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Gao F, Liu P, Huo Y, Bian L, Wu X, Liu M, Wang Q, He Q, Dong F, Wang Z, Xie Z, Zhang Z, Gu M, Xu Y, Li Y, Zhu R, Cheng T, Wang T, Mao Q, Liang Z. A screening study on the detection strain of Coxsackievirus A6: the key to evaluating neutralizing antibodies in vaccines. Emerg Microbes Infect 2024; 13:2322671. [PMID: 38390796 PMCID: PMC10906128 DOI: 10.1080/22221751.2024.2322671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 02/20/2024] [Indexed: 02/24/2024]
Abstract
The increasing incidence of diseases caused by Coxsackievirus A6 (CV-A6) and the presence of various mutants in the population present significant public health challenges. Given the concurrent development of multiple vaccines in China, it is challenging to objectively and accurately evaluate the level of neutralizing antibody response to different vaccines. The choice of the detection strain is a crucial factor that influences the detection of neutralizing antibodies. In this study, the National Institutes for Food and Drug Control collected a prototype strain (Gdula), one subgenotype D1, as well as 13 CV-A6 candidate vaccine strains and candidate detection strains (subgenotype D3) from various institutions and manufacturers involved in research and development. We evaluated cross-neutralization activity using plasma from naturally infected adults (n = 30) and serum from rats immunized with the aforementioned CV-A6 strains. Although there were differences between the geometric mean titer (GMT) ranges of human plasma and murine sera, the overall trends were similar. A significant effect of each strain on the neutralizing antibody test (MAX/MIN 48.0 ∼16410.3) was observed. Among all strains, neutralization of the S112 strain by 15 different sera resulted in higher neutralizing antibody titers (GMTS112 = 132.0) and more consistent responses across different genotypic immune sera (MAX/MIN = 48.0). Therefore, S112 may serve as a detection strain for NtAb testing in various vaccines, minimizing bias and making it suitable for evaluating the immunogenicity of the CV-A6 vaccine.
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Affiliation(s)
- Fan Gao
- School of Life Sciences, Tianjin University, Tianjin, People’s Republic of China
- Division of Hepatitis and Enterovirus Vaccines, National Institutes for Food and Drug Control, Beijing, People’s Republic of China
| | - Pei Liu
- National Center for AIDS/STD Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People’s Republic of China
| | - Yaqian Huo
- Division of Hepatitis and Enterovirus Vaccines, National Institutes for Food and Drug Control, Beijing, People’s Republic of China
- Department of Research & Development, Shanghai Institute of Biological Products Co., Ltd, Shanghai, People’s Republic of China
| | - Lianlian Bian
- Division of Hepatitis and Enterovirus Vaccines, National Institutes for Food and Drug Control, Beijing, People’s Republic of China
| | - Xing Wu
- Division of Hepatitis and Enterovirus Vaccines, National Institutes for Food and Drug Control, Beijing, People’s Republic of China
| | - Mingchen Liu
- Division of Hepatitis and Enterovirus Vaccines, National Institutes for Food and Drug Control, Beijing, People’s Republic of China
| | - Qian Wang
- Division of Hepatitis and Enterovirus Vaccines, National Institutes for Food and Drug Control, Beijing, People’s Republic of China
| | - Qian He
- Division of Hepatitis and Enterovirus Vaccines, National Institutes for Food and Drug Control, Beijing, People’s Republic of China
| | - Fangyu Dong
- Department of Research & Development, Taibang Biologic Group, Beijing, People’s Republic of China
| | - Zejun Wang
- Department of R&D, Wuhan Institute of Biological Products Co., LTD, Wuhan, People’s Republic of China
| | - Zhongping Xie
- Department of Production Management, Institute of Medical Biology, Chinese Academy of Medical Sciences, Kunming, People’s Republic of China
| | - Zhongyang Zhang
- The Second Research Laboratory, National Vaccine and Serum Institute, Beijing, People’s Republic of China
| | - Meirong Gu
- R&D Center, Minhai Biotechnology Co., LTD, Beijing, People’s Republic of China
| | - Yingzhi Xu
- R&D Center, Minhai Biotechnology Co., LTD, Beijing, People’s Republic of China
| | - Yajing Li
- R&D Center, Sinovac Biotech Co., LTD, Beijing, People’s Republic of China
| | - Rui Zhu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, People’s Republic of China
| | - Tong Cheng
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, People’s Republic of China
| | - Tao Wang
- School of Life Sciences, Tianjin University, Tianjin, People’s Republic of China
| | - Qunying Mao
- Division of Hepatitis and Enterovirus Vaccines, National Institutes for Food and Drug Control, Beijing, People’s Republic of China
| | - Zhenglun Liang
- Division of Hepatitis and Enterovirus Vaccines, National Institutes for Food and Drug Control, Beijing, People’s Republic of China
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Stolarczyk A, Wolf JR, Pentland A. COVID-19 pandemic-related decreases in hand, foot, and mouth disease and scabies: A retrospective study. J Am Acad Dermatol 2024; 90:654-655. [PMID: 37984721 DOI: 10.1016/j.jaad.2023.11.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/30/2023] [Accepted: 11/12/2023] [Indexed: 11/22/2023]
Affiliation(s)
- Ania Stolarczyk
- Department of Dermatology, University of Rochester Medical Center, Rochester, New York
| | - Julie Ryan Wolf
- Department of Dermatology, University of Rochester Medical Center, Rochester, New York
| | - Alice Pentland
- Department of Dermatology, University of Rochester Medical Center, Rochester, New York.
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Chau NVV, Thuong TC, Hung NT, Hong NTT, Quy DT, Thien TB, Hiep CM, Minh NNQ, Khanh TH, Han DDK, Truc THC, Ny NTH, Thanh LK, Nguyet LA, Thuy CT, Nhu LNT, Van Quang P, Nguyen PNT, Qui PT, Rogier van Doorn H, Thwaites CL, Thanh TT, Dung NT, Thwaites G, Anh NT, Nhan LNT, Van Tan L. Emerging Enterovirus A71 Subgenogroup B5 Causing Severe Hand, Foot, and Mouth Disease, Vietnam, 2023. Emerg Infect Dis 2024; 30:363-367. [PMID: 38270132 PMCID: PMC10826755 DOI: 10.3201/eid3002.231024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024] Open
Abstract
We report on a 2023 outbreak of severe hand, foot, and mouth disease in southern Vietnam caused by an emerging lineage of enterovirus A71 subgenogroup B5. Affected children were significantly older than those reported during previous outbreaks. The virus should be closely monitored to assess its potential for global dispersal.
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Bao NT, Luan VT, Liem BT, Nhu VHT, Viet DC, Tung TH, Burza S, Thanh NT. Extracorporeal life support and continuous renal replacement therapy in a patient with Enterovirus A71 associated cardiopulmonary failure: A case report. Medicine (Baltimore) 2024; 103:e36797. [PMID: 38181280 PMCID: PMC10766259 DOI: 10.1097/md.0000000000036797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/06/2023] [Indexed: 01/07/2024] Open
Abstract
RATIONALE Hand-foot-mouth disease (HFMD) caused by Enterovirus A71, complicated by cardiopulmonary failure, is associated with a high mortality rate despite intensive treatment. To date, there is a paucity of clinical management data, regarding the use of extracorporeal life support (VA-ECMO) for Enterovirus-A71 associated cardiopulmonary failure reported. PATIENT CONCERNS The patient in this study presented with severe HFMD complicated by cardiopulmonary failure, polymorphic ventricular tachycardia, and cardiac arrest. DIAGNOSES Clinical presentations, laboratory data, and polymerase chain reaction (PCR) results from rectal swabs were used to confirm the diagnosis of severe HFMD caused by Enterovirus A71. INTERVENTIONS The patient was managed with chest compression and an automatic external defibrillator, mechanical ventilation, intravenous immunoglobulin (IVIG), continuous renal replacement therapy (CRRT) and inotrope (milrinone). The patient did not respond to these interventions and subsequently required further management with VA-ECMO. OUTCOMES The patient achieved a favorable outcomes. LESSONS Our study highlights that extracorporeal membrane oxygenation and CRRT can enhance the survival outcomes of patients with severe HFMD with cardiopulmonary failure complications. Furthermore, we propose specific indications for the initiation of VA-ECMO.
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Affiliation(s)
- Nguyen Trung Bao
- Department of Infectious Diseases, Children Hospital No.2, Ho Chi Minh City, Vietnam
| | - Vo Thanh Luan
- Department of Infectious Diseases, Children Hospital No.2, Ho Chi Minh City, Vietnam
| | - Bui Thanh Liem
- Department of Infectious Diseases, Children Hospital No.2, Ho Chi Minh City, Vietnam
- Faculty of Pediatrics, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | | | - Do Chau Viet
- Department of Infectious Diseases, Children Hospital No.2, Ho Chi Minh City, Vietnam
| | - Trinh Huu Tung
- Department of Infectious Diseases, Children Hospital No.2, Ho Chi Minh City, Vietnam
| | - Sakib Burza
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Health in Harmony, London, United Kingdom
| | - Nguyen Tat Thanh
- Department of Infectious Diseases, Children Hospital No.2, Ho Chi Minh City, Vietnam
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Woolcock Institute of Medical Research, Ho Chi Minh City, Vietnam
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Mehta N, Gupta S. Blistering exanthems in the times of monkeypox-Keep calm and do not panic! J Am Acad Dermatol 2023; 88:e153-e155. [PMID: 36574862 PMCID: PMC9794030 DOI: 10.1016/j.jaad.2022.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 12/09/2022] [Accepted: 12/09/2022] [Indexed: 12/25/2022]
Affiliation(s)
- Nikhil Mehta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Somesh Gupta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India.
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Xiao J, Huang K, Lu H, Song Y, Han Z, Zhang M, Li J, Zhou X, Chen J, Yu Q, Yang M, Yan D, Ji T, Yang Q, Zhu S, Xu W, Zhang Y. Genomic Epidemiology and Phylodynamic Analysis of Enterovirus A71 Reveal Its Transmission Dynamics in Asia. Microbiol Spectr 2022; 10:e0195822. [PMID: 36200890 DOI: 10.1128/spectrum.01958-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Enterovirus A71 (EV-A71) is one of the main pathogens causing hand, foot, and mouth disease (HFMD) outbreaks in Asian children under 5 years of age. In severe cases, it can cause neurological complications and be life-threatening. In this study, 200 newly sequenced EV-A71 whole-genome sequences were combined with 772 EV-A71 sequences from GenBank for large-scale analysis to investigate global EV-A71 epidemiology, phylogeny, and Bayesian phylodynamic characteristics. Based on the phylogenetic analysis of the EV-A71 3Dpol region, six new evolutionary lineages (lineages B, J, K, O, P, and Q) were found in this study, and the number of evolutionary lineages was expanded from 11 to 17. Temporal dynamics and recombination breakpoint analyses based on genotype C revealed that recombination of nonstructural protein-coding regions, including 3Dpol, is an important reason for the emergence of new lineages. The EV-A71 epidemic in the Asia-Pacific region is complex, and phylogeographic analysis found that Vietnam played a key role in the spread of subgenotypes B5 and C4. The origin of EV-A71 subgenotype C4 in China is East China, which is closely related to the prevalence of subgenotype C4 in the south and throughout China. Selection pressure analysis revealed that, in addition to VP1 amino acid residues VP1-98 and VP1-145, which are associated with EV-A71 pathogenicity, amino acid residues VP1-184 and VP1-249 were also positively selected, and their functions still need to be determined by biology and immunology. This study aimed to provide a solid theoretical basis for EV-A71-related disease surveillance and prevention, antiviral research, and vaccine development through a comprehensive analysis. IMPORTANCE EV-A71 is one of the most important pathogens causing HFMD outbreaks; however, large-scale studies of EV-A71 genomic epidemiology are currently lacking. In this study, 200 new EV-A71 whole-genome sequences were determined. Combining these with 772 EV-A71 whole-genome sequences in the GenBank database, the evolutionary and transmission characteristics of global and Asian EV-A71 were analyzed. Six new evolutionary lineages were identified in this study. We also found that recombination in nonstructural protein-coding regions, including 3Dpol, is an important cause for the emergence of new lineages. The results provided a solid theoretical basis for EV-A71-related disease surveillance and prevention, antiviral research, and vaccine development.
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Sripattaraphan A, Sanachai K, Chavasiri W, Boonyasuppayakorn S, Maitarad P, Rungrotmongkol T. Computational Screening of Newly Designed Compounds against Coxsackievirus A16 and Enterovirus A71. Molecules 2022; 27:molecules27061908. [PMID: 35335272 PMCID: PMC8955072 DOI: 10.3390/molecules27061908] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/27/2022] [Accepted: 03/10/2022] [Indexed: 12/20/2022]
Abstract
Outbreaks of hand, foot, and mouth disease (HFMD) that occur worldwide are mainly caused by the Coxsackievirus-A16 (CV-A16) and Enterovirus-A71 (EV-A71). Unfortunately, neither an anti-HFMD drug nor a vaccine is currently available. Rupintrivir in phase II clinical trial candidate for rhinovirus showed highly potent antiviral activities against enteroviruses as an inhibitor for 3C protease (3Cpro). In the present study, we focused on designing 50 novel rupintrivir analogs against CV-A16 and EV-A71 3Cpro using computational tools. From their predicted binding affinities, the five compounds with functional group modifications at P1′, P2, P3, and P4 sites, namely P1′-1, P2-m3, P3-4, P4-5, and P4-19, could bind with both CV-A16 and EV-A71 3Cpro better than rupintrivir. Subsequently, these five analogs were studied by 500 ns molecular dynamics simulations. Among them, P2-m3, the derivative with meta-aminomethyl-benzyl group at the P2 site, showed the greatest potential to interact with the 3Cpro target by delivering the highest number of intermolecular hydrogen bonds and contact atoms. It formed the hydrogen bonds with L127 and K130 residues at the P2 site stronger than rupintrivir, supported by significantly lower MM/PB(GB)SA binding free energies. Elucidation of designed rupintrivir analogs in our study provides the basis for developing compounds that can be candidate compounds for further HFMD treatment.
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Affiliation(s)
- Amita Sripattaraphan
- Structural and Computational Biology Research Unit, Department of Biochemistry, Faculty of Science, Chulalongkorn University, Bangkok 10330, Thailand; (A.S.); (K.S.)
| | - Kamonpan Sanachai
- Structural and Computational Biology Research Unit, Department of Biochemistry, Faculty of Science, Chulalongkorn University, Bangkok 10330, Thailand; (A.S.); (K.S.)
| | - Warinthorn Chavasiri
- Department of Chemistry, Faculty of Science, Chulalongkorn University, Bangkok 10330, Thailand;
| | - Siwaporn Boonyasuppayakorn
- Applied Medical Virology Research Unit, Department of Microbiology, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand;
| | - Phornphimon Maitarad
- Research Center of Nano Science and Technology, Shanghai University, Shanghai 200444, China;
| | - Thanyada Rungrotmongkol
- Structural and Computational Biology Research Unit, Department of Biochemistry, Faculty of Science, Chulalongkorn University, Bangkok 10330, Thailand; (A.S.); (K.S.)
- Ph.D. Program in Bioinformatics and Computational Biology, Graduate School, Chulalongkorn University, Bangkok 10330, Thailand
- Correspondence: or
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Zhang XA, Zhao RQ, Chen JJ, Yuan Y, Tang X, Zhou ZW, Ren L, Lu QB, Wang YN, Zhang HY, Zhang PH, Fang LQ, Zhou HS, Liu EM, Xu HM, Liu W. The Identification and Genetic Characterization of Parechovirus Infection Among Pediatric Patients With Wide Clinical Spectrum in Chongqing, China. Front Microbiol 2021; 12:709849. [PMID: 34594310 PMCID: PMC8477803 DOI: 10.3389/fmicb.2021.709849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 08/05/2021] [Indexed: 12/03/2022] Open
Abstract
Human parechoviruses (HPeVs) are important causes of infection in children. However, without a comprehensive and persistent surveillance, the epidemiology and clinical features of HPeV infection remain ambiguous. We performed a hospital-based surveillance study among three groups of pediatric patients with acute respiratory infection (Group 1), acute diarrhea (Group 2), and hand, foot and mouth disease (Group 3) in Chongqing, China, from 2009 to 2015. Among 10,212 tested patients, 707 (6.92%) were positive for HPeV, with the positive rates differing significantly among three groups (Group 1, 3.43%; Group 2, 14.94%; Group 3, 3.55%; P < 0.001). The co-infection with other pathogens was detected in 75.2% (531/707) of HPeV-positive patients. Significant negative interaction between HPeV and Parainfluenza virus (PIV) (P = 0.046, OR = 0.59, 95% CI = 0.34–0.98) and positive interactions between HPeV and Enterovirus (EV) (P = 0.015, OR = 2.28, 95% CI = 1.23–4.73) were identified. Among 707 HPeV-positive patients, 592 (83.73%) were successfully sequenced, and 10 genotypes were identified, with HPeV1 (n = 396), HPeV4 (n = 86), and HPeV3 (n = 46) as the most frequently seen. The proportion of genotypes differed among three groups (P < 0.001), with HPeV1 and HPeV4 overrepresented in Group 2 and HPeV6 overrepresented in Group 3. The spatial patterns of HPeV genotypes disclosed more close clustering of the currently sequenced strains than those from other countries/regions, although they were indeed mixed. Three main genotypes (HPeV1, HPeV3, and HPeV4) had shown distinct seasonal peaks, highlighting a bi-annual cycle of all HpeV and two genotypes (HPeV 1 and HPeV 4) with peaks in odd-numbered years and with peaks in even-numbered years HPeV3. Significantly higher HPeV1 viral loads were associated with severe diarrhea in Group 2 (P = 0.044), while associated with HPeV single infection than HPeV-EV coinfection among HFMD patients (P = 0.001). It’s concluded that HPeV infection was correlated with wide clinical spectrum in pediatric patients with a high variety of genotypes determined. Still no clinical significance can be confirmed, which warranted more molecular surveillance in the future.
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Affiliation(s)
- Xiao-Ai Zhang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Rui-Qiu Zhao
- Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Jin-Jin Chen
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Yang Yuan
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Xiang Tang
- Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Zi-Wei Zhou
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Luo Ren
- Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Qin-Bin Lu
- Department of Laboratorial Science and Technology, School of Public Health, Peking University, Beijing, China
| | - Yu-Na Wang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Hai-Yang Zhang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Pan-He Zhang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Li-Qun Fang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Hai-Sheng Zhou
- Key Laboratory of Dermatology, Anhui Medical University, Hefei, China.,Department of Biochemistry and Molecular Biology, Anhui Medical University, Hefei, China
| | - En-Mei Liu
- Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Hong-Mei Xu
- Children's Hospital of Chongqing Medical University, Chongqing, China
| | - Wei Liu
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China.,Beijing Key Laboratory of Vector Borne and Natural Focus Infectious Diseases, Beijing, China
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Kamau E, Nguyen D, Celma C, Blomqvist S, Horby P, Simmonds P, Harvala H. Seroprevalence and Virologic Surveillance of Enterovirus 71 and Coxsackievirus A6, United Kingdom, 2006-2017. Emerg Infect Dis 2021; 27:2261-2268. [PMID: 34423767 PMCID: PMC8386771 DOI: 10.3201/eid2709.204915] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Enterovirus A71 (EV-A71) and coxsackievirus A6 (CVA6) cause hand, foot and mouth disease (HFMD) and are occasionally linked to severe neurologic complications and large outbreaks worldwide. We estimated EV-A71 and CVA6 seroprevalence using cross-sectional age-stratified samples collected in 2006, 2011, and 2017. Seroprevalences of EV-A71 and CVA6 increased from 32% and 54% at 6-11 months to >75% by 10 years of age. Antibody titers declined after 20 years, which could indicate infrequent re-exposure in older populations. Age profiles for acquiring infections and mean titers were comparable in the 3 testing years, despite the marked increase in incidence of CVA6-related HFMD from 2010. The uncoupling of changes in disease severity from the infection kinetics of CVA6 as we inferred from the seroprevalence data, rather than incidence of infection over the 11-year study period, provides further evidence for a change in its pathogenicity.
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Ai Y, Zhang W, Wu J, Zhang J, Shen M, Yao S, Deng C, Li X, Wu D, Tian P, Cheng X, Zha H, Wu K. Molecular Epidemiology and Clinical Features of Enteroviruses-Associated Hand, Foot, and Mouth Disease and Herpangina Outbreak in Zunyi, China, 2019. Front Med (Lausanne) 2021; 8:656699. [PMID: 33981716 PMCID: PMC8109248 DOI: 10.3389/fmed.2021.656699] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/31/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Hand, foot and mouth disease (HFMD) and herpangina (HA), two of the most common childhood infectious diseases, are associated with enteroviruses (EVs) infection. The aim of this study was to identify the molecular epidemiology of enterovirus causing HFMD/HA in Zunyi, China, during 2019, and to describe the clinical features of the cases. Methods: We collected the information on demographic and clinical characteristics, laboratory data of laboratory-confirmed EVs associated HFMD/HA cases in Zunyi Medical University Third Affiliated Hospital between March 1 and July 31, 2019. EV types were determined by either one-step real time RT-PCR or partial VP1 gene sequencing and sequence alignment. Phylogenetic analysis of CVA6, CVA2, and CVA5 were established based on the partial VP1 gene sequences by neighbor-joining method. Differences in clinical characteristics and laboratory results of the cases were compared among patients infected with the most prevalent EV types. Results: From 1 March to 31 July 2019, 1,377 EVs associated HFMD/HA inpatients were confirmed. Of them, 4 (0.3%, 4/1,377) were EV-A71-associated cases, 84 (6.1%, 84/1,377) were CVA16-associated cases, and 1,289 (93.6%, 1,289/1,377) were non-EV-A71/CVA16-associated cases. Of the randomly selected 372 non-EV-A71/CVA16 cases, EV types have been successfully determined in 273 cases including 166 HFMD and 107 HA cases. For HFMD cases, the three most common types were CVA6 (80.7%, 134/166), CVA2 (5.4%, 9/166) and CVA5 (3.0%, 5/166); similarly, for HA cases, the three most prevalent serotypes were CVA6 (36.5%, 39/107), CVA2 (21.5%, 23/107) and CVA5 (18.7%, 20/107). Phylogenetic analysis showed that subclade D of CVA5, and subclade E of CVA6 and CVA2 were predominant in Zunyi during the outbreak in 2019. Compared with the cases caused by CVA16, the incidence of high fever and severe infection associated with CVA2, CVA5, and CVA6 was higher. Conclusions: The recent HFMD/HA outbreak in Zunyi is due to a larger incidence of CVA6, CVA2, and CVA5. Novel diagnostic reagents and vaccines against these types would be important to monitor and control EV infections.
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Affiliation(s)
- Yuanhang Ai
- Department of Clinical Laboratory, Zunyi Medical University Third Affiliated Hospital, Zunyi, China
| | - Weiwei Zhang
- Department of Pediatrics and Child Health, Zunyi Medical University Third Affiliated Hospital, Zunyi, China
| | - Jie Wu
- Department of Scientific Research Laboratory, Zunyi Medical University Third Affiliated Hospital, Zunyi, China
| | - Jingzhi Zhang
- Department of Clinical Laboratory, Zunyi Medical University Third Affiliated Hospital, Zunyi, China
| | - Meijing Shen
- Department of Clinical Laboratory, Zunyi Medical University Third Affiliated Hospital, Zunyi, China
| | - Shifei Yao
- Department of Clinical Laboratory, Zunyi Medical University Third Affiliated Hospital, Zunyi, China
| | - Chengmin Deng
- Department of Scientific Research Laboratory, Zunyi Medical University Third Affiliated Hospital, Zunyi, China
| | - Xiaoqian Li
- Department of Scientific Research Laboratory, Zunyi Medical University Third Affiliated Hospital, Zunyi, China
| | - Dejing Wu
- Department of Scientific Research Laboratory, Zunyi Medical University Third Affiliated Hospital, Zunyi, China
| | - Peng Tian
- Department of Scientific Research Laboratory, Zunyi Medical University Third Affiliated Hospital, Zunyi, China
| | - Xiaoju Cheng
- Department of Scientific Research Laboratory, Zunyi Medical University Third Affiliated Hospital, Zunyi, China
| | - He Zha
- Department of Clinical Laboratory, Zunyi Medical University Third Affiliated Hospital, Zunyi, China
| | - Kaifeng Wu
- Department of Clinical Laboratory, Zunyi Medical University Third Affiliated Hospital, Zunyi, China.,Department of Scientific Research Laboratory, Zunyi Medical University Third Affiliated Hospital, Zunyi, China
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12
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Chen YZ, Zhan ZQ, Zhou LQ, Chen MS, Cao XJ, Li YP, Guo XG. Diagnostic value of loop-mediated isothermal amplification assay for hand, foot, and mouth disease. J Clin Lab Anal 2021; 35:e23776. [PMID: 33792998 PMCID: PMC8183915 DOI: 10.1002/jcla.23776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/17/2021] [Accepted: 03/19/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Nowadays, hand, foot, and mouth disease (HFMD) has a significant negative impact on children's health, especially in the Asia-Pacific region. Loop-mediated isothermal amplification assay (LAMP) is a highly efficient and convenient novel tool. However, its diagnostic accuracy for HFMD is still not clear. Therefore, we conducted a meta-analysis in order to evaluate the potential of LAMP assay for the diagnosis of HFMD, in which the reference standard was polymerase chain reaction (PCR). METHODS A protocol was predetermined (CRD42020212882) in PROSPERO. We retrieved seven databases including PubMed for relevant studies published before October 2020. Articles were included if they compared the diagnostic efficiency of LAMP with PCR for HFMD through detecting clinical samples which was more than 15. Statistical analysis was performed by STATA 15.1 software. Risk of bias and applicability were assessed using Quality Assessment of Diagnostic Accuracy Studies. No funding was used for the study. RESULTS A total of 18 retrospective studies including 2495 samples from China were finally included. Reference standards of them included RT-PCR and non-RT-PCR. The merged sensitivity and specificity with 95% confidence interval (95% CI) were 1.00 (0.97-1.00) and 0.97 (0.88-0.99), respectively. The pooled PLR, NLR, and DOR with 95% CI were 11.17 (5.91-21.11), 0.05 (0.03-0.09), and 538.12 (183.17-1580.83), respectively. The AUC of SROC was 1.00 (95% CI: 0.99-1.00). CONCLUSION In conclusion, our research revealed high sensitivity and specificity of LAMP in diagnosing HFMD. However, more high-quality research is required to prove this conclusion.
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Affiliation(s)
- Ying-Zhou Chen
- Department of Clinical Laboratory Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Department of Clinical Medicine, The First Clinical School of Guangzhou Medical University, Guangzhou, China
| | - Zhi-Qing Zhan
- Department of Clinical Laboratory Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Department of Clinical Medicine, The Third Clinical School of Guangzhou Medical University, Guangzhou, China
| | - Li-Quan Zhou
- Department of Clinical Laboratory Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Department of Clinical Medicine, The First Clinical School of Guangzhou Medical University, Guangzhou, China
| | - Min-Shan Chen
- Department of Clinical Laboratory Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Department of Clinical Medicine, The First Clinical School of Guangzhou Medical University, Guangzhou, China
| | - Xun-Jie Cao
- Department of Clinical Laboratory Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Department of Clinical Medicine, The Third Clinical School of Guangzhou Medical University, Guangzhou, China
| | - Ya-Ping Li
- Department of Clinical Laboratory Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Department of Clinical Medicine, The Second Clinical School of Guangzhou Medical University, Guangzhou, China
| | - Xu-Guang Guo
- Department of Clinical Laboratory Medicine, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Department of Clinical Medicine, The Third Clinical School of Guangzhou Medical University, Guangzhou, China.,Key Laboratory for Major Obstetric Diseases of Guangdong Province, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.,Key Laboratory of Reproduction and Genetics of Guangdong Higher Education Institutes, The Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
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13
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Nguyet LA, Thanh TT, Nhan LNT, Hong NTT, Nhu LNT, Van HMT, Ny NTH, Anh NT, Han DDK, Tuan HM, Huy VQ, Viet HL, Cuong HQ, Thao NTT, Viet DC, Khanh TH, Thwaites L, Clapham H, Hung NT, Chau NVV, Thwaites G, Ha DQ, van Doorn HR, Tan LV. Neutralizing Antibodies against Enteroviruses in Patients with Hand, Foot and Mouth Disease. Emerg Infect Dis 2021; 26:298-306. [PMID: 31961293 PMCID: PMC6986819 DOI: 10.3201/eid2602.190721] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Hand, foot and mouth disease (HFMD) is an emerging infection with pandemic potential. Knowledge of neutralizing antibody responses among its pathogens is essential to inform vaccine development and epidemiologic research. We used 120 paired-plasma samples collected at enrollment and >7 days after the onset of illness from HFMD patients infected with enterovirus A71 (EV-A71), coxsackievirus A (CVA) 6, CVA10, and CVA16 to study cross neutralization. For homotypic viruses, seropositivity increased from <60% at enrollment to 97%-100% at follow-up, corresponding to seroconversion rates of 57%-93%. Seroconversion for heterotypic viruses was recorded in only 3%-23% of patients. All plasma samples from patients infected with EV-A71 subgenogroup B5 could neutralize the emerging EV-A71 subgenogroup C4. Collectively, our results support previous reports about the potential benefit of EV-A71 vaccine but highlight the necessity of multivalent vaccines to control HFMD.
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14
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Mustafa S, Abd-Aziz N, Saw WT, Liew SY, Yusoff K, Shafee N. Recombinant Enterovirus 71 Viral Protein 1 Fused to a Truncated Newcastle Disease Virus NP (NPt) Carrier Protein. Vaccines (Basel) 2020; 8:E742. [PMID: 33297428 DOI: 10.3390/vaccines8040742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 11/20/2020] [Accepted: 11/26/2020] [Indexed: 01/14/2023] Open
Abstract
Enterovirus 71 (EV71) is the major causative agent in hand, foot, and mouth disease (HFMD), and it mainly infects children worldwide. Despite the risk, there is no effective vaccine available for this disease. Hence, a recombinant protein construct of truncated nucleocapsid protein viral protein 1 (NPt-VP1198–297), which is capable of inducing neutralizing antibody against EV71, was evaluated in a mouse model. Truncated nucleocapsid protein Newcastle disease virus that was used as immunological carrier fused to VP1 of EV71 as antigen. The recombinant plasmid carrying corresponding genes was constructed by recombinant DNA technology and the corresponding protein was produced in Escherichia coli expression system. The recombinant NPt-VP1198–297 protein had elicited neutralizing antibodies against EV71 with the titer of 1:16, and this result is higher than the titer that is elicited by VP1 protein alone (1:8). It was shown that NPt containing immunogenic epitope(s) of VP1 was capable of inducing a greater functional immune response when compared to full-length VP1 protein alone. It was capable to carry larger polypeptide compared to full-length NP protein. The current study also proved that NPt-VP1198–297 protein can be abundantly produced in recombinant protein form by E. coli expression system. The findings from this study support the importance of neutralizing antibodies in EV71 infection and highlight the potential of the recombinant NPt-VP1198–297 protein as EV71 vaccine.
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15
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Guo WP, Chen GQ, Xie GC, Du LY, Tang Q. Mosaic genome of Human Coxsackievirus A4 associated with herpangina and HFMD in Yancheng, China, 2016 and 2018. Int J Infect Dis 2020; 96:538-540. [PMID: 32439540 DOI: 10.1016/j.ijid.2020.05.057] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES To better understand the spectrums of pathogens causing herpangina and circulation of Coxsackievirus A4 in Yancheng, China. METHODS Stool samples from herpangina and HFMD cases were collected. Real Time PCR Kits was used to identify Enterovirus 71, CV-A16 and CV-A6, and nested reverse transcription PCR (nRT-PCR) to detect the other enterovirus types. Complete VP1 and genome sequence of CV-A4 were amplified by using nRT-PCR. Genetic, phylogenetic and recombination analysis were performed. RESULTS Co-circulation of three recombinant CV-A4 groups, including one novel (C2 lineage), was identified in Yancheng, China, 2016 and 2018. One was the major causative agent of herpangina, and another two were responsible for HFMD. Phylogenetic and recombination analysis indicated that the non-structural region of their genome originated from the same ancestry and subsequently adaptation. C2 lineage of CV-A4 group may be introduced from countries outside China and its genome occurred recombination in China. CONCLUSION Novel recombinant CV-A4 was mainly associated with herpanginain in Yancheng, 2018, China. C2 lineage of CV-A4 group with recombinant non-structural region was also identified in HFMD patients.
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Affiliation(s)
- Wen-Ping Guo
- Department of Pathogenic Biology, College of Basic Medicine, Chengde Medical University, Chengde, Hebei, China.
| | - Guo-Qing Chen
- Yancheng Center for Disease Control and Prevention, Yancheng, Jiangsu, China.
| | - Guang-Cheng Xie
- Department of Pathogenic Biology, College of Basic Medicine, Chengde Medical University, Chengde, Hebei, China.
| | - Luan-Ying Du
- Department of Pathogenic Biology, College of Basic Medicine, Chengde Medical University, Chengde, Hebei, China.
| | - Quan Tang
- Yancheng Center for Disease Control and Prevention, Yancheng, Jiangsu, China.
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16
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Van HMT, Anh NT, Hong NTT, Nhu LNT, Nguyet LA, Thanh TT, Ny NTH, Hang VTT, Khanh TH, Viet HL, Viet DC, Tuan HM, Hung NT, Quy DT, Ha DQ, Qui PT, Nhan LNT, Thwaites G, Chau NVV, Thwaites L, Rogier van Doorn H, Van Tan L. Enterovirus A71 Phenotypes Causing Hand, Foot and Mouth Disease, Vietnam. Emerg Infect Dis 2019; 25:788-791. [PMID: 30882309 PMCID: PMC6433038 DOI: 10.3201/eid2504.181367] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
We investigated enterovirus A71–associated hand, foot and mouth disease in Vietnam and found that, after replacing subgenogroup C4 in 2013, B5 remained the leading cause of this disease. In contrast with previous observations, this switch did not result in an explosive outbreak, and B5 evolution was driven by negative selection.
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17
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Zhang H, Zhang L, Xie J, Wen W, Wei L, Nie B. Probiotics supplement in children with severe hand, foot, and mouth disease: A systematic review and meta-analysis protocol. Medicine (Baltimore) 2019; 98:e17939. [PMID: 31702682 PMCID: PMC6855594 DOI: 10.1097/md.0000000000017939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Severe hand, foot, and mouth disease (HFMD) is an acute infectious disease caused by infection with serotypes of Enterovirus A, most commonly by enterovirus A71 and coxsackievirus A16. Clinical symptoms usually include fever, malaise, rashes on hands and feet, and oral vesicles. Of note, severe and even life-threatening complications can develop rapidly in young children, such as acute pulmonary edema, cardiopulmonary failure, aseptic meningitis, encephalitis and acute flaccid paralysis. Probiotics supplement have been demonstrated play a positive role as a therapeutic approaches for modulation of gut microbiota. This study aims to systematically investigate the efficacy and safety of probiotics for children with severe HFMD. METHODS All randomized controlled trials related to probiotics and severe HFMD will be searched in 9 electronic databases (PubMed, Cochrane Library, Embase, ClinicalTrails, China National Knowledge Infrastructure, Sino Med, ScienceDirect, VIP, and Wanfang Data databases) from their inception to November 2019. The primary outcome is total effective rate, fever clearance time, rash regression time, remission time of neurological symptoms, and clinical cure time. Two researchers will perform the study selection, data extraction, and assessment of risk of bias independently. RevMan software (version 5.3) will be used for data synthesis. RESULTS The findings of this study will be published in a peer-reviewed journal. CONCLUSION The study will provide evidence to judge whether probiotics is an effective therapeutic intervention for severe HFMD. PROSPERO REGISTRATION NUMBER PROSPERO CRD42019152946.
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Affiliation(s)
- Haibo Zhang
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Lei Zhang
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Jiadong Xie
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Wenting Wen
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Luxia Wei
- Nanjing University of Chinese Medicine, Nanjing, China
| | - Bo Nie
- University College London, London, England
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18
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Takechi M, Fukushima W, Nakano T, Inui M, Ohfuji S, Kase T, Ito K, Kondo K, Maeda A, Shimizu H, Hirota Y. Nationwide Survey of Pediatric Inpatients With Hand, Foot, and Mouth Disease, Herpangina, and Associated Complications During an Epidemic Period in Japan: Estimated Number of Hospitalized Patients and Factors Associated With Severe Cases. J Epidemiol 2019; 29:354-362. [PMID: 30416163 PMCID: PMC6680054 DOI: 10.2188/jea.je20180060] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Accepted: 08/20/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Severe pediatric cases of hand, foot, and mouth disease (HFMD), herpangina (HA), and associated complications caused by enterovirus 71 (EV71) infection have brought substantial public health impact in Asia. This study aimed to elucidate the epidemiology of these pediatric cases in Japan. METHODS A nationwide survey was conducted using stratified random sampling of hospital pediatric departments. We estimated the number of inpatients with HFMD, HA, and associated complications between April 1 and September 30, 2010, during which EV71 was circulating predominantly. Factors associated with severe cases with ≥7 days of admission, sequelae, or outcome of death were analyzed using multivariate logistic regression. RESULTS During the 6-month epidemic period, the number of pediatric inpatients aged <15 years was about 2,900 (estimated cumulative incidence of hospitalized cases: 17.0 per 100,000 population). Severe cases were significantly associated with younger age. Compared to patients ≥5 years of age, the odds ratios (ORs) for <1 year of age and 1 to <3 years of age were 5.74 (95% confidence interval [CI], 2.14-15.4) and 2.94 (95% CI, 1.02-8.51), respectively. Elevated ORs for hyperglycemia (plasma glucose level of ≥8.3 mmol/L) on admission (OR 3.60; 95% CI, 0.94-13.8) were also observed. CONCLUSIONS Disease burden of pediatric inpatients with HFMD, HA, and associated complications in Japan was described for the first time. During an EV71 epidemic, younger age and, suggestively, hyperglycemia may have been critical factors requiring more careful treatment.
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Affiliation(s)
- Maria Takechi
- Department of Public Health, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Wakaba Fukushima
- Department of Public Health, Osaka City University Graduate School of Medicine, Osaka, Japan
- Research Center for Infectious Disease Sciences, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Takashi Nakano
- Department of Pediatrics, Kawasaki Medical School, Okayama, Japan
| | - Miki Inui
- Department of Public Health, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Satoko Ohfuji
- Department of Public Health, Osaka City University Graduate School of Medicine, Osaka, Japan
- Research Center for Infectious Disease Sciences, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Tetsuo Kase
- Department of Public Health, Osaka City University Graduate School of Medicine, Osaka, Japan
- Research Center for Infectious Disease Sciences, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kazuya Ito
- Department of Public Health, Osaka City University Graduate School of Medicine, Osaka, Japan
- Research Center for Infectious Disease Sciences, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kyoko Kondo
- Osaka City University Hospital, Osaka, Japan
| | - Akiko Maeda
- Department of Public Health, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hiroyuki Shimizu
- Department of Virology II, National Institute of Infectious Diseases, Tokyo, Japan
| | - Yoshio Hirota
- Department of Public Health, Osaka City University Graduate School of Medicine, Osaka, Japan
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19
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Yang Z, Gao F, Wang X, Shi L, Zhou Z, Jiang Y, Ma X, Zhang C, Zhou C, Zeng X, Liu G, Fan J, Mao Q, Shi L. Development and characterization of an enterovirus 71 (EV71) virus-like particles (VLPs) vaccine produced in Pichia pastoris. Hum Vaccin Immunother 2019; 16:1602-1610. [PMID: 31403352 DOI: 10.1080/21645515.2019.1649554] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Enterovirus 71 (EV71) is one of the major causative agents for hand, foot and mouth disease (HFMD) in children. Although there are three inactivated virus-based HFMD vaccines licensed in China, alternative approaches have been taken to produce an effective and safer vaccine that is easier to manufacture in large scale. Among these, a virus-like particles (VLPs) based EV71 vaccine is under active development. For this purpose, an efficient methodology for the production of EV71-VLPs by recombinant technology is needed. We here report the construction and expression of the P1 and 3C genes of EV71 in Pichia pastoris for producing VLP-based EV71 vaccine antigen with a high yield and simple manufacturing process. Based on codon-optimized P1 and 3C genes, EV71-VLPs were efficiently expressed in Pichia pastoris system, and the expression level reached 270 mg/L. Biochemical and biophysical analyses showed that the produced EV71-VLPs consisted of processed VP0, VP1, and VP3 present as ~35nm spherical particles. The immune response as a function of EV71-VLPs and adjuvant dose ratio was investigated for vaccine development. Immunization with EV71-VLPs of 1-5 µg/dose and adjuvant of 225 µg/dose induced robust neutralizing antibody responses in mice and provided effective protection against lethal challenge in both maternally transferred antibody and passive transfer protection mouse models. Therefore, the yeast produced EV71-VLPs antigen is a promising candidate for the development of a vaccine against HFMD.
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Affiliation(s)
- Zhijian Yang
- Shanghai Zerun Biotechnology Co., Ltd , Shanghai, PR China
| | - Fan Gao
- Division of Hepatitis Virus Vaccines, National Institutes for Food and Drug Control (NIFDC) , Beijing, PR China
| | - Xiaoliang Wang
- Shanghai Zerun Biotechnology Co., Ltd , Shanghai, PR China
| | - Likang Shi
- Shanghai Zerun Biotechnology Co., Ltd , Shanghai, PR China
| | - Zheng Zhou
- Shanghai Zerun Biotechnology Co., Ltd , Shanghai, PR China
| | | | - Xinxing Ma
- Shanghai Zerun Biotechnology Co., Ltd , Shanghai, PR China
| | - Chao Zhang
- Shanghai Zerun Biotechnology Co., Ltd , Shanghai, PR China
| | - Chenliang Zhou
- Shanghai Zerun Biotechnology Co., Ltd , Shanghai, PR China
| | - Xianfang Zeng
- Shanghai Zerun Biotechnology Co., Ltd , Shanghai, PR China
| | - Ge Liu
- Shanghai Zerun Biotechnology Co., Ltd , Shanghai, PR China
| | - Jiang Fan
- Shanghai Zerun Biotechnology Co., Ltd , Shanghai, PR China
| | - Qunying Mao
- Division of Hepatitis Virus Vaccines, National Institutes for Food and Drug Control (NIFDC) , Beijing, PR China
| | - Li Shi
- Shanghai Zerun Biotechnology Co., Ltd , Shanghai, PR China
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20
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Meng T, Jia Q, Wong SM, Chua KB. In Vitro and In Vivo Inhibition of the Infectivity of Human Enterovirus 71 by a Sulfonated Food Azo Dye, Brilliant Black BN. J Virol 2019; 93:e00061-19. [PMID: 31167919 DOI: 10.1128/JVI.00061-19] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Accepted: 01/18/2019] [Indexed: 12/13/2022] Open
Abstract
Hand, foot, and mouth disease (HFMD), a highly contagious disease in children, is caused by human enteroviruses, including enterovirus 71 (EV71), coxsackievirus A16 (CVA16), and coxsackievirus A6 (CVA6). Although HFMD is usually mild and self-limiting, EV71 infection occasionally leads to fatal neurological disorders. Currently, no commercial antiviral drugs for HFMD treatment are available. Here, numerous sulfonated azo dyes, widely used as food additives, were identified as having potent antiviral activities against human enteroviruses. Among them, brilliant black BN (E151) was able to inhibit all EV71, CVA16, and CVA6 strains tested. In rhabdomyosarcoma cells, the 50% inhibitory concentrations of the dye E151 for various strains of EV71 ranged from 2.39 μM to 28.12 μM, whereas its 50% cytotoxic concentration was 1,870 μM. Food azo dyes, including E151, interacted with the vertex of the 5-fold axis of EV71 and prevented viral entry. Their efficacy in viral inhibition was regulated by amino acids at VP1-98, VP1-145, and/or VP1-246. Dye E151 not only prevented EV71 attachment but also eluted attached viruses in a concentration-dependent manner. Moreover, E151 inhibited the interaction between EV71 and its cellular uncoating factor cyclophilin A. In vivo studies demonstrated that E151 at a dose of 200 mg/kg of body weight/day given on the initial 4 days of challenge protected AG129 mice challenged with 10× the 50% lethal dose of wild-type EV71 isolates. Taken together, these data highlight E151 as a promising antiviral agent against EV71 infection.IMPORTANCE Human enterovirus 71 (EV71) is one of the causative agents of hand, foot, and mouth disease in children and is responsible for thousands of deaths in the past 20 years. Food azo dyes have been widely used since the nineteenth century; however, their biological effects on humans and microbes residing in humans are poorly understood. Here, we discovered that one of these dyes, brilliant black BN (E151), was particularly effective in inhibiting the infectivity of EV71 in both cell culture and mouse model studies. Mechanistic studies demonstrated that these sulfonated dyes mainly competed with EV71 attachment factors for viral binding to block viral attachment/entry to host cells. As no commercial antiviral drugs against EV71 are currently available, our findings open an avenue to exploit the development of permitted food dye E151 as a potential anti-EV71 agent.
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Li Y, Chang Z, Wu P, Liao Q, Liu F, Zheng Y, Luo L, Zhou Y, Chen Q, Yu S, Guo C, Chen Z, Long L, Zhao S, Yang B, Yu H, Cowling BJ. Emerging Enteroviruses Causing Hand, Foot and Mouth Disease, China, 2010-2016. Emerg Infect Dis 2019; 24:1902-1906. [PMID: 30226172 PMCID: PMC6154135 DOI: 10.3201/eid2410.171953] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Coxsackievirus A6 emerged as one of the predominant causative agents of hand, foot and mouth disease epidemics in many provinces of China in 2013 and 2015. This virus strain accounted for 25.9% of mild and 15.2% of severe cases in 2013 and 25.8% of mild and 16.9% of severe cases in 2015.
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MESH Headings
- China/epidemiology
- Communicable Diseases, Emerging/epidemiology
- Communicable Diseases, Emerging/history
- Communicable Diseases, Emerging/virology
- Enterovirus/classification
- Enterovirus/genetics
- Enterovirus A, Human/classification
- Enterovirus A, Human/genetics
- Genotype
- Geography, Medical
- Hand, Foot and Mouth Disease/epidemiology
- Hand, Foot and Mouth Disease/history
- Hand, Foot and Mouth Disease/virology
- History, 21st Century
- Humans
- Population Surveillance
- Prevalence
- Serogroup
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22
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Huang J, Liao Q, Ooi MH, Cowling BJ, Chang Z, Wu P, Liu F, Li Y, Luo L, Yu S, Yu H, Wei S. Epidemiology of Recurrent Hand, Foot and Mouth Disease, China, 2008-2015. Emerg Infect Dis 2019; 24. [PMID: 29460747 PMCID: PMC5823341 DOI: 10.3201/eid2403.171303] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Children who have received the enterovirus A71 vaccine are still at risk for disease with infections of enteroviruses of other serotypes. Using China’s national surveillance data on hand, foot and mouth disease (HFMD) for 2008–2015, we described the epidemiologic and virologic features of recurrent HFMD. A total of 398,010 patients had HFMD recurrence; 1,767 patients had 1,814 cases of recurrent laboratory-confirmed HFMD: 99 reinfections of enterovirus A71 (EV-A71) with EV-A71, 45 of coxsackievirus A16 (CV-A16) with CV-A16, 364 of other enteroviruses with other enteroviruses, 383 of EV-A71 with CV-A16 and CV-A16 with EV-A71, and 923 of EV-A71 or CV-A16 with other enteroviruses and other enteroviruses with EV-A71 or CV-A16. The probability of HFMD recurrence was 1.9% at 12 months, 3.3% at 24 months, 3.9% at 36 months, and 4.0% at 38.8 months after the primary episode. HFMD severity was not associated with recurrent episodes or time interval between episodes. Elucidation of the mechanism underlying HFMD recurrence with the same enterovirus serotype and confirmation that HFMD recurrence is not associated with disease severity is needed.
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Seo D. Estimating the Incidence of Cases and Deaths Resulting from Hand, Foot and Mouth Disease and Its Related Socioeconomic Disease Burden in Republic of Korea (2010 - 2014). Osong Public Health Res Perspect 2018; 9:112-117. [PMID: 30023155 PMCID: PMC6037392 DOI: 10.24171/j.phrp.2018.9.3.05] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Objectives Hand, Foot and Mouth disease (HFMD) is a highly contagious viral disease that affects young children and frequently causes epidemics. A vaccine is available in China (enterovirus 71) and, the Republic of Korea took the first step to develop a new vaccine. New vaccine development requires that disease burden is calculated in advance so the financial cost, morbidity and mortality can be measured. Methods Data from National Sentinel Surveillance and health insurance systems of 1 million claimants were used. Direct medical and non-medical costs, indirect (caregiving and premature death) costs, cases and related deaths were summarized. Results From 2010 to 2014, there were an estimated 3,605 to 9,271 cases of HFMD, with 1 to 3 deaths. The estimated socioeconomic disease burden ranged from 80.5 to 164.2 million USD and was similar to that of hepatitis A (93.6-103.8 million USD). Among each costs, costs of caregiving consisted of highest proportion mainly due to hiring caregivers (50% - 60%) or opportunity costs from day off (62% - 69%). Conclusion Considering the social impact of HFMD, the estimated socioeconomic disease burden is not high and government policies need to focus on reducing the loss of work in caregivers.
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Affiliation(s)
- Donghee Seo
- Division of Infectious Disease Surveillance, Korea Centers for Disease Control and Prevention, Cheongju, Korea
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24
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Mei L, Song X, Kong Y, Yu G. An assessment of a pediatric early warning system score in severe hand-foot-and-mouth disease children: To detect clinical deterioration in hospitalized children. Medicine (Baltimore) 2018; 97:e11355. [PMID: 29953028 PMCID: PMC6039599 DOI: 10.1097/md.0000000000011355] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Identification of deteriorating severe hand, foot, and mouth disease (HFMD) children for referral to intensive care remains problematic.The medical records of 2382 hospitalized children with severe HFMD from May 2013 to September 2015 were retrospectively reviewed. A Pediatric Early Warning System (PEWS) score was designed based on study parameters on admission, evaluated in a logistic regression model, and subsequently validated with different cut-off scores, to predict the risk for clinical deterioration.After admission, 191 cases were transferred to the pediatric intensive care unit (PICU) and 2191 were admitted to the infectious disease department. Of which, 116 cases were subsequently transferred to PICU, with younger age, consciousness levels of sluggishness, lethargy or drowsiness, rashes with vesicles on the hands or feet, moderate or high fever, increased or disordered lung marking or pulmonary infiltration, abnormal heart rate, fasting plasma glucose, blood platelet, and C-reactive protein. A corresponding 10-component PEWS score >7 was significantly associated with subsequent transfer to PICU.A 10-component PEWS score >7 has good specificity but poor sensitivity for identifying severe HFMD children vulnerable to clinical deterioration.
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Affiliation(s)
- Lu Mei
- Qingdao Women and Children's Hospital
| | - Xin Song
- Qingdao Municipal Center For Disease Control and Prevention
- Qingdao Institute of Preventive Medicine, Qingdao, P.R. China
| | - Yan Kong
- Qingdao Women and Children's Hospital
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25
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Yao X, Mao Q, Li Y, Hao C, Bian L, Chen P, Gao F, Wu X, Lu W, Gao Q, Li X, Liang Z. Poorly neutralizing polyclonal antibody in vitro against coxsackievirus A16 circulating strains can prevent a lethal challenge in vivo. Hum Vaccin Immunother 2018; 14:1275-1282. [PMID: 29337652 DOI: 10.1080/21645515.2018.1426420] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Neutralizing antibodies (NTAbs) is a major criterion for evaluation the immunogenicity of many vaccines, for example, poliovirus and EV71 vaccine. Here, we firstly discovered that polyclonal antibodies induced by inactivated CVA16 vaccine and lived CVA16 virus have poor ability to neutralize circulating CVA16 strains in vitro. However, the passive transfer of poorly neutralizing polyclonal antibodies can protect suckling mice from lethally challenged with circulating strains in vivo. In addition, the obvious dose response was found between the titer of antibodies and the survival rate. Interestingly, poorly neutralizing polyclonal antibodies against circulating CVA16 strains, have good ability to neutralize prototype strain G10 in vitro. Between G10 and circulating CVA16 strains, there are total 47 variant sites in capsid, which are near the interface of VP1, VP2, and VP3, and close to 2-fold axis. Based on the structure of CVA16, the obvious structural changes were observed in residue 213 of VP1 GH loop, residue 139 of VP2 EF loop, and residues 59, 182 and 183 of VP3 GH loop. What we found may provide a new sight for the development of CVA16 vaccine.
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Affiliation(s)
- Xin Yao
- a Division Hepatitis Virus Vaccines, National Institute for Food and Drug Control , Beijing , PR China
| | - QunYing Mao
- a Division Hepatitis Virus Vaccines, National Institute for Food and Drug Control , Beijing , PR China
| | - Yajing Li
- b Division Research and Development, Sinovac Biotech Co. Ltd , Beijing , PR China
| | - Chunsheng Hao
- c Division 2, Beijing Vigoo Biological , Beijing , PR China
| | - LianLian Bian
- a Division Hepatitis Virus Vaccines, National Institute for Food and Drug Control , Beijing , PR China
| | - Pan Chen
- a Division Hepatitis Virus Vaccines, National Institute for Food and Drug Control , Beijing , PR China
| | - Fan Gao
- a Division Hepatitis Virus Vaccines, National Institute for Food and Drug Control , Beijing , PR China
| | - Xing Wu
- a Division Hepatitis Virus Vaccines, National Institute for Food and Drug Control , Beijing , PR China
| | - WeiWei Lu
- c Division 2, Beijing Vigoo Biological , Beijing , PR China
| | - Qiang Gao
- b Division Research and Development, Sinovac Biotech Co. Ltd , Beijing , PR China
| | - XiuLing Li
- c Division 2, Beijing Vigoo Biological , Beijing , PR China
| | - Zhenglun Liang
- a Division Hepatitis Virus Vaccines, National Institute for Food and Drug Control , Beijing , PR China
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26
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Li YP, Li M, Jia XL, Deng HL, Wang WJ, Wu FP, Wang J, Dang SS. Association of gene polymorphisms of pattern-recognition receptor signaling pathway with the risk and severity of hand, foot, and mouth disease caused by enterovirus 71 in Chinese Han population. J Med Virol 2018; 90:692-698. [PMID: 29235129 DOI: 10.1002/jmv.25000] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Accepted: 11/29/2017] [Indexed: 12/11/2022]
Abstract
Hand, foot, and mouth disease (HFMD) caused by enterovirus 71 (EV71) presents with a wide variety of clinical manifestations. Host immune response is a factor that influences disease susceptibility and severity. We investigated the potential association of gene polymorphisms in the pattern recognition receptor (PRR) pathway with the risk and severity of EV71 infection. A total of 180 EV71 HFMD cases (108 severe case; 72 mild cases) were enrolled. A group of 201 sex- and age-matched children was included as a control. All subjects were genotyped for the most common single-nucleotide polymorphisms (SNPs) in the PRR and the PRR signaling pathway using the SNPscan multiple SNP typing method. Binary logistic regression analysis revealed statistically significant differences in polymorphism of RIG-1 between patients and controls (rs3739674 G vs C: OR = 1.502, 95%CI: 1.120-2.014; rs9695310 G vs C: OR = 1.782, 95%CI: 1.312-2.419). Polymorphisms of RIG-1 rs3739674 (G vs C: OR = 2.047, 95%CI: 1.307-3.205) and TLR3 rs5743305 (A vs T: OR = 0.346, 95%CI: 0.212-0.566) were found to be associated with disease severity. The results indicated that RIG-1 (rs3739674 and rs9695310) polymorphisms are associated with an increased risk of EV71-induced HFMD in Chinese children, whereas RIG-1 rs3739674 and TLR3 rs5743305 polymorphisms are associated with disease severity. These findings support an important role of innate immune mechanism in EV71 infection.
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Affiliation(s)
- Ya-Ping Li
- Department of Infectious Diseases, Second Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an, China
| | - Mei Li
- Department of Infectious Diseases, Second Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an, China
| | - Xiao-Li Jia
- Department of Infectious Diseases, Second Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an, China
| | - Hui-Ling Deng
- Department of Infectious Diseases, Second Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an, China.,Department of Infectious Diseases, Xi'an Children's Hospital, Xi'an, China
| | - Wen-Jun Wang
- Department of Infectious Diseases, Second Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an, China
| | - Feng-Ping Wu
- Department of Infectious Diseases, Second Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an, China
| | - Jun Wang
- Department of Infectious Diseases, Second Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an, China.,Department of Infectious Diseases, Xi'an Children's Hospital, Xi'an, China
| | - Shuang-Suo Dang
- Department of Infectious Diseases, Second Affiliated Hospital of Medical College of Xi'an Jiaotong University, Xi'an, China
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Thao NTT, Donato C, Trang VTH, Kien NT, Trang PMT, Khanh TQ, Nguyet DT, Sessions OM, Cuong HQ, Lan PT, Huong VTQ, van Doorn HR, Vijaykrishna D. Evolution and Spatiotemporal Dynamics of Enterovirus A71 Subgenogroups in Vietnam. J Infect Dis 2017; 216:1371-1379. [PMID: 29029128 PMCID: PMC5853389 DOI: 10.1093/infdis/jix500] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Accepted: 09/14/2017] [Indexed: 12/18/2022] Open
Abstract
Background Enterovirus A71 (EV-A71) is the major cause of severe hand, foot, and mouth disease and viral encephalitis in children across the Asia-Pacific region, including in Vietnam, which has experienced a high burden of disease in recent years. Multiple subgenogroups (C1, C4, C5, and B5) concurrently circulate in the region with a large variation in epidemic severity. The relative differences in their evolution and epidemiology were examined within Vietnam and globally. Methods A total of 752 VP1 gene sequences were analyzed (413 generated in this study combined with 339 obtained from GenBank), collected from patients in 36 provinces in Vietnam during 2003-2013, along with epidemiological metadata. Globally representative VP1 gene datasets of subgenogroups were used to coestimate time-resolved phylogenies and relative genetic diversity to infer virus origins and regional transmission network. Results Despite frequent virus migration between countries, the highest genetic diversity of individual subgenogroups was maintained independently for several years in specific Asian countries representing genogroup-specific sources of EV-A71 diversity. Conclusion This study highlights a persistent transmission network of EV-A71, with specific Asian countries seeding other countries in the region and beyond, emphasizing the need for improved EV-A71 surveillance and detailed genetic and antigenic characterization.
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Affiliation(s)
- Nguyen Thi Thanh Thao
- Immunology and Microbiology Department, Pasteur Institute, Ho Chi Minh City, Vietnam
| | - Celeste Donato
- Program in Emerging Infectious Diseases, Duke-NUS Medical School Singapore
| | - Vu Thi Huyen Trang
- Immunology and Microbiology Department, Pasteur Institute, Ho Chi Minh City, Vietnam
| | - Nguyen Trung Kien
- Immunology and Microbiology Department, Pasteur Institute, Ho Chi Minh City, Vietnam
| | - Phạm Mai Thuy Trang
- Immunology and Microbiology Department, Pasteur Institute, Ho Chi Minh City, Vietnam
| | - Tran Quoc Khanh
- Immunology and Microbiology Department, Pasteur Institute, Ho Chi Minh City, Vietnam
| | - Dang Thi Nguyet
- Immunology and Microbiology Department, Pasteur Institute, Ho Chi Minh City, Vietnam
| | - October M Sessions
- Program in Emerging Infectious Diseases, Duke-NUS Medical School Singapore
| | - Hoang Quoc Cuong
- Immunology and Microbiology Department, Pasteur Institute, Ho Chi Minh City, Vietnam
| | - Phan Trong Lan
- Immunology and Microbiology Department, Pasteur Institute, Ho Chi Minh City, Vietnam
| | - Vu Thi Que Huong
- Immunology and Microbiology Department, Pasteur Institute, Ho Chi Minh City, Vietnam
| | | | - Dhanasekaran Vijaykrishna
- Program in Emerging Infectious Diseases, Duke-NUS Medical School Singapore
- Biomedicine Discovery Institute and Department of Microbiology, Monash University, Melbourne, Victoria, Australia
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28
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Crabol Y, Pean P, Mey C, Duong V, Richner B, Laurent D, Santy K, Sothy H, Dussart P, Tarantola A, Buchy P, Horwood PF. A prospective, comparative study of severe neurological and uncomplicated hand, foot and mouth forms of paediatric enterovirus 71 infections. Int J Infect Dis 2017; 59:69-76. [PMID: 28438677 DOI: 10.1016/j.ijid.2017.04.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 03/06/2017] [Accepted: 04/03/2017] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES In this study, we document the clinical characteristics and investigated risk factors for uncomplicated and severe forms of EV-A71 disease in Cambodian children. METHODS From March to July 2014 inclusive, all patients with suspicion of EV-A71 infection presenting to Kantha Bopha Hospitals in Phnom Penh and Siem Reap and confirmed by the Virology Unit at the Institut Pasteur du Cambodge were prospectively enrolled in this study. Throat swabs, rectal swabs and serum samples were collected from all consecutive patients with suspected EV-A71 infection. In addition, CSF was also collected from patients with suspected EV-A71 associated encephalitis. A total of 122 patients (29 with uncomplicated disease and 93 with severe disease) with confirmed EV-A71 infection with all available demographic and clinical data for clinical classification and further analysis were included in the study. RESULTS In this prospective EV-A71 study in Cambodia, we confirmed the previously reported association of male gender and absence of mouth or skin lesions with severe disease. We also highlighted the strong association of neutrophils in blood, but also in CSF in patients with pulmonary oedema. More importantly, we identified new putative nutrition-related risk factors for severe disease. CONCLUSIONS EV-A71 is an important cause of encephalitis in the Asia-Pacific region. Further studies to determine the risk factors associated with severe EV-A71 disease are needed.
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Affiliation(s)
- Yoann Crabol
- Epidemiology Unit, Institut Pasteur in Cambodia, Phnom Penh, Cambodia
| | - Polidy Pean
- Immunology Platform, Institut Pasteur in Cambodia, Phnom Penh, Cambodia
| | - Channa Mey
- Virology Unit, Institut Pasteur in Cambodia, Phnom Penh, Cambodia
| | - Veasna Duong
- Virology Unit, Institut Pasteur in Cambodia, Phnom Penh, Cambodia
| | | | | | - Ky Santy
- Kantha Bopha Hospital, Phnom Penh, Cambodia
| | - Heng Sothy
- Kantha Bopha Hospital, Phnom Penh, Cambodia
| | - Philippe Dussart
- Virology Unit, Institut Pasteur in Cambodia, Phnom Penh, Cambodia
| | - Arnaud Tarantola
- Epidemiology Unit, Institut Pasteur in Cambodia, Phnom Penh, Cambodia
| | - Philippe Buchy
- Virology Unit, Institut Pasteur in Cambodia, Phnom Penh, Cambodia; GlaxoSmithKline Vaccines Asia-Pacific, Singapore.
| | - Paul F Horwood
- Virology Unit, Institut Pasteur in Cambodia, Phnom Penh, Cambodia.
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29
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Abstract
Acute skin graft-versus-host disease (GVHD) classically presents as a pruritic erythematous maculopapular rash. We describe a patient who underwent allogeneic hematopoietic stem cell transplantation and presented with a hand foot and mouth disease like clinical presentation. Histopathology was suggestive of acute GVHD. This case is being reported to make dermatologists aware of this unusual presentation of GVHD.
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Affiliation(s)
- Gauri Mahabal
- Department of Dermatology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Leni George
- Department of Dermatology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Mandeep Bindra
- Department of Clinical Pathology, Christian Medical College, Vellore, Tamil Nadu, India
| | - Biju George
- Department of Hematology, Christian Medical College, Vellore, Tamil Nadu, India
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30
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Duong V, Mey C, Eloit M, Zhu H, Danet L, Huang Z, Zou G, Tarantola A, Cheval J, Perot P, Laurent D, Richner B, Ky S, Heng S, Touch S, Sovann L, van Doorn R, Tan Tran T, Farrar JJ, Wentworth DE, Das SR, Stockwell TB, Manuguerra JC, Delpeyroux F, Guan Y, Altmeyer R, Buchy P. Molecular epidemiology of human enterovirus 71 at the origin of an epidemic of fatal hand, foot and mouth disease cases in Cambodia. Emerg Microbes Infect 2016; 5:e104. [PMID: 27651091 PMCID: PMC5113052 DOI: 10.1038/emi.2016.101] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2016] [Revised: 07/03/2016] [Accepted: 07/25/2016] [Indexed: 02/08/2023]
Abstract
Human enterovirus 71 (EV-A71) causes hand, foot and mouth disease (HFMD). EV-A71 circulates in many countries and has caused large epidemics, especially in the Asia-Pacific region, since 1997. In April 2012, an undiagnosed fatal disease with neurological involvement and respiratory distress occurred in young children admitted to the Kantha Bopha Children's Hospital in Phnom Penh, Cambodia. Most died within a day of hospital admission, causing public panic and international concern. In this study, we describe the enterovirus (EV) genotypes that were isolated during the outbreak in 2012 and the following year. From June 2012 to November 2013, 312 specimens were collected from hospitalized and ambulatory patients and tested by generic EV and specific EV-A71 reverse transcription PCR. EV-A71 was detected in 208 clinical specimens while other EVs were found in 32 patients. The VP1 gene and/or the complete genome were generated. Our phylogenetic sequencing analysis demonstrated that 80 EV-A71 strains belonged to the C4a subgenotype and 3 EV-A71 strains belonged to the B5 genotype. Furthermore, some lineages of EV-A71 were found to have appeared in Cambodia following separate introductions from neighboring countries. Nineteen EV A (CV-A6 and CV-A16), 9 EV B (EV-B83, CV-B3, CV-B2, CV-A9, E-31, E-2 and EV-B80) and 4 EV C (EV-C116, EV-C96, CV-A20 and Vaccine-related PV-3) strains were also detected. We found no molecular markers of disease severity. We report here that EV-A71 genotype C4 was the main etiological agent of a large outbreak of HFMD and particularly of severe forms associated with central nervous system infections. The role played by other EVs in the epidemic could not be clearly established.
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MESH Headings
- Adolescent
- Adult
- Cambodia/epidemiology
- Child
- Child, Preschool
- Disease Outbreaks
- Enterovirus A, Human/classification
- Enterovirus A, Human/genetics
- Enterovirus A, Human/isolation & purification
- Enterovirus A, Human/pathogenicity
- Epidemics
- Female
- Genome, Viral
- Genotype
- Hand, Foot and Mouth Disease/epidemiology
- Hand, Foot and Mouth Disease/mortality
- Hand, Foot and Mouth Disease/virology
- Hospitalization
- Humans
- Infant
- Male
- Phylogeny
- RNA, Viral/genetics
- Reverse Transcriptase Polymerase Chain Reaction
- Sequence Analysis, DNA
- Young Adult
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Affiliation(s)
- Veasna Duong
- Pasteur Institute in Cambodia, Phnom Penh 12000, Cambodia
| | - Channa Mey
- Pasteur Institute in Cambodia, Phnom Penh 12000, Cambodia
| | | | - Huachen Zhu
- State Key Laboratory of Emerging Infectious Diseases, School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Lucie Danet
- Pasteur Institute in Cambodia, Phnom Penh 12000, Cambodia
| | - Zhong Huang
- Institut Pasteur in Shanghai, Shanghai 200025, China
| | - Gang Zou
- Institut Pasteur in Shanghai, Shanghai 200025, China
| | | | | | | | | | - Beat Richner
- Kantha Bopha Hospital, Phnom Penh 12000, Cambodia
| | - Santy Ky
- Kantha Bopha Hospital, Phnom Penh 12000, Cambodia
| | - Sothy Heng
- Kantha Bopha Hospital, Phnom Penh 12000, Cambodia
| | - Sok Touch
- Ministry of Health, Phnom Penh 12000, Cambodia
| | - Ly Sovann
- Ministry of Health, Phnom Penh 12000, Cambodia
| | - Rogier van Doorn
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh P1Q5, Vietnam
| | - Thanh Tan Tran
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh P1Q5, Vietnam
| | - Jeremy J Farrar
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh P1Q5, Vietnam
| | | | - Suman R Das
- J. Craig Venter Institute, Rockville, MD 92037, USA
| | | | | | - Francis Delpeyroux
- Pasteur Institute, Paris 75724, France
- National Institute for Health and Medical Research, INSERM U994, Paris 75000, France
| | - Yi Guan
- State Key Laboratory of Emerging Infectious Diseases, School of Public Health, The University of Hong Kong, Hong Kong, China
| | - Ralf Altmeyer
- Institut Pasteur in Shanghai, Shanghai 200025, China
| | - Philippe Buchy
- Pasteur Institute in Cambodia, Phnom Penh 12000, Cambodia
- GlaxoSmithKline Vaccines R&D, Singapore 189720, Singapore
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Sun S, Gao F, Mao Q, Shao J, Jiang L, Liu D, Wang Y, Yao X, Wu X, Sun B, Zhao D, Ma Y, Lu J, Kong W, Jiang C, Liang Z. Immunogenicity and protective efficacy of an EV71 virus-like particle vaccine against lethal challenge in newborn mice. Hum Vaccin Immunother 2016; 11:2406-13. [PMID: 26036916 DOI: 10.1080/21645515.2015.1053675] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Enterovirus 71(EV71) has caused severe epidemics of hand, foot and mouth disease (HFMD) in the Asia Pacific in recent years, particularly in infants and pre-school children. It has become a serious public health threat, as currently there are no approved vaccines or antiviral drugs for EV71 infection. Many EV71 vaccines have been under development worldwide, however the main focus is inactivated EV71 vaccines. For example, the inactivated EV71 vaccine has recently finished phase III clinical trial in Mainland China. There have been very few studies on EV71 virus like particles (VLPs). In this study, the immunogenicity and protective potency of the EV71 VLPs produced in insect cells were evaluated in mice with different dosages. Our results showed that EV71 VLPs could elicit high titers of neutralizing antibodies (NTAbs) in a dose-dependent manner and NTAbs were sustained after the second injection with an average GMT (geometric mean titer) level from 19 to 2960 in immunized mice. Survival rates were 100%, 100%, 85%, and 40% after challenge with 15 LD50 (median lethal dose) of EV71 in these newborn mice, respectively. ED50 (50% effective dose) of VLPs was 0.20 μg/dose in newborn mice, while NTAb titer under this dosage was about 50. Passive protection was determined with 2 methods and demonstrated that the survival rates were positively correlated with NTAb titers, which at 24 and 54 induced 50% survival rates in experimental animals. The ED50 of VLP vaccines and the passive NTAb titers were also analyzed. The maternal NTAb titer was similar as the passive NTAb titer in the mouse model challenged with our lethal mouse EV71 strain. Hence, our work has provided preliminary data on the protection potency of VLPs as a vaccine candidate and would facilitate future VLP vaccine development.
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Affiliation(s)
- Shiyang Sun
- a School of Life Sciences; Jilin University ; Changchun , PR China.,b National Engineering Laboratory for AIDS Vaccine; Jilin University ; Changchun , PR China
| | - Fan Gao
- c National Institutes for Food and Drug Control ; Beijing , PR China
| | - Qunying Mao
- c National Institutes for Food and Drug Control ; Beijing , PR China
| | - Jie Shao
- a School of Life Sciences; Jilin University ; Changchun , PR China.,b National Engineering Laboratory for AIDS Vaccine; Jilin University ; Changchun , PR China
| | - Liping Jiang
- a School of Life Sciences; Jilin University ; Changchun , PR China.,b National Engineering Laboratory for AIDS Vaccine; Jilin University ; Changchun , PR China
| | - Dawei Liu
- d Changchun BCHT Biotechnology Co. ; Changchun , PR China
| | - Yiping Wang
- c National Institutes for Food and Drug Control ; Beijing , PR China
| | - Xin Yao
- c National Institutes for Food and Drug Control ; Beijing , PR China
| | - Xing Wu
- c National Institutes for Food and Drug Control ; Beijing , PR China
| | - Bo Sun
- d Changchun BCHT Biotechnology Co. ; Changchun , PR China
| | - Dandan Zhao
- a School of Life Sciences; Jilin University ; Changchun , PR China.,b National Engineering Laboratory for AIDS Vaccine; Jilin University ; Changchun , PR China
| | - Youlei Ma
- d Changchun BCHT Biotechnology Co. ; Changchun , PR China
| | - Jingcai Lu
- a School of Life Sciences; Jilin University ; Changchun , PR China.,b National Engineering Laboratory for AIDS Vaccine; Jilin University ; Changchun , PR China
| | - Wei Kong
- a School of Life Sciences; Jilin University ; Changchun , PR China.,b National Engineering Laboratory for AIDS Vaccine; Jilin University ; Changchun , PR China.,e Key Laboratory for Molecular Enzymology & Engineering; The Ministry of Education; Jilin University ; Changchun , PR China
| | - Chunlai Jiang
- a School of Life Sciences; Jilin University ; Changchun , PR China.,b National Engineering Laboratory for AIDS Vaccine; Jilin University ; Changchun , PR China.,e Key Laboratory for Molecular Enzymology & Engineering; The Ministry of Education; Jilin University ; Changchun , PR China
| | - Zhenglun Liang
- c National Institutes for Food and Drug Control ; Beijing , PR China
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32
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Thong WY, Han A, Wang SJF, Lin J, Isa MS, Koay ESC, Tay SKH. Enterovirus infections in Singaporean children: an assessment of neurological manifestations and clinical outcomes. Singapore Med J 2016; 58:189-195. [PMID: 27245861 DOI: 10.11622/smedj.2016099] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Enterovirus infections in childhood can be associated with significant neurological morbidity. This study aimed to describe the prevalence and range of neurological manifestations, determine the clinical characteristics and assess differences in clinical outcomes for Singaporean children diagnosed with enterovirus infections. METHODS In this single-centre, case-control study, clinical data was collected retrospectively from patients admitted to National University Hospital, Singapore, from August 2007 to October 2011 and diagnosed with enterovirus infection, based on the enterovirus polymerase chain reaction test, or cultures from throat and rectal swabs or cerebrospinal fluid samples. The occurrence of neurological manifestations was reviewed and clinical outcomes were assessed. RESULTS A total of 48 patients (age range: six days-17.8 years) were included in the study. Neurological manifestations were seen in 75.0% of patients, 63.9% of whom presented with aseptic meningitis. Other neurological manifestations included encephalitis, acute cerebellitis, transverse myelitis and autonomic dysfunction. The incidence of neurological manifestations was significantly higher in patients aged > 1 year as compared to younger patients (p = 0.043). In patients without neurological manifestations, a significantly higher proportion presented with hand, foot and mouth disease and poor feeding. Long-term neurological sequelae were seen in 16.7% of patients with neurological manifestations. CONCLUSION A wide spectrum of neurological manifestations resulting in a relatively low incidence of long-term neurological sequelae was observed in our study of Singaporean children with enterovirus infections. As some of these neurological morbidities were severe, careful evaluation of children with neurological involvement is therefore necessary.
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Affiliation(s)
- Wen Yi Thong
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore
| | - Audrey Han
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - S J Furene Wang
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore
| | - Jeremy Lin
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore
| | - Mas Suhaila Isa
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore
| | - Evelyn Siew Chuan Koay
- Laboratory Medicine, Molecular Diagnosis Centre, National University Health System, Singapore
| | - Stacey Kiat-Hong Tay
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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33
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Li J, Sun Y, Du Y, Yan Y, Huo D, Liu Y, Peng X, Yang Y, Liu F, Lin C, Liang Z, Jia L, Chen L, Wang Q, He Y. Characterization of Coxsackievirus A6- and Enterovirus 71-Associated Hand Foot and Mouth Disease in Beijing, China, from 2013 to 2015. Front Microbiol 2016; 7:391. [PMID: 27065963 PMCID: PMC4812011 DOI: 10.3389/fmicb.2016.00391] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 03/11/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Etiology surveillance of Hand Foot and Mouth disease (HFMD) in Beijing showed that Coxsackievirus A6 (CVA6) became the major pathogen of HFMD in 2013 and 2015. In order to understand the epidemiological characteristics and clinical manifestations of CVA6-associated HFMD, a comparison study among CVA6-, EV71- (Enterovirus 71), and CVA16- (Coxsackievirus A16) associated HFMD was performed. METHODS Epidemiological characteristics and clinical manifestations among CVA6-, EV71- and CVA16-associated mild or severe cases were compared from 2013 to 2015. VP1 gene of CVA6 and EV71 from mild cases, severe cases were sequenced, aligned, and compared with strains from 2009 to 2015 in Beijing and strains available in GenBank. Phylogenetic tree was constructed by neighbor-joining method. RESULTS CVA6 became the predominant causative agent of HFMD and accounted for 35.4 and 36.9% of total positive cases in 2013 and 2015, respectively. From 2013 to 2015, a total of 305 severe cases and 7 fatal cases were reported. CVA6 and EV71 were responsible for 57.5% of the severe cases. Five out six samples from fatal cases were identified as EV71. High fever, onychomadesis, and decrustation were the typical symptoms of CVA6-associated mild HFMD. CVA6-associated severe cases were characterized by high fever with shorter duration and twitch compared with EV71-associated severe cases which were characterized by poor mental condition, abnormal pupil, and vomiting. Poor mental condition, lung wet rales, abnormal pupil, and tachycardia were the most common clinical features of fatal cases. The percentage of lymphocyte in CVA6-associated cases was significantly lower than that of EV71. High percentage of lymphocyte and low percentage of neutrophils were the typical characteristics of fatal cases. VP1 sequences between CVA6- or EV71-associated mild and severe cases were highly homologous. CONCLUSION CVA6 became one of the major pathogens of HFMD in 2013 and 2015 in Beijing. Epidemiological characteristics, clinical manifestations of CVA6-, EV71- and CVA16-associated cases in this study enriched the definition of HFMD caused by different pathogens and shed light to accurate diagnosis, appropriate treatment and effective prevention of HFMD.
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Affiliation(s)
- Jie Li
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical UniversityBeijing, China; Beijing Center for Disease Prevention and Control, Institute for Infectious Disease and Endemic Disease ControlBeijing, China
| | - Ying Sun
- Beijing Center for Disease Prevention and Control, Institute for Infectious Disease and Endemic Disease Control Beijing, China
| | - Yiwei Du
- Beijing Center for Disease Prevention and Control, Institute for Infectious Disease and Endemic Disease Control Beijing, China
| | - Yuxiang Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University Beijing, China
| | - Da Huo
- Beijing Center for Disease Prevention and Control, Institute for Infectious Disease and Endemic Disease Control Beijing, China
| | - Yuan Liu
- Beijing Center for Disease Prevention and Control, Institute for Infectious Disease and Endemic Disease Control Beijing, China
| | - Xiaoxia Peng
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University Beijing, China
| | - Yang Yang
- Beijing Center for Disease Prevention and Control, Institute for Infectious Disease and Endemic Disease Control Beijing, China
| | - Fen Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University Beijing, China
| | - Changying Lin
- Beijing Center for Disease Prevention and Control, Institute for Infectious Disease and Endemic Disease Control Beijing, China
| | - Zhichao Liang
- Beijing Center for Disease Prevention and Control, Institute for Infectious Disease and Endemic Disease Control Beijing, China
| | - Lei Jia
- Beijing Center for Disease Prevention and Control, Institute for Infectious Disease and Endemic Disease Control Beijing, China
| | - Lijuan Chen
- Beijing Center for Disease Prevention and Control, Institute for Infectious Disease and Endemic Disease Control Beijing, China
| | - Quanyi Wang
- Beijing Center for Disease Prevention and Control, Institute for Infectious Disease and Endemic Disease Control Beijing, China
| | - Yan He
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University Beijing, China
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Abstract
PURPOSE OF REVIEW Enteroviruses cause a wide variety of diseases with neurologic, respiratory, skin, and gastrointestinal findings. The purpose of this review is to clarify changes in the classification of enteroviruses, provide information about recent disease outbreaks, and to summarize progress toward the treatment and prevention of these infections. RECENT FINDINGS Enteroviruses are now classified into four distinct species. New variants of coxsackievirus B1, enterovirus-A71, and enterovirus-D68 (EV-D68) have emerged as causes of recent outbreaks in the United States and other countries, including more severe disease manifestations than previously described. EV-D68 now commonly circulates in the United States, and has been linked to severe respiratory disease and associated with acute flaccid myelitis (AFM). Overcoming enormous political and logistical challenges, fewer than 100 cases of polio have been reported in 2015, and the initiation of 'endgame' strategies appears imminent. Unfortunately, treatment for enterovirus infections remains supportive, although the recently completed pleconaril trial in newborns suggests that antiviral therapy may reduce mortality in neonatal disease. SUMMARY Clinicians should be aware of the respiratory and neurological manifestations associated with EV-D68 and the potential for severe disease seen with other recently described enterovirus variants. Healthcare professionals should recognize the utility of rapid diagnostic methods and progress toward prevention and treatment of enterovirus infections.
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Wang J, Chen X, Wang W, Zhang Y, Yang Z, Jin Y, Ge HM, Li E, Yang G. Glycyrrhizic acid as the antiviral component of Glycyrrhiza uralensis Fisch. against coxsackievirus A16 and enterovirus 71 of hand foot and mouth disease. J Ethnopharmacol 2013; 147:114-21. [PMID: 23454684 PMCID: PMC7125661 DOI: 10.1016/j.jep.2013.02.017] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Revised: 01/28/2013] [Accepted: 02/06/2013] [Indexed: 05/08/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE The radices of Glycyrrhiza uralensis Fisch. and herbal preparations containing Glycyrrhiza spp. have been used for thousands of years as an herbal medicine for the treatment of viral induced cough, viral hepatitis, and viral skin diseases like ulcers in China. Glycyrrhizic acid (GA) is considered the principal component in Glycyrrhiza spp. with a wide spectrum of antiviral activity. AIM The present study attempt to validate the medicinal use of Glycyrrhiza uralensis for hand, foot and mouth disease (HFMD) and further to verify whether GA is an active antiviral component in the water extract of Glycyrrhiza uralensis. MATERIALS AND METHODS Radices of Glycyrrhiza uralensis Fisch. were extracted with hot water. The chemical contents of the extract were profiled with HPLC analysis. The antiviral activity of the extract and the major components was evaluated against infection of enterovirus 71 (EV71) and coxsackievirus A16 (CVA16) on Vero cells. The cytopathic effect caused by the infection was measured with MTT assay. Infectious virion production was determined using secondary infection assays and viral protein expression by immunoblotting analysis. RESULTS The extract at 1000 μg/ml suppressed EV71 replication by 1.0 log and CVA16 by 1.5 logs. The antiviral activity was associated with the content of GA in the extract since selective depletion of GA from the extract by acid precipitation resulted in loss of antiviral activity. In contrast, the acid precipitant retained antiviral activity. The precipitant at a concentration of 200 μg/ml inhibited EV71 and CVA16 replication by 1.7 and 2.2 logs, respectively. Furthermore, GA dose-dependently blocked viral replication of EV71 and CVA16. At 3 mM, GA reduced infectious CVA16 and EV71 production by 3.5 and 2.2 logs, respectively. At 5mM, CVA16 production was reduced by 6.0 logs and EV71 by 4.0 logs. Both EV71 and CVA16 are members of Enterovirus genus, time-of-drug addition studies however showed that GA directly inactivated CVA16, while GA anti-EV71 effect was associated with an event(s) post virus cell entry. CONCLUSIONS This study validated the medicinal usefulness of radices Glycyrrhiza uralensis against the etiological agents of HFMD. In addition to the identification of GA as the antiviral component of Glycyrrhiza uralensis against EV71 and CVA16 infection, this study also reveals that GA inhibits EV71 and CVA16 with distinct mechanisms.
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MESH Headings
- Animals
- Antiviral Agents/chemistry
- Antiviral Agents/isolation & purification
- Antiviral Agents/pharmacology
- Blotting, Western
- Chemical Precipitation
- Chlorocebus aethiops
- Chromatography, High Pressure Liquid
- Dose-Response Relationship, Drug
- Enterovirus/drug effects
- Enterovirus/growth & development
- Enterovirus/metabolism
- Enterovirus/pathogenicity
- Enterovirus A, Human/drug effects
- Enterovirus A, Human/growth & development
- Enterovirus A, Human/metabolism
- Enterovirus A, Human/pathogenicity
- Glycyrrhiza uralensis/chemistry
- Glycyrrhizic Acid/chemistry
- Glycyrrhizic Acid/isolation & purification
- Glycyrrhizic Acid/pharmacology
- Hand, Foot and Mouth Disease/drug therapy
- Hand, Foot and Mouth Disease/virology
- Phytotherapy
- Plant Extracts/chemistry
- Plant Extracts/isolation & purification
- Plant Extracts/pharmacology
- Plant Roots
- Plants, Medicinal
- Solvents/chemistry
- Time Factors
- Vero Cells
- Viral Proteins/metabolism
- Virus Internalization/drug effects
- Virus Replication/drug effects
- Water/chemistry
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Affiliation(s)
- Jingjing Wang
- Jiangsu Laboratory of Molecular Medicine, Medical School of Nanjing University, Nanjing 210093, China
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Pan J, Chen M, Zhang X, Chen Y, Liu H, Shen W. High risk factors for severe hand, foot and mouth disease: a multicenter retrospective survey in Anhui Province China, 2008-2009. Indian J Dermatol 2012; 57:316-21. [PMID: 22837575 PMCID: PMC3401856 DOI: 10.4103/0019-5154.97683] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES This study sought to determine the high risk factors for severe hand, foot, and mouth disease (HFMD). MATERIALS AND METHODS Retrospective 229 severe HFMD cases from four hospitals in FuYang, HeFei, and BoZhou (Anhui Provincial Hospital, Fuyang City People's Hospital, No. 2 People's Hospital of Fuyang and Bozhou city People's Hospital) in 2008-2009 were studied, with 140 mild HFMD cases in the same area. Using univariate and multivariate logistic regression analyses, the high risk factors of HFMD were identified by comparing clinical and laboratory findings between severe cases and mild cases. RESULTS There was a significant difference in age, total duration of fever, rate of respiratory and heart, shake of limbs, white blood cell count, blood sugar, and CK-MB between the two groups. Univariate logistic regression analysis showed that severe cases were associated with age (<3 years), withdrawnness and lethargy, shake of limbs, tachycardia, total leukocyte count (≥17×10⁹/l), blood sugar (≥7 mmol/l), and CK-MB (≥16 mmol/l). Furthermore, age (<3 years), withdrawnness, and lethargy, shake of limbs, WBC (≥17×10⁹/l), and CK-MB (≥16 mmol/l) were found to be high risk factors for severe cases after multivariate logistic regression analysis. CONCLUSIONS Clinicians should give importance to these risk factors. Early recognition of children at risk and timely intervention is the key to reduce acute mortality and morbidity.
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Affiliation(s)
- Jiahua Pan
- Department of Pediatrics, Anhui Provincial Hospital affiliated to Anhui Medical University, 17 Lu Jiang Road, Hefei, People's Republic of China.
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Abstract
Hand foot and mouth disease is a febrile sickness complex characterized by cutaneous eruption (exanthem) on the palms and soles with simultaneous occurrence of muco-cutanous vesiculo-ulcerative lesions (enanthem) affecting the mouth. The illness is caused by a number of enteroviruses with coxsackievirus A16 and enterovirus 71 as the main causative agents. Human enterovirus 71 (EV71) belongs to the species Human enterovirus A under the genus Enterovirus within the family Picornaviridae. EV71 has been associated with an array of clinical diseases including hand foot and mouth disease (HFMD), aseptic meningitis, encephalitis and poliomyelitis-like acute flaccid paralysis. A large outbreak of HFMD due to highly neurovirulent EV71 emerged in Malaysia in 1997, and caused 41 deaths amongst young children. In late 2000, a recurrence of an outbreak of HFMD occurred in Malaysia with 8 fatalities in peninsular Malaysia. Outbreak of HFMD due to EV71 recurred in 2003 with an unknown number of cases and mortalities. A similar outbreak of HFMD with 2 recorded deaths in young children occurred in peninsular Malaysia in late 2005 and this was followed by a larger outbreak in Sarawak (Malaysian Borneo) with 6 reported fatalities in the early part of 2006. The current on-going outbreak of HFMD started in peninsular Malaysia in epidemiological week 12 of 2010. As with other HFMD outbreaks in Malaysia, both EV71 and CA16 were the main aetiological viruses isolated. In similarity with the HFMD outbreak in 2005, the isolation of CA16 preceded the appearance of EV71. Based on the VP1 gene nucleotide sequences, 4 sub-genogroups of EV71 (C1, C2, B3 and B4) co-circulated and caused the outbreak of hand, foot and mouth disease in peninsular Malaysia in 1997. Two sub-genogroups (C1 and B4) were noted to cause the outbreak in 2000 in both peninsular Malaysia and Sarawak. EV71 of sub-genogroup B5 with smaller contribution from sub-genogroup C1 caused the outbreak in 2003. In the 2005 outbreak, besides the EV71 strains of sub-genogroup C1, EV71 strains belonging to sub-genogroup B5 were isolated but formed a cluster which was distinct from the EV71 strains from the sub-genogroup B5 isolated in 2003. The four EV71 strains isolated from clinical specimens of patients with hand, foot and mouth disease in the Sarawak outbreak in early 2006 also belonged to sub-genogroup B5. Phylogenetic analysis of the VP1 gene suggests that the EV71 strains causing the outbreak in Sarawak could have originated from peninsular Malaysia. Epidemiological and molecular data since 1997 show the recurrence of HFMD due to EV71 in Malaysia every 2 to 4 years. In each of the past outbreaks, more than one sub-genogroup of the virus co-circulate.
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Affiliation(s)
- Kaw Bing Chua
- National Public Health Laboratory, Ministry of Health, Lot 1853, 47000 Sungai Buloh, Selangor, Malaysia.
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Sarma N, Sarkar A, Mukherjee A, Ghosh A, Dhar S, Malakar R. Epidemic of hand, foot and mouth disease in West Bengal, India in August, 2007: a multicentric study. Indian J Dermatol 2010; 54:26-30. [PMID: 20049265 PMCID: PMC2800866 DOI: 10.4103/0019-5154.48982] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Hand, foot, and mouth disease (HFMD) is caused mostly by Coxsackievirus A16 (CA16) and enterovirus 71 (EV71). Epidemic of HFMD has occurred in India only once in Kerala in 2003. We report here a recent outbreak of HFMD in three districts of West Bengal, India. Materials and Methods: A case detection system developed with 1) three private clinics in three districts; two at Howrah and one at Hooghly, 2) Pediatrics Department of two medical colleges in Kolkata, 3) 12 practioners of these three districts with 4) a central referral center at Department of Dermatology, NRS Medical College, Kolkata where all cases from this system were confirmed by a single observer. Pediatric Dermatology unit of the Institute of Child Health, Kolkata was another independent unit. Results: A total of 38 cases of HFMD were reported till 08.10.07. Age group ranged from 12 months to 12 years (mean 40.76 months, SD 29.49). Males were slightly higher than females (M:F - 21:17). Disease was distributed mostly over buttocks, knees, hands, feet - both dorsum and palmar or the plantar surface and the oral mucosa. Highest severity noted over the buttocks and the knee. Healing time for skin lesions was 6-13 days (mean 9.13 days, SD 1.93). Oral lesions were found in 33 (86.8%) cases. Conclusion: This outbreak far away from the initial one confirmed regular outsourcing of the virus with possibilities of future epidemics. Also the fact that EV71 induced epidemic is on rise in this part of globe is alarming for India. We hope this early report will be of help for strategic planning for a better management of the disease and prevention of dreaded neurological complications in India.
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Affiliation(s)
- Nilendu Sarma
- Department of Dermatology, NRS Medical College, Kolkata-700014, West Bengal, India.
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Zhang XN, Song ZG, Jiang T, Shi BS, Hu YW, Yuan ZH. Rupintrivir is a promising candidate for treating severe cases of Enterovirus-71 infection. World J Gastroenterol 2010; 16:201-9. [PMID: 20066739 PMCID: PMC2806558 DOI: 10.3748/wjg.v16.i2.201] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Revised: 11/08/2009] [Accepted: 11/15/2009] [Indexed: 02/06/2023] Open
Abstract
AIM To evaluate the suitability of rupintrivir against Enterovirus 71 (EV71) induced severe clinical symptoms using computational methods. METHODS The structure of EV71 3C protease was predicted by homology modeling. The binding free energies between rupintrivir and EV71 3C and human rhinovirus 3C protease were computed by molecular dynamics and molecular mechanics Poisson-Boltzmann/surface area and molecular mechanics generalized-born/surface area methods. EV71 3C fragments obtained from clinical samples collected during May to July 2008 in Shanghai were amplified by reverse-transcription and polymerase chain reaction and sequenced. RESULTS We observed that rupintrivir had favorable binding affinity with EV71 3C protease (-10.76 kcal/mol). The variability of the 3C protein sequence in isolates of various outbreaks, including those obtained in our hospital from May to July 2008, were also analyzed to validate the conservation of the drug binding pocket. CONCLUSION Rupintrivir, whose safety profiles had been proved, is an attractive candidate and can be quickly utilized for treating severe EV71 infection.
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