Epidemiology and virologic investigation of human enterovirus 71 infection in the Republic of Korea from 2007 to 2012: a nationwide cross-sectional study

Kim, Hye-Jin; Hyeon, Ji-Yeon; Hwang, Sun-Mi; Lee, Yong-Pyo; Lee, Sang Won; Yoo, Jung Sik; Kang, Byunghak; Ahn, Jeongbae; Jeong, Yongseok; Lee, June-Woo

doi:10.1186/s12879-016-1755-0

Cited by 27 publications

(17 citation statements)

References 40 publications

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“…Although EV infection is usually asymptomatic, sometimes it is associated with diverse clinical syndromes ranging from minor febrile illness to severe, potentially fatal diseases, such as aseptic meningitis, encephalitis, paralysis, myocarditis, and neonatal enteroviral sepsis (2)(3)(4). In some cases, individual EV serotypes can cause particular symptoms; CV type A24 (CVA24) has been associated with acute hemorrhagic conjunctivitis (5,6), while enterovirus 71 (EV71) has been associated with major outbreaks of hand, foot, and mouth disease (HFMD) and concurrent fatal encephalitis among very young children (7,8).…”

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confidence: 99%

Laboratory Surveillance of Polio and Other Enteroviruses in High-Risk Populations and Environmental Samples

Pogka

Labropoulou

Emmanouil

et al. 2017

Appl Environ Microbiol

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In the context of poliomyelitis eradication, a reinforced supplementary laboratory surveillance of enteroviruses was implemented in Greece. Between 2008 and 2014, the Hellenic Polioviruses/Enteroviruses Reference Laboratory performed detailed supplementary surveillance of circulating enteroviruses among healthy individuals in high-risk population groups, among immigrants from countries in which poliovirus is endemic, and in environmental samples. In total, 722 stool samples and 179 sewage water samples were included in the study. No wild-type polioviruses were isolated during these 7 years of surveillance, although two imported vaccine polioviruses were detected. Enterovirus presence was recorded in 25.3 and 25.1% of stool and sewage water samples, respectively. Nonpolio enteroviruses isolated from stool samples belonged to species A, B, or C; coxsackievirus A24 was the most frequently identified serotype. Only enteroviruses of species B were identified in sewage water samples, including four serotypes of echoviruses and four serotypes of coxsackie B viruses. Phylogenetic analysis revealed close genetic relationships among virus isolates from sewage water samples and stool samples, which in most cases fell into the same cluster. To the best of our knowledge, this is the first study to compare enterovirus serotypes circulating in fecal specimens of healthy individuals and environmental samples, emphasizing the burden of enterovirus circulation in asymptomatic individuals at high risk. Given that Greece continues to receive a large number of short-term arrivals, students, migrants, and refugees from countries in which poliovirus is endemic, it is important to guarantee high-quality surveillance in order to maintain its polio-free status until global eradication is achieved. IMPORTANCE This article summarizes the results of supplementary poliovirus surveillance in Greece and the subsequent characterization of enteroviral circulation in human feces and the environment. The examination of stool samples from healthy refugees and other individuals in "high-risk" groups for poliovirus enables the identification of enterovirus cases and forms the basis for further investigation of the community-level risk of viral transmission. In addition, the examination of composite human fecal samples through environmental surveillance links poliovirus and nonpoliovirus isolates from unknown individuals to populations served by the sewage or wastewater system. Supplementary surveillance is necessary to comply with the prerequisites imposed by the World Health Organization for monitoring the emergence of vaccine-derived polioviruses, reemergence of wild polioviruses, or disappearance of all vaccine-related strains in order for countries such as Greece to maintain their polio-free status and contribute to global poliovirus eradication.

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confidence: 99%

Laboratory Surveillance of Polio and Other Enteroviruses in High-Risk Populations and Environmental Samples

Pogka

Labropoulou

Emmanouil

et al. 2017

Appl Environ Microbiol

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“…However, those infected with EV71 may suffer severe clinical manifestations ranging from aseptic meningitis to acute flaccid paralysis and brainstem encephalitis, which may even lead to death (Jang et al, 2013). EV71 was first isolated in 1969 from a patient with HFMD in California that presented with neurological disease and then described in 1974 (Kim et al, 2016b). Since then, EV71 has caused numerous outbreaks and epidemics worldwide, particularly in Asian-Pacific regions such as Malaysia in 1997, Taiwan in 1998, South Korea in 2000, Singapore in 2000, Vietnam in 2003, and China in 2008(Wang et al, 2012Donato et al, 2016;Kim et al, 2016b).…”

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confidence: 99%

“…EV71 was first isolated in 1969 from a patient with HFMD in California that presented with neurological disease and then described in 1974 (Kim et al, 2016b). Since then, EV71 has caused numerous outbreaks and epidemics worldwide, particularly in Asian-Pacific regions such as Malaysia in 1997, Taiwan in 1998, South Korea in 2000, Singapore in 2000, Vietnam in 2003, and China in 2008(Wang et al, 2012Donato et al, 2016;Kim et al, 2016b). EV71 is a member in the enterovirus A species of the genus Enterovirus in the family Picornaviridae.…”

Section: Introductionmentioning

confidence: 99%

Sequence analysis of the first B5 subgenogroup strain of enterovirus 71 isolated in Korea

et al. 2020

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Enterovirus A71 (EV71), the main etiological agent of handfoot-mouth disease (HFMD), circulates in many areas of the world and has caused large epidemics since 1997, especially in the Asia-Pacific region. In this study, we determined the full-genome sequence of CMC718, a newly isolated EV71 strain in Korea. The CMC718 genome was 7,415 nucleotides in length and was confirmed by whole-genome phylogenetic analysis to belong to the B5 genotype. In particular, CMC718 demonstrated maximum identity with strain M988 of the B5 genotype and numerous amino acid variants were detected in the 3D domain of the viral protein P3, which is consistent with the mutation pattern of a B5 strain isolated in 2012-2013. Comparison of the CMC718 sequence with other EV71 reference strains confirmed the relationship and genetic variation of CMC718. Our study was a full-genome sequence analysis of the first EV71 strain of the B5 genotype isolated in South Korea. This information will be a valuable reference for the development of methods for the detection of recombinant viruses, the tracking of infections, and the diagnosis of EV71.

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“…virus, and group A beta-hemolytic streptococcus. Hand-foot-mouth disease (HFMD) is among the most common of acute rashes caused by enterovirus infection [1]. The potential pathogens causing HFMD include enterovirus 71 [2], coxsackievirus group A 4 (CA4) [3], CA6 [4][5][6], CA10 [5,7], and CAl6 [1][2][3][4][5][6].…”

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A clinical scoring system for pediatric hand-foot-mouth disease

Huang

Deng²,

Jia

et al. 2019

Preprint

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Background:The aim of the present study was to develop a clinical scoring system for the diagnosis of hand-foot-mouth disease (HFMD) with improved accuracy.Methods: A retrospectiveanalysis was performed on standardized patienthistory and clinicalexamination data obtained from 1435 pediatric patients under the age of three years who presented with acute rash illness and underwent enterovirus nucleicaciddetection. Patients were then divided into the HFMD (1094 patients) group or non-HFMD (341 patients) group based on a positive or a negative result from the assay, respectively. We then divided the data into a training set (1004 cases, 70%) and a test set (431 cases, 30%) using a random number method. Multivariate logistic regression was performed on 15 clinical variables (e.g. age, exposure history, number of rash spots in a single body region) to identify variables highly predictive of a positive diagnosisin the training set.Using the variables with high impact on the diagnostic accuracy, we generated a scoring system for predicting HFMDand subsequently evaluated this system in the test set.Results: Using the logistic model, we identified seven clinical variables (age, exposure history,and rash density at specific regions of the body) to be included into the scoring system. The final scores ranged from −5 to 24 (higher scores positively predicted HFMD diagnosis).Through our training set,a cutoff score of 7resulted ina sensitivity of 0.76 and specificity of 0.68. The area under the receiver operating characteristiccurve(AUC)was 0.804 (95% confidence interval [CI]: 0.773–0.835)(P < 0.001). Using the test set, we obtained an AUC of 0.76 (95% CI: 0.710–0.810) with a sensitivity of 0.76 and a specificity of 0.62. These results from the test set were consistent with those from the training set.Conclusions:This study establishes an objective scoring system for the diagnosis of typical and atypical HFMD using measures accessible through routine clinical encounters. Due to the accuracy and sensitivity achieved by this scoring system, it can be employed as a rapid, low-cost method for establishing diagnoses in children with acute rash illness.

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Epidemiology and virologic investigation of human enterovirus 71 infection in the Republic of Korea from 2007 to 2012: a nationwide cross-sectional study

Cited by 27 publications

References 40 publications

Laboratory Surveillance of Polio and Other Enteroviruses in High-Risk Populations and Environmental Samples

Laboratory Surveillance of Polio and Other Enteroviruses in High-Risk Populations and Environmental Samples

Sequence analysis of the first B5 subgenogroup strain of enterovirus 71 isolated in Korea

A clinical scoring system for pediatric hand-foot-mouth disease

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