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Jartti M, Flodström-Tullberg M, Hankaniemi MM. Enteroviruses: epidemic potential, challenges and opportunities with vaccines. J Biomed Sci 2024; 31:73. [PMID: 39010093 PMCID: PMC11247760 DOI: 10.1186/s12929-024-01058-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Accepted: 06/23/2024] [Indexed: 07/17/2024] Open
Abstract
Enteroviruses (EVs) are the most prevalent viruses in humans. EVs can cause a range of acute symptoms, from mild common colds to severe systemic infections such as meningitis, myocarditis, and flaccid paralysis. They can also lead to chronic diseases such as cardiomyopathy. Although more than 280 human EV serotypes exist, only four serotypes have licenced vaccines. No antiviral drugs are available to treat EV infections, and global surveillance of EVs has not been effectively coordinated. Therefore, poliovirus still circulates, and there have been alarming epidemics of non-polio enteroviruses. Thus, there is a pressing need for coordinated preparedness efforts against EVs.This review provides a perspective on recent enterovirus outbreaks and global poliovirus eradication efforts with continuous vaccine development initiatives. It also provides insights into the challenges and opportunities in EV vaccine development. Given that traditional whole-virus vaccine technologies are not suitable for many clinically relevant EVs and considering the ongoing risk of enterovirus outbreaks and the potential for new emerging pathogenic strains, the need for new effective and adaptable enterovirus vaccines is emphasized.This review also explores the difficulties in translating promising vaccine candidates for clinical use and summarizes information from published literature and clinical trial databases focusing on existing enterovirus vaccines, ongoing clinical trials, the obstacles faced in vaccine development as well as the emergence of new vaccine technologies. Overall, this review contributes to the understanding of enterovirus vaccines, their role in public health, and their significance as a tool for future preparedness.
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Affiliation(s)
- Minne Jartti
- Virology and Vaccine Immunology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Malin Flodström-Tullberg
- Department of Medicine Huddinge and Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Minna M Hankaniemi
- Virology and Vaccine Immunology, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
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Kordi R, Chang AJ, Hicar MD. Seasonal Testing, Results, and Effect of the Pandemic on Coxsackievirus Serum Studies. Microorganisms 2024; 12:367. [PMID: 38399771 PMCID: PMC10893248 DOI: 10.3390/microorganisms12020367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/25/2024] Open
Abstract
Coxsackieviruses (CVs) are common causes of infections and can be life-threatening. Unfortunately, rigorous studies guiding the clinician in interpreting CV serum antibody titer testing is lacking. To explore the epidemiology of circulating CVs and the serological test utility in aiding diagnosis of CV infections in our community, we obtained results of CV immunologic diagnostic tests between 2018 and 2022 from a regional healthcare database. For CV type A, rare individuals had positive CF (complement fixation) tests whereas all 16 individuals with IFA testing showed at least one positive serotype. For CV type B CF testing, 52.2% of 222 patients had at least one serotype positive, with B5 being most common and also the most common with higher titers (14.8% with ≥1:32). We found a significant reduction in seropositivity rate during the pandemic in 2020 compared to 2018, which continued through 2022 (OR: 0.2, 95% CI: 0.08-0.49, p-value < 0.001). During the pandemic, the seasonal pattern of positive tests varied from the pre-pandemic pattern. Testing for CVs was increased after the first year of the pandemic. Overall, the variability by month and seasonal change in our data support that CF testing can be used to identify recent CVB infection.
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Affiliation(s)
- Ramesh Kordi
- Department of Pediatric Infectious Diseases, State University of New York at Buffalo, Buffalo, NY 14203, USA;
| | - Arthur J. Chang
- Division of Pediatric Infectious Diseases, University of Nebraska Medical Center, Omaha, NE 68198, USA;
| | - Mark D. Hicar
- Department of Pediatric Infectious Diseases, State University of New York at Buffalo, Buffalo, NY 14203, USA;
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Ivanova OE, Eremeeva TP, Morozova NS, Mikhailova YM, Kozlovskaya LI, Baikova OY, Shakaryan AK, Krasota AY, Korotkova EA, Yakovchuk EV, Shustova EY, Lukashev AN. Non-Polio Enteroviruses Isolated by Acute Flaccid Paralysis Surveillance Laboratories in the Russian Federation in 1998-2021: Distinct Epidemiological Features of Types. Viruses 2024; 16:135. [PMID: 38257835 PMCID: PMC10819661 DOI: 10.3390/v16010135] [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: 12/13/2023] [Revised: 01/08/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
More than 100 types of non-polio enteroviruses (NPEVs) are ubiquitous in the human population and cause a variety of symptoms ranging from very mild to meningitis and acute flaccid paralysis (AFP). Much of the information regarding diverse pathogenic properties of NPEVs comes from the surveillance of poliovirus, which also yields NPEV. The analysis of 265 NPEV isolations from 10,433 AFP cases over 24 years of surveillance and more than 2500 NPEV findings in patients without severe neurological lesions suggests that types EV-A71, E13, and E25 were significantly associated with AFP. EV-A71 was also significantly more common among AFP patients who had fever at the onset and residual paralysis compared to all AFP cases. In addition, a significant disparity was noticed between types that were common in humans (CV-A2, CVA9, EV-A71, E9, and E30) or in sewage (CVA7, E3, E7, E11, E12, and E19). Therefore, there is significant evidence of non-polio viruses being implicated in severe neurological lesions, but further multicenter studies using uniform methodology are needed for a definitive conclusion.
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Affiliation(s)
- Olga E. Ivanova
- Federal State Autonomous Scientific Institution “Chumakov Federal Center for Research and Development of Immune-and-Biological Products of the Russian Academy of Sciences” (Institute of Poliomyelitis) (FSASI “Chumakov FSC R&D IBP RAS”), 108819 Moscow, Russia (E.V.Y.); (E.Y.S.)
- Department of Organization and Technology of Production of Immunobiological Preparations, Institute for Translational Medicine and Biotechnology, First Moscow State Medical University (Sechenov University), 119048 Moscow, Russia
| | - Tatiana P. Eremeeva
- Federal State Autonomous Scientific Institution “Chumakov Federal Center for Research and Development of Immune-and-Biological Products of the Russian Academy of Sciences” (Institute of Poliomyelitis) (FSASI “Chumakov FSC R&D IBP RAS”), 108819 Moscow, Russia (E.V.Y.); (E.Y.S.)
| | - Nadezhda S. Morozova
- The Federal Budgetary Health Institution “Federal Center of Hygiene and Epidemiology” of the Federal Office for Inspectorate in the Field of Customers and Human Well-Being Protection”(FBHI FCH&E), 117105 Moscow, Russia
| | - Yulia M. Mikhailova
- The Federal Budgetary Health Institution “Federal Center of Hygiene and Epidemiology” of the Federal Office for Inspectorate in the Field of Customers and Human Well-Being Protection”(FBHI FCH&E), 117105 Moscow, Russia
| | - Liubov I. Kozlovskaya
- Federal State Autonomous Scientific Institution “Chumakov Federal Center for Research and Development of Immune-and-Biological Products of the Russian Academy of Sciences” (Institute of Poliomyelitis) (FSASI “Chumakov FSC R&D IBP RAS”), 108819 Moscow, Russia (E.V.Y.); (E.Y.S.)
- Department of Organization and Technology of Production of Immunobiological Preparations, Institute for Translational Medicine and Biotechnology, First Moscow State Medical University (Sechenov University), 119048 Moscow, Russia
| | - Olga Y. Baikova
- Federal State Autonomous Scientific Institution “Chumakov Federal Center for Research and Development of Immune-and-Biological Products of the Russian Academy of Sciences” (Institute of Poliomyelitis) (FSASI “Chumakov FSC R&D IBP RAS”), 108819 Moscow, Russia (E.V.Y.); (E.Y.S.)
| | - Armen K. Shakaryan
- Federal State Autonomous Scientific Institution “Chumakov Federal Center for Research and Development of Immune-and-Biological Products of the Russian Academy of Sciences” (Institute of Poliomyelitis) (FSASI “Chumakov FSC R&D IBP RAS”), 108819 Moscow, Russia (E.V.Y.); (E.Y.S.)
- Department of Childrenʹs Infectious Diseases, Pediatric Faculty, Pirogov Russian National Research Medical University, 119121 Moscow, Russia
| | - Alexandr Y. Krasota
- Federal State Autonomous Scientific Institution “Chumakov Federal Center for Research and Development of Immune-and-Biological Products of the Russian Academy of Sciences” (Institute of Poliomyelitis) (FSASI “Chumakov FSC R&D IBP RAS”), 108819 Moscow, Russia (E.V.Y.); (E.Y.S.)
- Belozersky Institute of Physical-Chemical Biology, Lomonosov Moscow State University, 119899 Moscow, Russia
| | - Ekaterina A. Korotkova
- Belozersky Institute of Physical-Chemical Biology, Lomonosov Moscow State University, 119899 Moscow, Russia
| | - Elizaveta V. Yakovchuk
- Federal State Autonomous Scientific Institution “Chumakov Federal Center for Research and Development of Immune-and-Biological Products of the Russian Academy of Sciences” (Institute of Poliomyelitis) (FSASI “Chumakov FSC R&D IBP RAS”), 108819 Moscow, Russia (E.V.Y.); (E.Y.S.)
| | - Elena Y. Shustova
- Federal State Autonomous Scientific Institution “Chumakov Federal Center for Research and Development of Immune-and-Biological Products of the Russian Academy of Sciences” (Institute of Poliomyelitis) (FSASI “Chumakov FSC R&D IBP RAS”), 108819 Moscow, Russia (E.V.Y.); (E.Y.S.)
| | - Alexander N. Lukashev
- Martsinovsky Institute of Medical Parasitology, Tropical and Vector-Borne Diseases, First Moscow State Medical University (Sechenov University), 119048 Moscow, Russia
- Research Institute for Systems Biology and Medicine, 117246 Moscow, Russia
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Łuczyńska A, Beyrer K, Holle I, Baillot A, Monazahian M, Dreesman J, Mertens E, Rettenbacher-Riefler S. Evaluation of 17 years of MERIN (Meningitis and Encephalitis register in Lower Saxony, Germany) surveillance system: participants acceptability survey, completeness and timeliness of data. BMC Health Serv Res 2024; 24:59. [PMID: 38212779 PMCID: PMC10782521 DOI: 10.1186/s12913-023-10482-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 12/15/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND A Meningitis and Encephalitis Surveillance (MERIN) was implemented in 2003 in Lower Saxony, Germany as an alternative to acute flaccid paralyses surveillance, as the latter did not reach WHO sensitivity criteria. The system provides information on circulating enterovirus (EV) serotypes by focussing on patients with suspected aseptic meningitis, encephalitis or acute flaccid paralysis and contributes to the national surveillance in documenting polio free status. MERIN is based on voluntary participation of hospitals. Therefore, our evaluation focusses on acceptability of the system's objectives and performance, and identifying areas for improvement. METHODS To assess acceptability, 32 contributing hospitals were invited to an online-based survey (11/2021 to 01/2022) to rate the MERIN objectives, laboratory's performance, their workload, modes of processes and communication. Ideas for improvement were collected in open fields. In addition, data completeness and timeliness of laboratory diagnostics were assessed. RESULTS Of 32 hospitals, 21 responded (66% response rate), sending 30 questionnaires, 25 from pediatric and 5 from neurological departments. High levels of satisfaction with the communication (≥ 96%), timeliness (≥ 81%), and distribution of the results (≥ 85%) were reported, 97% of participants judged the required workload as adequate. The median proportion of eligible patients included in MERIN was 75%. Participants gave rapid and reliable diagnostic testing the highest priority (96%), while monitoring of Germany's polio-free status was rated the lowest (61%). Providing medical reports digitally as well as regular updates about circulating EV serotypes were identified as areas for improvement. Data completeness of selected variables ranged from 78.3 to 99.9%. Median time between sample collection and arrival at laboratory was 2 days [IQR 1-3], EV diagnostics via PCR took one day [IQR 0-6] and EV isolation on cell culture 11 days [IQR 10-13]. CONCLUSION MERIN is a highly accepted surveillance system. Its quality was enhanced further by addressing the suggested improvements such as regular reports on circulating EV serotypes and facilitating digital access to laboratory results. Our results emphasise the importance of recognizing and considering participants' motivations and expectations, and addressing their priorities, even if this is not the surveillance system's main focus. This approach can be applied to surveillance systems of other non-mandatory notifiable diseases.
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Affiliation(s)
- Anna Łuczyńska
- European Centre for Disease Control and Prevention (ECDC), ECDC Fellowship Programme, Field Epidemiology Path (EPIET), Stockholm, Sweden
- Department for Microbiology, Infection Protection, Hospital Hygiene and Epidemiology of Infectious Diseases, Public Health Agency of Lower Saxony, Hanover, Lower Saxony, Germany
| | - Konrad Beyrer
- Department for Microbiology, Infection Protection, Hospital Hygiene and Epidemiology of Infectious Diseases, Public Health Agency of Lower Saxony, Hanover, Lower Saxony, Germany
| | - Ina Holle
- Department for Microbiology, Infection Protection, Hospital Hygiene and Epidemiology of Infectious Diseases, Public Health Agency of Lower Saxony, Hanover, Lower Saxony, Germany
| | - Armin Baillot
- Department for Microbiology, Infection Protection, Hospital Hygiene and Epidemiology of Infectious Diseases, Public Health Agency of Lower Saxony, Hanover, Lower Saxony, Germany
| | - Masyar Monazahian
- Department for Microbiology, Infection Protection, Hospital Hygiene and Epidemiology of Infectious Diseases, Public Health Agency of Lower Saxony, Hanover, Lower Saxony, Germany
| | - Johannes Dreesman
- Department for Microbiology, Infection Protection, Hospital Hygiene and Epidemiology of Infectious Diseases, Public Health Agency of Lower Saxony, Hanover, Lower Saxony, Germany
| | - Elke Mertens
- Department for Microbiology, Infection Protection, Hospital Hygiene and Epidemiology of Infectious Diseases, Public Health Agency of Lower Saxony, Hanover, Lower Saxony, Germany
| | - Sophie Rettenbacher-Riefler
- Department for Microbiology, Infection Protection, Hospital Hygiene and Epidemiology of Infectious Diseases, Public Health Agency of Lower Saxony, Hanover, Lower Saxony, Germany.
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Itani TM, Chalapa VI, Slautin VN, Bykov RO, Imangaliev BS, Starikova PK, Sergeev AG, Semenov AV. Non-Polio Enterovirus Surveillance in the Ural Federal District and Western Siberia, 2022: Is There a Need for a Vaccine? Vaccines (Basel) 2023; 11:1588. [PMID: 37896990 PMCID: PMC10610881 DOI: 10.3390/vaccines11101588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 09/29/2023] [Accepted: 09/30/2023] [Indexed: 10/29/2023] Open
Abstract
Human non-polio enteroviruses (NPEVs) are the etiological agents involved in most cases of hand-foot-and-mouth disease (HFMD), herpangina and aseptic meningitis. Information on the epidemiology profiles of NPEV in the Ural Federal District and Western Siberia is very limited, with no published data available. The aim of this study is to describe NPEV incidence in the Ural Federal District and Western Siberia among patients with different forms of non-polio enterovirus infections (NPEVIs) during 2022, stratified by age and clinical manifestations. A total of 265 samples that tested positive for NPEV using a polymerase chain reaction (PCR) were genotyped by semi-nested PCR for the VP1 gene. The results showed that 21 genotypes were identified among patients in this study. CVA6 was the most common genotype for HFMD. CVA6, along with CVA10, accounted for the majority of herpangina cases, while CVA9 was implicated in most meningitis cases. Sequence and phylogenetic analysis showed that nearly all of the CVA6 strains identified in this study displayed a close genetic relationship to strains identified in other cities in Russia and strains from China. NPEV surveillance allows for monitoring the circulation of clinically relevant genotypes, resulting in continuous data about NPEV epidemiology. This is important for improving case prevention, diagnosis and guiding clinical management.
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Affiliation(s)
- Tarek M. Itani
- Laboratory of Enteric Virus Infections, Federal Budgetary Institution of Science «Federal Scientific Research Institute of Viral Infections «Virome»», Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing, 620030 Yekaterinburg, Russia; (V.I.C.); (V.N.S.); (R.O.B.); (B.S.I.); (P.K.S.); (A.G.S.); (A.V.S.)
| | - Vladislav I. Chalapa
- Laboratory of Enteric Virus Infections, Federal Budgetary Institution of Science «Federal Scientific Research Institute of Viral Infections «Virome»», Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing, 620030 Yekaterinburg, Russia; (V.I.C.); (V.N.S.); (R.O.B.); (B.S.I.); (P.K.S.); (A.G.S.); (A.V.S.)
| | - Vasilii N. Slautin
- Laboratory of Enteric Virus Infections, Federal Budgetary Institution of Science «Federal Scientific Research Institute of Viral Infections «Virome»», Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing, 620030 Yekaterinburg, Russia; (V.I.C.); (V.N.S.); (R.O.B.); (B.S.I.); (P.K.S.); (A.G.S.); (A.V.S.)
| | - Roman O. Bykov
- Laboratory of Enteric Virus Infections, Federal Budgetary Institution of Science «Federal Scientific Research Institute of Viral Infections «Virome»», Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing, 620030 Yekaterinburg, Russia; (V.I.C.); (V.N.S.); (R.O.B.); (B.S.I.); (P.K.S.); (A.G.S.); (A.V.S.)
| | - Bolat S. Imangaliev
- Laboratory of Enteric Virus Infections, Federal Budgetary Institution of Science «Federal Scientific Research Institute of Viral Infections «Virome»», Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing, 620030 Yekaterinburg, Russia; (V.I.C.); (V.N.S.); (R.O.B.); (B.S.I.); (P.K.S.); (A.G.S.); (A.V.S.)
| | - Polina K. Starikova
- Laboratory of Enteric Virus Infections, Federal Budgetary Institution of Science «Federal Scientific Research Institute of Viral Infections «Virome»», Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing, 620030 Yekaterinburg, Russia; (V.I.C.); (V.N.S.); (R.O.B.); (B.S.I.); (P.K.S.); (A.G.S.); (A.V.S.)
| | - Aleksandr G. Sergeev
- Laboratory of Enteric Virus Infections, Federal Budgetary Institution of Science «Federal Scientific Research Institute of Viral Infections «Virome»», Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing, 620030 Yekaterinburg, Russia; (V.I.C.); (V.N.S.); (R.O.B.); (B.S.I.); (P.K.S.); (A.G.S.); (A.V.S.)
- Department of Microbiology, Virology and Immunology, Ural State Medical University, 620109 Ekaterinburg, Russia
| | - Aleksandr V. Semenov
- Laboratory of Enteric Virus Infections, Federal Budgetary Institution of Science «Federal Scientific Research Institute of Viral Infections «Virome»», Federal Service for Surveillance on Consumer Rights Protection and Human Wellbeing, 620030 Yekaterinburg, Russia; (V.I.C.); (V.N.S.); (R.O.B.); (B.S.I.); (P.K.S.); (A.G.S.); (A.V.S.)
- Institute of Natural Sciences and Mathematics, Ural Federal University Named after the First President of Russia B.N. Yeltsin, 620075 Ekaterinburg, Russia
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Bubba L, Benschop KSM, Blomqvist S, Duizer E, Martin J, Shaw AG, Bailly JL, Rasmussen LD, Baicus A, Fischer TK, Harvala H. Wastewater Surveillance in Europe for Non-Polio Enteroviruses and Beyond. Microorganisms 2023; 11:2496. [PMID: 37894154 PMCID: PMC10608818 DOI: 10.3390/microorganisms11102496] [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: 09/11/2023] [Revised: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023] Open
Abstract
Wastewater surveillance (WWS) was developed in the early 1960s for the detection of poliovirus (PV) circulation in the population. It has been used to monitor several pathogens, including non-polio enteroviruses (NPEVs), which are increasingly recognised as causes of morbidity in children. However, when applying WWS to a new pathogen, it is important to consider the purpose of such a study as well as the suitability of the chosen methodology. With this purpose, the European Non-Polio Enterovirus Network (ENPEN) organised an expert webinar to discuss its history, methods, and applications; its evolution from a culture-based method to molecular detection; and future implementation of next generation sequencing (NGS). The first simulation experiments with PV calculated that a 400 mL sewage sample is sufficient for the detection of viral particles if 1:10,000 people excrete poliovirus in a population of 700,000 people. If the method is applied correctly, several NPEV types are detected. Despite culture-based methods remaining the gold standard for WWS, direct methods followed by molecular-based and sequence-based assays have been developed, not only for enterovirus but for several pathogens. Along with case-based sentinel and/or syndromic surveillance, WWS for NPEV and other pathogens represents an inexpensive, flexible, anonymised, reliable, population-based tool for monitoring outbreaks and the (re)emergence of these virus types/strains within the general population.
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Affiliation(s)
- Laura Bubba
- European Non-Polio Enterovirus Network (E.N.P.E.N.), 1207 Geneva, Switzerland
| | - Kimberley S. M. Benschop
- National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, The Netherlands; (K.S.M.B.); (E.D.)
| | - Soile Blomqvist
- Finnish Institute for Health and Welfare, P.O. Box 95, 70701 Kuopio, Finland;
| | - Erwin Duizer
- National Institute for Public Health and the Environment (RIVM), 3721 MA Bilthoven, The Netherlands; (K.S.M.B.); (E.D.)
| | - Javier Martin
- Division of Vaccines, Medicines and Healthcare Products Regulatory Agency, Potters Bar EN6 3QG, UK;
| | - Alexander G. Shaw
- MRC Centre for Global Infectious Disease Analysis, London SW7 2AZ, UK;
- Abdul Latif Jameel Institute for Disease and Emergency Analytics, School of Public Health, Imperial College London, London SW7 2BX, UK
| | - Jean-Luc Bailly
- Laboratoire Micro-Organismes Genome Environnement (LMGE), Université Clermont Auvergne CNRS, 63001 Clermont-Ferrand, France;
| | - Lasse D. Rasmussen
- Virus Surveillance and Research Section Department of Virus and Microbiological Special Diagnostics Statens Serum Institut, DK-2300 Copenhagen, Denmark;
| | - Anda Baicus
- Enteric Viral Infections Laboratory, Cantacuzino National Institute for Medical-Military Research and Development, 020123 Bucharest, Romania;
| | - Thea K. Fischer
- Department of Clinical Research, University Hospital of Nordsjaelland, 3400 Hilleroed, Denmark
- Department of Public Health, University of Copenhagen, 1172 Copenhagen, Denmark
| | - Heli Harvala
- Microbiology Services National Health Service (NHS) Blood and Transplant, London NW9 5BG, UK;
- Division of Infection and Immunity, University College London, London WC1E 6BT, UK
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Akinnurun OM, Narvaez Encalada M, Orth J, Petzold M, Böttcher S, Diedrich S, Smitka M, Schröttner P. Enterovirus A71-associated acute flaccid paralysis in a pediatric patient: a case report. J Med Case Rep 2023; 17:310. [PMID: 37464446 DOI: 10.1186/s13256-023-04041-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 06/14/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Enterovirus A71 is one of the causative agents of hand, foot, and mouth disease, which is usually a self-limiting disease. Complications of enterovirus infection are also very rare. However, when such complications occur, they can lead to serious neurological diseases or even death. CASE PRESENTATION In this report, we describe a case of enterovirus A71-associated acute flaccid paralysis in a 13-month-old Caucasian girl that was managed in our hospital. The patient presented with sudden onset of left arm paresis that could not be attributed to any other cause. Establishing a diagnosis was furthermore complicated by negative virological investigations of cerebrospinal fluid and non-pathological radiological findings. A polymerase chain reaction test of the child's stool sample however tested positive for enterovirus and sequencing results revealed the presence of enterovirus A71. A previous history of febrile gastroenteritis just before the paresis started also supported the suspected diagnosis of enterovirus-associated acute flaccid paralysis. Following this, the child was treated with intravenous immunoglobulin over 5 days and a remarkable improvement was observed in the child's paresis. CONCLUSION This case report describes a possible complication of enterovirus A71 infection in a child. It also highlights the prolonged detection of enterovirus in the child's stool sample as compared with cerebrospinal fluid weeks after the primary infection occurred. Finally, it shows the need for increased clinical and diagnostic awareness especially in the management of sudden and unknown causes of paresis or paralysis in children.
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Affiliation(s)
- Oluwafemi M Akinnurun
- Carl Gustav Carus Faculty of Medicine, Institute for Medical Microbiology and Virology, TU Dresden, Dresden, Germany.
| | - Marco Narvaez Encalada
- Carl Gustav Carus Faculty of Medicine, Institute for Medical Microbiology and Virology, TU Dresden, Dresden, Germany
| | - Julia Orth
- Carl Gustav Carus Faculty of Medicine, Department of Paediatric Neurology, TU Dresden, Dresden, Germany
| | - Markus Petzold
- Carl Gustav Carus Faculty of Medicine, Institute for Medical Microbiology and Virology, TU Dresden, Dresden, Germany
| | - Sindy Böttcher
- National Reference Centre for Poliomyelitis and Enteroviruses, Robert Koch- Institute, Berlin, Germany
| | - Sabine Diedrich
- National Reference Centre for Poliomyelitis and Enteroviruses, Robert Koch- Institute, Berlin, Germany
| | - Martin Smitka
- Carl Gustav Carus Faculty of Medicine, Department of Paediatric Neurology, TU Dresden, Dresden, Germany
| | - Percy Schröttner
- Carl Gustav Carus Faculty of Medicine, Institute for Medical Microbiology and Virology, TU Dresden, Dresden, Germany
- Carl Gustav Carus Faculty of Medicine, Institute for Clinical Chemistry and Laboratory Medicine, TU Dresden, Dresden, Germany
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8
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Ibba R, Corona P, Nonne F, Caria P, Serreli G, Palmas V, Riu F, Sestito S, Nieddu M, Loddo R, Sanna G, Piras S, Carta A. Design, Synthesis, and Antiviral Activities of New Benzotriazole-Based Derivatives. Pharmaceuticals (Basel) 2023; 16:ph16030429. [PMID: 36986528 PMCID: PMC10054465 DOI: 10.3390/ph16030429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/03/2023] [Accepted: 03/07/2023] [Indexed: 03/16/2023] Open
Abstract
Several human diseases are caused by enteroviruses and are currently clinically untreatable, pushing the research to identify new antivirals. A notable number of benzo[d][1,2,3]triazol-1(2)-yl derivatives were designed, synthesized, and in vitro evaluated for cytotoxicity and antiviral activity against a wide spectrum of RNA positive- and negative-sense viruses. Five of them (11b, 18e, 41a, 43a, 99b) emerged for their selective antiviral activity against Coxsackievirus B5, a human enteroviruses member among the Picornaviridae family. The EC50 values ranged between 6 and 18.5 μM. Among all derivatives, compounds 18e and 43a were interestingly active against CVB5 and were selected to better define the safety profile on cell monolayers by transepithelial resistance test (TEER). Results indicated compound 18e as the hit compound to investigate the potential mechanism of action by apoptosis assay, virucidal activity test, and the time of addition assay. CVB5 is known to be cytotoxic by inducing apoptosis in infected cells; in this study, compound 18e was proved to protect cells from viral infection. Notably, cells were mostly protected when pre-treated with derivative 18e, which had, however, no virucidal activity. From the performed biological assays, compound 18e turned out to be non-cytotoxic as well as cell protective against CVB5 infection, with a mechanism of action ascribable to an interaction on the early phase of infection, by hijacking the viral attachment process.
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Affiliation(s)
- Roberta Ibba
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Via Muroni, 23/A, 07100 Sassari, Italy; (R.I.); (P.C.); (F.R.); (M.N.)
| | - Paola Corona
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Via Muroni, 23/A, 07100 Sassari, Italy; (R.I.); (P.C.); (F.R.); (M.N.)
| | - Francesca Nonne
- GSK Vaccine Institute for Global Health GSK, Via Fiorentina, 1, 53100 Siena, Italy;
| | - Paola Caria
- Department of Biomedical Sciences, Section of Microbiology and Virology, University of Cagliari, Cittadella Universitaria, 09042 Monserrato, Italy; (P.C.); (G.S.); (V.P.); (R.L.)
| | - Gabriele Serreli
- Department of Biomedical Sciences, Section of Microbiology and Virology, University of Cagliari, Cittadella Universitaria, 09042 Monserrato, Italy; (P.C.); (G.S.); (V.P.); (R.L.)
| | - Vanessa Palmas
- Department of Biomedical Sciences, Section of Microbiology and Virology, University of Cagliari, Cittadella Universitaria, 09042 Monserrato, Italy; (P.C.); (G.S.); (V.P.); (R.L.)
| | - Federico Riu
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Via Muroni, 23/A, 07100 Sassari, Italy; (R.I.); (P.C.); (F.R.); (M.N.)
- Department of Chemistry, Biomedicinskt Centrum, BMC, Uppsala University, Box 576, 75123 Uppsala, Sweden
| | - Simona Sestito
- Department of Chemical, Physical, Mathematical and Natural Sciences, University of Sassari, Via Vienna 2, 07100 Sassari, Italy;
| | - Maria Nieddu
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Via Muroni, 23/A, 07100 Sassari, Italy; (R.I.); (P.C.); (F.R.); (M.N.)
| | - Roberta Loddo
- Department of Biomedical Sciences, Section of Microbiology and Virology, University of Cagliari, Cittadella Universitaria, 09042 Monserrato, Italy; (P.C.); (G.S.); (V.P.); (R.L.)
| | - Giuseppina Sanna
- Department of Biomedical Sciences, Section of Microbiology and Virology, University of Cagliari, Cittadella Universitaria, 09042 Monserrato, Italy; (P.C.); (G.S.); (V.P.); (R.L.)
- Correspondence: (G.S.); (S.P.)
| | - Sandra Piras
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Via Muroni, 23/A, 07100 Sassari, Italy; (R.I.); (P.C.); (F.R.); (M.N.)
- Correspondence: (G.S.); (S.P.)
| | - Antonio Carta
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Via Muroni, 23/A, 07100 Sassari, Italy; (R.I.); (P.C.); (F.R.); (M.N.)
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9
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Kim MJ, Lee JE, Kim KG, Park DW, Cho SJ, Kim TS, Kee HY, Kim SH, Park HJ, Seo MH, Chung JK, Seo JJ. Long-term sentinel surveillance of enteroviruses in Gwangju, South Korea, 2011-2020. Sci Rep 2023; 13:2798. [PMID: 36797345 PMCID: PMC9933826 DOI: 10.1038/s41598-023-29461-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 02/06/2023] [Indexed: 02/18/2023] Open
Abstract
Human enteroviruses (EVs) are associated with a broad spectrum of diseases. To understand EV epidemiology, we present longitudinal data reflecting changing EV prevalence patterns in South Korea. We collected 7160 specimens from patients with suspected EV infections in ten hospitals in Gwangju, Korea during 2011-2020. RNA extraction and real-time reverse transcription polymerase chain reaction using EV-specific probes and primers were performed. EV genotyping and phylogenetic analysis were performed; EVs were detected in 3076 samples (43.0%), and the annual EV detection rate varied. EV infection rates did not differ with sex, and children aged ≤ 4 years were the most prone to EV infection; this trend did not change over time. Overall, 35 different EV types belonging to four distinctive species and rhinoviruses were identified. Although serotype distribution changed annually, the most frequently observed EVs were EV-A71 (13.1% of the cases), CVA6 (8.3%), CVB5 (7.6%), CVA16 (7.6%), CVA10 (7.5%), E18 (7.5%), E30 (7.0%), and E11 (5.0%) during 2011-2020. The predominant EV genotypes by clinical manifestation were CVB5 for aseptic meningitis; EV-A71 for hand, foot, and mouth disease cases; and CVA10 for herpangina. These results will aid the development of vaccines against EV infection and allow comprehensive disease control.
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Affiliation(s)
- Min Ji Kim
- Department of Infectious Disease Research, Health & Environment Research Institute of Gwangju, 584 Mujin-Daero, Seogu, Gwangju, Republic of Korea, 61954.
| | - Ji-eun Lee
- Department of Infectious Disease Research, Health & Environment Research Institute of Gwangju, 584 Mujin-Daero, Seogu, Gwangju, Republic of Korea 61954
| | - Kwang gon Kim
- Department of Infectious Disease Research, Health & Environment Research Institute of Gwangju, 584 Mujin-Daero, Seogu, Gwangju, Republic of Korea 61954
| | - Duck Woong Park
- Department of Infectious Disease Research, Health & Environment Research Institute of Gwangju, 584 Mujin-Daero, Seogu, Gwangju, Republic of Korea 61954
| | - Sun Ju Cho
- Department of Infectious Disease Research, Health & Environment Research Institute of Gwangju, 584 Mujin-Daero, Seogu, Gwangju, Republic of Korea 61954
| | - Tae sun Kim
- Department of Infectious Disease Research, Health & Environment Research Institute of Gwangju, 584 Mujin-Daero, Seogu, Gwangju, Republic of Korea 61954
| | - Hye-young Kee
- Department of Infectious Disease Research, Health & Environment Research Institute of Gwangju, 584 Mujin-Daero, Seogu, Gwangju, Republic of Korea 61954
| | - Sun-Hee Kim
- Department of Infectious Disease Research, Health & Environment Research Institute of Gwangju, 584 Mujin-Daero, Seogu, Gwangju, Republic of Korea 61954
| | - Hye jung Park
- Department of Infectious Disease Research, Health & Environment Research Institute of Gwangju, 584 Mujin-Daero, Seogu, Gwangju, Republic of Korea 61954
| | - Mi Hee Seo
- Department of Infectious Disease Research, Health & Environment Research Institute of Gwangju, 584 Mujin-Daero, Seogu, Gwangju, Republic of Korea 61954
| | - Jae Keun Chung
- Department of Infectious Disease Research, Health & Environment Research Institute of Gwangju, 584 Mujin-Daero, Seogu, Gwangju, Republic of Korea 61954
| | - Jin-jong Seo
- Department of Infectious Disease Research, Health & Environment Research Institute of Gwangju, 584 Mujin-Daero, Seogu, Gwangju, Republic of Korea 61954
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10
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Epidemiology of Echovirus 30 Infections Detected in a University Hospital in Catalonia, Spain, in 1995–2020. Microorganisms 2022; 10:microorganisms10030592. [PMID: 35336167 PMCID: PMC8955149 DOI: 10.3390/microorganisms10030592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/06/2022] [Accepted: 03/07/2022] [Indexed: 12/17/2022] Open
Abstract
There is a growing interest in echovirus 30 (E30), an enterovirus responsible for neurological disease and hospitalization. There are multiple studies of outbreaks, but few that study the epidemiology over long periods of time. Our study aims to describe the clinical, epidemiological and microbiological characteristics of a series of E30 infections detected over 26 years. Data were retrospectively collected from a database of all enterovirus infections identified in our laboratory. They were detected by viral isolation or nucleic acid detection in patients presenting with respiratory or neurological infections, rash, sepsis-like syndrome, or gastroenteritis. Enterovirus genotyping was performed by amplification of the VP1 gene using RT-nested PCR, followed by sequencing and BLAST analysis. Of the 2402 enterovirus infections detected, 1619 were linked to at least one genotype and 173 were caused by E30. Clinical information was available for 158 (91.3%) patients. E30 was associated with neurological infection in 107 (67.8%) cases and it was detected almost every year. Phylogenetic analysis was performed with 67 sequences. We observed that E30 strains circulating in Catalonia from 1996 to 2016 belong to two lineages (E and F), although the majority cluster was in F. In 2018, lineage I emerged as the dominant lineage.
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