Non-Polio Enteroviruses from Acute Flaccid Paralysis Surveillance in Shandong Province, China, 1988–2013

Abstract

Enteroviruses (EVs) are important human pathogens associated with various clinical syndromes. This study represents an overview of non-polio enteroviruses (NPEVs) isolated from acute flaccid paralysis (AFP) surveillance in Shandong Province, China from 1988 to 2013. Altogether 792 and 170 NPEV isolates were isolated from stool specimens of 9263 AFP cases and 1059 contacts, respectively. Complete VP1 sequencing and typing on all 962 isolates revealed 53 NPEV types in which echovirus (E) 6 (7.6%), E14 (7.6%), E11 (7.4%), coxsackievirus (CV) B3 (7.4%), E25 (5.6%), CVB5 (4.9%), E7 (4.5%) and EV-A71 (4.4%) were the eight most commonly reported serotypes. Distinct summer–fall seasonality was observed, with June–October accounting for 79.3% of isolation from AFP cases with known month of specimen collection. Increase of isolation of EV-A71 and CVA—the predominant pathogens for the hand, foot, and mouth disease—was observed in recent years. Sequence analysis on VP1 coding region of EV-A71 and E6 suggested Shandong strains had great genetic divergence with isolates from other countries. The results described in this study provide valuable information on the circulation and emergence of different EV types in the context of limited EV surveillance in China.

Enteroviruses Associated with Aseptic Meningitis in Poland, 2011–2014

“…-meningitis is less prevalent and ranged between 16% and 27% (Tao et al, 2014). The incidence of the enteroviruses varies globally according to different populations and methodologies.…”

Human enterovirus A71 (EV-A71) isolated from acute flaccid paralysis patients without symptoms of hand foot and mouth disease

“…Toward the final stage of polio eradication program, probably less poliovirus will be found circulating due to change of vaccine from OPV to IPV in many countries including Malaysia. Therefore, viruses other than polioviruses have been found associated with AFP cases [34], among them were echoviruses, coxsackieviruses, and EV-A71 [17].…”

“…AFP is one of the most common neurological symptoms in children with suspected infection of polio, even though most children are asymptomatic. Now EV-A71 considered as one of the leading causes of AFP since the wild poliovirus has been nearly eradicated [11,17]. This was proven in animal model [18,40] by orally administered of EV-A71 in neonatal mice.…”

“…In the road to achieve total eradication of poliomyelitis, viruses other than polioviruses have been reported to cause AFP. These include viruses such as echoviruses, coxsackieviruses, and EV-A71 [17].…”

Evolutionary phylogeography and transmission pattern of echovirus 14: an exploration of spatiotemporal dynamics based on the 26-year acute flaccid paralysis surveillance in Shandong, China

“…Similarly, association of E-14 with many clinical recognized syndromes such as gastrointestinal syndrome [8–10], acute serous meningitis [12], paralysis [13], fatal neonatal hepatic necrosis [14], aseptic meningitis [11, 15] has been reported previously. In recent years, E-14 is more than detected in an outbreak or epidemic caused by other pathogens [16, 17] or exhibited sporadic infection in conventional virological surveillance [18–20]. …”