, Principi N. Enterovirus D68 Infection. Viruses 2015; 7:6043-50. [PMID: 26610548 PMCID: PMC4664996 DOI: 10.3390/v7112925] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Revised: 11/15/2015] [Accepted: 11/18/2015] [Indexed: 12/25/2022] Open
Abstract
First described in 1962 in children hospitalized for pneumonia and bronchiolitis, the Enterovirus D68 (EV-D68) is an emergent viral pathogen. Since its discovery, during the long period of surveillance up to 2005, EV-D68 was reported only as a cause of sporadic outbreaks. In recent years, many reports from different countries have described an increasing number of patients with respiratory diseases due to EV-D68 associated with relevant clinical severity. In particular, an unexpectedly high number of children have been hospitalized for severe respiratory disease due to EV-D68, requiring intensive care such as intubation and mechanical ventilation. Moreover, EV-D68 has been associated with acute flaccid paralysis and cranial nerve dysfunction in children, which has caused concerns in the community. As no specific antiviral therapy is available, treatment is mainly supportive. Moreover, because no vaccines are available, conventional infection control measures (i.e., standard, for contacts and droplets) in both community and healthcare settings are recommended. However, further studies are required to fully understand the real importance of this virus. Prompt diagnosis and continued surveillance of EV-D68 infections are essential to managing and preventing new outbreaks. Moreover, if the association between EV-D68 and severe diseases will be confirmed, the development of adequate preventive and therapeutic approaches are a priority.
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Affiliation(s)
- Susanna Esposito
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
| | - Samantha Bosis
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
| | - Hubert Niesters
- Department of Medical Microbiology, Division of Clinical Virology, University Medical Center, The University of Groningen, 9713 Groningen, The Netherlands.
| | - Nicola Principi
- Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
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35
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Thongpan I, Wanlapakorn N, Vongpunsawad S, Linsuwanon P, Theamboonlers A, Payungporn S, Poovorawan Y. Prevalence and Phylogenetic Characterization of Enterovirus D68 in Pediatric Patients with Acute Respiratory Tract Infection in Thailand. Jpn J Infect Dis 2015; 69:426-30. [PMID: 26567839 DOI: 10.7883/yoken.jjid.2015.352] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Enterovirus D68 (EV-D68) is associated with severe lower respiratory tract infection and neurological abnormalities including acute myelitis and cranial nerve dysfunction. To determine whether an increased incidence of EV-D68 occurs in Southeast Asia, we retrospectively tested specimens collected from Thai pediatric patients who were less than 5 years of age and presented with acute respiratory tract infections between 2012 and 2014. Reverse transcription-polymerase chain reaction and nucleotide sequencing of the 5'-UTR/VP2 region were used to identify EV-D68. We also examined the epidemiological pattern of EV-D68 since 2009, when it was first identified in Thailand, and compiled records of clinical manifestations in children with confirmed EV-D68 infection. From 837 samples, 5 samples (0.6%) tested positive for EV-D68. All patients presented with viral pneumonia and required hospitalization. Phylogenetic analysis of the VP4/VP2 regions revealed that EV-D68 strains circulating in Thailand between 2012 and 2014 were closely related to strains reported in Japan, United Kingdom, China, and France. Continued surveillance of probable EV-D68-associated severe respiratory tract infection and the development of a rapid diagnostic test for EV-D68 are essential in supporting awareness and facilitating disease prevention and control.
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Affiliation(s)
- Ilada Thongpan
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University
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Abstract
The outbreak of Enterovirus D-68 (EV-D68) in the United States in 2014 raised great interest due to it affecting large numbers of people and because patients presented with severe respiratory and/or central nervous system involvement. Many studies have tried to evaluate the biologic and genetic characteristics of this virus, its association with disease development and the possibility of infection prevention and therapy. The main aim of this paper is to discuss what is presently known and what might be expected in the future regarding EV-D68. We highlight that further studies are needed to precisely define the epidemiology and total burden of EV-D68, the real age prevalence, and the factors that may lead to negative outcomes in some patients and not in others. Moreover, if recently reported clinical data are confirmed, specific efficacious prophylactic and therapeutic measures should be urgently developed.
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Affiliation(s)
- Nicola Principi
- a Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation , Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
| | - Susanna Esposito
- a Pediatric Highly Intensive Care Unit, Department of Pathophysiology and Transplantation , Università degli Studi di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico , Milan , Italy
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