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Chen Y, Chen S, Shen Y, Li Z, Li X, Zhang Y, Zhang X, Wang F, Jin Y. Molecular Evolutionary Dynamics of Coxsackievirus A6 Causing Hand, Foot, and Mouth Disease From 2021 to 2023 in China: Genomic Epidemiology Study. JMIR Public Health Surveill 2024; 10:e59604. [PMID: 39087568 DOI: 10.2196/59604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 06/19/2024] [Accepted: 06/20/2024] [Indexed: 08/02/2024] Open
Abstract
Background Hand, foot, and mouth disease (HFMD) is a global public health concern, notably within the Asia-Pacific region. Recently, the primary pathogen causing HFMD outbreaks across numerous countries, including China, is coxsackievirus (CV) A6, one of the most prevalent enteroviruses in the world. It is a new variant that has undergone genetic recombination and evolution, which might not only induce modifications in the clinical manifestations of HFMD but also heighten its pathogenicity because of nucleotide mutation accumulation. Objective The study assessed the epidemiological characteristics of HFMD in China and characterized the molecular epidemiology of the major pathogen (CV-A6) causing HFMD. We attempted to establish the association between disease progression and viral genetic evolution through a molecular epidemiological study. Methods Surveillance data from the Chinese Center for Disease Control and Prevention from 2021 to 2023 were used to analyze the epidemiological seasons and peaks of HFMD in Henan, China, and capture the results of HFMD pathogen typing. We analyzed the evolutionary characteristics of all full-length CV-A6 sequences in the NCBI database and the isolated sequences in Henan. To characterize the molecular evolution of CV-A6, time-scaled tree and historical population dynamics regarding CV-A6 sequences were estimated. Additionally, we analyzed the isolated strains for mutated or missing amino acid sites compared to the prototype CV-A6 strain. Results The 2021-2023 epidemic seasons for HFMD in Henan usually lasted from June to August, with peaks around June and July. The monthly case reporting rate during the peak period ranged from 20.7% (4854/23,440) to 35% (12,135/34,706) of the total annual number of cases. Analysis of the pathogen composition of 2850 laboratory-confirmed cases identified 8 enterovirus serotypes, among which CV-A6 accounted for the highest proportion (652/2850, 22.88%). CV-A6 emerged as the major pathogen for HFMD in 2022 (203/732, 27.73%) and 2023 (262/708, 37.01%). We analyzed all CV-A6 full-length sequences in the NCBI database and the evolutionary features of viruses isolated in Henan. In China, the D3 subtype gradually appeared from 2011, and by 2019, all CV-A6 virus strains belonged to the D3 subtype. The VP1 sequences analyzed in Henan showed that its subtypes were consistent with the national subtypes. Furthermore, we analyzed the molecular evolutionary features of CV-A6 using Bayesian phylogeny and found that the most recent common ancestor of CV-A6 D3 dates back to 2006 in China, earlier than the 2011 HFMD outbreak. Moreover, the strains isolated in 2023 had mutations at several amino acid sites compared to the original strain. Conclusions The CV-A6 virus may have been introduced and circulating covertly within China prior to the large-scale HFMD outbreak. Our laboratory testing data confirmed the fluctuation and periodic patterns of CV-A6 prevalence. Our study provides valuable insights into understanding the evolutionary dynamics of CV-A6.
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Affiliation(s)
- Yu Chen
- Department of Infectious Diseases, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, China
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Shouhang Chen
- Department of Infectious Diseases, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Yuanfang Shen
- Department of Infectious Diseases, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Zhi Li
- Department of Infectious Diseases, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Xiaolong Li
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yaodong Zhang
- Henan International Joint Laboratory of Children's Infectious Diseases, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Xiaolong Zhang
- NHC Key Laboratory of Birth Defects Prevention, Henan Key Laboratory of Population Defects Prevention, Zhengzhou, China
| | - Fang Wang
- Department of Infectious Diseases, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, China
| | - Yuefei Jin
- Department of Infectious Diseases, Children's Hospital Affiliated to Zhengzhou University, Zhengzhou, China
- College of Public Health, Zhengzhou University, Zhengzhou, China
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Chen J, You P, Chen X, Li H, Zhang N, Zhang G, Xu C, Ma C, Zhang Y, Lv T. Genetic characteristics and phylogenetic analysis of coxsackievirus A6 isolated in Linyi, China, 2022-2023. Jpn J Infect Dis 2024:JJID.2024.072. [PMID: 38945859 DOI: 10.7883/yoken.jjid.2024.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Hand, foot and mouth disease (HFMD) was one of the most common infectious disease in the past few decades. After 2013, coxsackievirus A6 (CVA6) has replaced enterovirus 71 (EV-A71) and coxsackievirus A16 (CVA16), becoming the predominant pathogen responsible for HFMD in many areas in China. The objective of this study is to investigate the genetic characteristics and molecular epidemiology of CVA6 in Linyi from 2022 to 2023. A total of 965 HFMD cases were enrolled in this study and analyses based on VP1 nucleotide sequences were performed to determine the evolutionary trajectory of CVA6. In 2022, 281 (281/386, 72.8%) were positive for enterovirus (EVs), and 217 (217/281, 77.2%) were CVA6 positive. In 2023, 398 (398/579, 68.7%) samples were positive for EVs, and 243 (243/398, 61.1%) were CVA6 positive. Six sequences were selected from each year for the homology analysis. The results showed that 12 strains isolated in Linyi were far from the prototype strain (AY421764) and the first CVA6 strain reported in China (JQ364886). Phylogenetic analysis showed that the CVA6 strains isolated in Linyi all belonged to D3 subgenotype. CVA6 is emerging as a common pathogen causing HFMD in Linyi, and continuous surveillance of HFMD etiological agents is necessary.
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Affiliation(s)
- Jie Chen
- Linyi Key Laboratory of Birth Defects Prevention and Control, Linyi Maternal and Child Healthcare Hospital, China
| | - Pengfei You
- Children's Emergency Department, Linyi Maternal and Child Healthcare Hospital, China
| | - Xiaoyan Chen
- Linyi Key Laboratory of Birth Defects Prevention and Control, Linyi Maternal and Child Healthcare Hospital, China
| | - Huafeng Li
- Linyi Key Laboratory of Birth Defects Prevention and Control, Linyi Maternal and Child Healthcare Hospital, China
| | - Na Zhang
- Children's Emergency Department, Linyi Maternal and Child Healthcare Hospital, China
| | - Guangyun Zhang
- Linyi Key Laboratory of Birth Defects Prevention and Control, Linyi Maternal and Child Healthcare Hospital, China
| | - Conghong Xu
- Linyi Key Laboratory of Birth Defects Prevention and Control, Linyi Maternal and Child Healthcare Hospital, China
| | - Chunling Ma
- Linyi Key Laboratory of Birth Defects Prevention and Control, Linyi Maternal and Child Healthcare Hospital, China
- Department of Immunology Teaching and Research, Shandong Medical College, China
| | - Yanli Zhang
- Linyi Key Laboratory of Birth Defects Prevention and Control, Linyi Maternal and Child Healthcare Hospital, China
| | - Tiegang Lv
- Linyi Key Laboratory of Birth Defects Prevention and Control, Linyi Maternal and Child Healthcare Hospital, China
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Wang Z, Wen H. A review of the recombination events, mechanisms and consequences of Coxsackievirus A6. INFECTIOUS MEDICINE 2024; 3:100115. [PMID: 38974347 PMCID: PMC11225671 DOI: 10.1016/j.imj.2024.100115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 02/25/2024] [Accepted: 04/22/2024] [Indexed: 07/09/2024]
Abstract
Hand, foot, and mouth disease (HFMD) is one of the most common class C infectious diseases, posing a serious threat to public health worldwide. Enterovirus A71 (EV-A71) and coxsackievirus A16 (CV-A16) have been regarded as the major pathogenic agents of HFMD; however, since an outbreak caused by coxsackievirus A6 (CV-A6) in France in 2008, CV-A6 has gradually become the predominant pathogen in many regions. CV-A6 infects not only children but also adults, and causes atypical clinical symptoms such as a more generalized rash, eczema herpeticum, high fever, and onychomadesis, which are different from the symptoms associated with EV-A71 and CV-A16. Importantly, the rate of genetic recombination of CV-A6 is high, which can lead to changes in virulence and the rapid evolution of other characteristics, thus posing a serious threat to public health. To date, no specific vaccines or therapeutics have been approved for CV-A6 prevention or treatment, hence it is essential to fully understand the relationship between recombination and evolution of this virus. Here, we systematically review the genetic recombination events of CV-A6 that have occurred worldwide and explore how these events have promoted virus evolution, thus providing important information regarding future HFMD surveillance and prevention.
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Affiliation(s)
- Zequn Wang
- Department of Microbiological Laboratory Technology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
- Key Laboratory of Prevention and Control of Emerging Infectious Diseases, Biosafety in Universities of Shandong, Jinan 250012, China
| | - Hongling Wen
- Department of Microbiological Laboratory Technology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan 250012, China
- Key Laboratory of Prevention and Control of Emerging Infectious Diseases, Biosafety in Universities of Shandong, Jinan 250012, China
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Lee JE, Kim MJ, Lim MH, Han SJ, Kim JY, Kim SH, Ha YD, Gang GL, Chung YS, Seo JM. Epidemiological and Genetic Characterization of Coxsackievirus A6-Associated Hand, Foot, and Mouth Disease in Gwangju, South Korea, in 2022. Viruses 2024; 16:476. [PMID: 38543842 PMCID: PMC10975452 DOI: 10.3390/v16030476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/19/2024] [Accepted: 03/20/2024] [Indexed: 05/23/2024] Open
Abstract
Coxsackievirus A6 (CV-A6) has emerged as the predominant causative agent of hand, foot, and mouth disease (HFMD) in young children. Since the declaration of coronavirus disease 2019 (COVID-19) as a global pandemic, the incidence of infectious diseases, including HFMD, has decreased markedly. When social mitigation was relaxed during the COVID-19 pandemic in 2022, the re-emergence of HFMD was observed in Gwangju, South Korea, and seasonal characteristics of the disease appeared to have changed. To investigate the molecular characteristics of enterovirus (EV) associated with HFMD during 2022, 277 specimens were collected. Children aged younger than 5 years accounted for the majority of affected individuals. EV detection and genotyping were performed using real-time RT-PCR and nested RT-PCR followed by sequence analysis. The EV detection rate was found to be 82.3%, and the main genotype identified was CV-A6. Sixteen CV-A6 samples were selected for whole genome sequencing. According to phylogenetic analysis, all CV-A6 strains from this study belonged to the sub-genotype D3 clade based on VP1 sequences. Analysis of 3D polymerase phylogeny showed that only the recombinant RF-A group was identified. In conclusion, circulating EV types should be continuously monitored to understand pathogen emergence and evolution during the post-pandemic era.
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Affiliation(s)
- Ji-Eun Lee
- Health and Environment Research Institute of Gwangju, Gwangju 61954, Republic of Korea; (M.-J.K.); (M.-H.L.); (S.-J.H.); (J.-Y.K.); (S.-H.K.); (Y.-D.H.); (G.-L.G.); (J.-M.S.)
| | - Min-Ji Kim
- Health and Environment Research Institute of Gwangju, Gwangju 61954, Republic of Korea; (M.-J.K.); (M.-H.L.); (S.-J.H.); (J.-Y.K.); (S.-H.K.); (Y.-D.H.); (G.-L.G.); (J.-M.S.)
| | - Mi-Hyeon Lim
- Health and Environment Research Institute of Gwangju, Gwangju 61954, Republic of Korea; (M.-J.K.); (M.-H.L.); (S.-J.H.); (J.-Y.K.); (S.-H.K.); (Y.-D.H.); (G.-L.G.); (J.-M.S.)
| | - Sue-Ji Han
- Health and Environment Research Institute of Gwangju, Gwangju 61954, Republic of Korea; (M.-J.K.); (M.-H.L.); (S.-J.H.); (J.-Y.K.); (S.-H.K.); (Y.-D.H.); (G.-L.G.); (J.-M.S.)
| | - Jin-Yeong Kim
- Health and Environment Research Institute of Gwangju, Gwangju 61954, Republic of Korea; (M.-J.K.); (M.-H.L.); (S.-J.H.); (J.-Y.K.); (S.-H.K.); (Y.-D.H.); (G.-L.G.); (J.-M.S.)
| | - Soo-Hoo Kim
- Health and Environment Research Institute of Gwangju, Gwangju 61954, Republic of Korea; (M.-J.K.); (M.-H.L.); (S.-J.H.); (J.-Y.K.); (S.-H.K.); (Y.-D.H.); (G.-L.G.); (J.-M.S.)
| | - Yi-Duen Ha
- Health and Environment Research Institute of Gwangju, Gwangju 61954, Republic of Korea; (M.-J.K.); (M.-H.L.); (S.-J.H.); (J.-Y.K.); (S.-H.K.); (Y.-D.H.); (G.-L.G.); (J.-M.S.)
| | - Gyung-Li Gang
- Health and Environment Research Institute of Gwangju, Gwangju 61954, Republic of Korea; (M.-J.K.); (M.-H.L.); (S.-J.H.); (J.-Y.K.); (S.-H.K.); (Y.-D.H.); (G.-L.G.); (J.-M.S.)
| | - Yoon-Seok Chung
- Division of High-Risk Pathogen, Bureau of Infectious Diseases Diagnosis Control, Korea Disease Control and Prevention Agency (KDCA), Cheongju 28159, Republic of Korea
| | - Jung-Mi Seo
- Health and Environment Research Institute of Gwangju, Gwangju 61954, Republic of Korea; (M.-J.K.); (M.-H.L.); (S.-J.H.); (J.-Y.K.); (S.-H.K.); (Y.-D.H.); (G.-L.G.); (J.-M.S.)
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Ivanova OE, Eremeeva TP, Morozova NS, Mikhailova YM, Kozlovskaya LI, Baikova OY, Shakaryan AK, Krasota AY, Korotkova EA, Yakovchuk EV, Shustova EY, Lukashev AN. Non-Polio Enteroviruses Isolated by Acute Flaccid Paralysis Surveillance Laboratories in the Russian Federation in 1998-2021: Distinct Epidemiological Features of Types. Viruses 2024; 16:135. [PMID: 38257835 PMCID: PMC10819661 DOI: 10.3390/v16010135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 01/08/2024] [Accepted: 01/11/2024] [Indexed: 01/24/2024] Open
Abstract
More than 100 types of non-polio enteroviruses (NPEVs) are ubiquitous in the human population and cause a variety of symptoms ranging from very mild to meningitis and acute flaccid paralysis (AFP). Much of the information regarding diverse pathogenic properties of NPEVs comes from the surveillance of poliovirus, which also yields NPEV. The analysis of 265 NPEV isolations from 10,433 AFP cases over 24 years of surveillance and more than 2500 NPEV findings in patients without severe neurological lesions suggests that types EV-A71, E13, and E25 were significantly associated with AFP. EV-A71 was also significantly more common among AFP patients who had fever at the onset and residual paralysis compared to all AFP cases. In addition, a significant disparity was noticed between types that were common in humans (CV-A2, CVA9, EV-A71, E9, and E30) or in sewage (CVA7, E3, E7, E11, E12, and E19). Therefore, there is significant evidence of non-polio viruses being implicated in severe neurological lesions, but further multicenter studies using uniform methodology are needed for a definitive conclusion.
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Affiliation(s)
- Olga E. Ivanova
- Federal State Autonomous Scientific Institution “Chumakov Federal Center for Research and Development of Immune-and-Biological Products of the Russian Academy of Sciences” (Institute of Poliomyelitis) (FSASI “Chumakov FSC R&D IBP RAS”), 108819 Moscow, Russia (E.V.Y.); (E.Y.S.)
- Department of Organization and Technology of Production of Immunobiological Preparations, Institute for Translational Medicine and Biotechnology, First Moscow State Medical University (Sechenov University), 119048 Moscow, Russia
| | - Tatiana P. Eremeeva
- Federal State Autonomous Scientific Institution “Chumakov Federal Center for Research and Development of Immune-and-Biological Products of the Russian Academy of Sciences” (Institute of Poliomyelitis) (FSASI “Chumakov FSC R&D IBP RAS”), 108819 Moscow, Russia (E.V.Y.); (E.Y.S.)
| | - Nadezhda S. Morozova
- The Federal Budgetary Health Institution “Federal Center of Hygiene and Epidemiology” of the Federal Office for Inspectorate in the Field of Customers and Human Well-Being Protection”(FBHI FCH&E), 117105 Moscow, Russia
| | - Yulia M. Mikhailova
- The Federal Budgetary Health Institution “Federal Center of Hygiene and Epidemiology” of the Federal Office for Inspectorate in the Field of Customers and Human Well-Being Protection”(FBHI FCH&E), 117105 Moscow, Russia
| | - Liubov I. Kozlovskaya
- Federal State Autonomous Scientific Institution “Chumakov Federal Center for Research and Development of Immune-and-Biological Products of the Russian Academy of Sciences” (Institute of Poliomyelitis) (FSASI “Chumakov FSC R&D IBP RAS”), 108819 Moscow, Russia (E.V.Y.); (E.Y.S.)
- Department of Organization and Technology of Production of Immunobiological Preparations, Institute for Translational Medicine and Biotechnology, First Moscow State Medical University (Sechenov University), 119048 Moscow, Russia
| | - Olga Y. Baikova
- Federal State Autonomous Scientific Institution “Chumakov Federal Center for Research and Development of Immune-and-Biological Products of the Russian Academy of Sciences” (Institute of Poliomyelitis) (FSASI “Chumakov FSC R&D IBP RAS”), 108819 Moscow, Russia (E.V.Y.); (E.Y.S.)
| | - Armen K. Shakaryan
- Federal State Autonomous Scientific Institution “Chumakov Federal Center for Research and Development of Immune-and-Biological Products of the Russian Academy of Sciences” (Institute of Poliomyelitis) (FSASI “Chumakov FSC R&D IBP RAS”), 108819 Moscow, Russia (E.V.Y.); (E.Y.S.)
- Department of Childrenʹs Infectious Diseases, Pediatric Faculty, Pirogov Russian National Research Medical University, 119121 Moscow, Russia
| | - Alexandr Y. Krasota
- Federal State Autonomous Scientific Institution “Chumakov Federal Center for Research and Development of Immune-and-Biological Products of the Russian Academy of Sciences” (Institute of Poliomyelitis) (FSASI “Chumakov FSC R&D IBP RAS”), 108819 Moscow, Russia (E.V.Y.); (E.Y.S.)
- Belozersky Institute of Physical-Chemical Biology, Lomonosov Moscow State University, 119899 Moscow, Russia
| | - Ekaterina A. Korotkova
- Belozersky Institute of Physical-Chemical Biology, Lomonosov Moscow State University, 119899 Moscow, Russia
| | - Elizaveta V. Yakovchuk
- Federal State Autonomous Scientific Institution “Chumakov Federal Center for Research and Development of Immune-and-Biological Products of the Russian Academy of Sciences” (Institute of Poliomyelitis) (FSASI “Chumakov FSC R&D IBP RAS”), 108819 Moscow, Russia (E.V.Y.); (E.Y.S.)
| | - Elena Y. Shustova
- Federal State Autonomous Scientific Institution “Chumakov Federal Center for Research and Development of Immune-and-Biological Products of the Russian Academy of Sciences” (Institute of Poliomyelitis) (FSASI “Chumakov FSC R&D IBP RAS”), 108819 Moscow, Russia (E.V.Y.); (E.Y.S.)
| | - Alexander N. Lukashev
- Martsinovsky Institute of Medical Parasitology, Tropical and Vector-Borne Diseases, First Moscow State Medical University (Sechenov University), 119048 Moscow, Russia
- Research Institute for Systems Biology and Medicine, 117246 Moscow, Russia
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Han Z, Wang F, Xiao J, Fu H, Song Y, Jiang M, Lu H, Li J, Xu Y, Zhu R, Zhang Y, Zhao L. Synergetic association between coxsackievirus A16 genotype evolution and recombinant form shifts. Virus Evol 2023; 10:vead080. [PMID: 38361814 PMCID: PMC10868544 DOI: 10.1093/ve/vead080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 11/05/2023] [Accepted: 12/17/2023] [Indexed: 02/17/2024] Open
Abstract
Coxsackievirus A16 (CVA16) is a major pathogen that causes hand, foot, and mouth disease (HFMD). The recombination form (RF) shifts and global transmission dynamics of CVA16 remain unknown. In this retrospective study, global sequences of CVA16 were retrieved from the GenBank database and analyzed using comprehensive phylogenetic inference, RF surveys, and population structure. A total of 1,663 sequences were collected, forming a 442-sequences dataset for VP1 coding region analysis and a 345-sequences dataset for RF identification. Based on the VP1 coding region used for serotyping, three genotypes (A, B, and D), two subgenotypes of genotype B (B1 and B2), and three clusters of subgenotype B1 (B1a, B1b, and B1c) were identified. Cluster B1b has dominated the global epidemics, B2 disappeared in 2000, and D is an emerging genotype dating back to August 2002. Globally, four oscillation phases of CVA16 evolution, with a peak in 2013, and three migration pathways were identified. Europe, China, and Japan have served as the seeds for the global transmission of CVA16. Based on the 3D coding region of the RFs, five clusters of RFs (RF-A to -E) were identified. The shift in RFs from RF-B and RF-C to RF-D was accompanied by a change in genotype from B2 to B1a and B1c and then to B1b. In conclusion, the evolution and population dynamics of CVA16, especially the coevolution of 3D and VP1 genes, revealed that genotype evolution and RF replacement were synergistic rather than stochastic.
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Affiliation(s)
| | - Fangming Wang
- Laboratory of Virology, Beijing Key Laboratory of Etiology of Viral Diseases in Children, Capital Institute of Pediatrics, Yabao Road, Chaoyang District, Beijing 100020, China
| | - Jinbo Xiao
- WHO WPRO Regional Polio Reference Laboratory, NHC Key Laboratory for Biosafety, NHC Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No.155 Changbai Road, Changping District, Beijing 102206, People’s Republic of China
| | - Hanhaoyu Fu
- Laboratory of Virology, Beijing Key Laboratory of Etiology of Viral Diseases in Children, Capital Institute of Pediatrics, Yabao Road, Chaoyang District, Beijing 100020, China
| | - Yang Song
- WHO WPRO Regional Polio Reference Laboratory, NHC Key Laboratory for Biosafety, NHC Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No.155 Changbai Road, Changping District, Beijing 102206, People’s Republic of China
| | - Mingli Jiang
- Laboratory of Virology, Beijing Key Laboratory of Etiology of Viral Diseases in Children, Capital Institute of Pediatrics, Yabao Road, Chaoyang District, Beijing 100020, China
| | - Huanhuan Lu
- WHO WPRO Regional Polio Reference Laboratory, NHC Key Laboratory for Biosafety, NHC Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No.155 Changbai Road, Changping District, Beijing 102206, People’s Republic of China
| | - Jichen Li
- WHO WPRO Regional Polio Reference Laboratory, NHC Key Laboratory for Biosafety, NHC Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No.155 Changbai Road, Changping District, Beijing 102206, People’s Republic of China
| | - Yanpeng Xu
- Laboratory of Virology, Beijing Key Laboratory of Etiology of Viral Diseases in Children, Capital Institute of Pediatrics, Yabao Road, Chaoyang District, Beijing 100020, China
| | - Runan Zhu
- Laboratory of Virology, Beijing Key Laboratory of Etiology of Viral Diseases in Children, Capital Institute of Pediatrics, Yabao Road, Chaoyang District, Beijing 100020, China
| | - Yong Zhang
- WHO WPRO Regional Polio Reference Laboratory, NHC Key Laboratory for Biosafety, NHC Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No.155 Changbai Road, Changping District, Beijing 102206, People’s Republic of China
- Laboratory of Virology, Beijing Key Laboratory of Etiology of Viral Diseases in Children, Capital Institute of Pediatrics, Yabao Road, Chaoyang District, Beijing 100020, China
| | - Linqing Zhao
- Laboratory of Virology, Beijing Key Laboratory of Etiology of Viral Diseases in Children, Capital Institute of Pediatrics, Yabao Road, Chaoyang District, Beijing 100020, China
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Foronda JLM, Jiao MMAD, Climacosa FMM, Oshitani H, Apostol LNG. Epidemiological and molecular characterization of Coxsackievirus A6 causing hand, foot, and mouth disease in the Philippines, 2012-2017. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2023; 114:105498. [PMID: 37657679 DOI: 10.1016/j.meegid.2023.105498] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 08/27/2023] [Accepted: 08/30/2023] [Indexed: 09/03/2023]
Abstract
Coxsackievirus A6 (CVA6) is emerging as the dominant serotype among enteroviruses (EVs) responsible for hand, foot, and mouth disease (HFMD) outbreaks in multiple countries. However, details regarding this serotype in the Philippines are limited. In this study, we investigated the epidemiological and molecular characteristics of laboratory-confirmed CVA6 HFMD cases in the Philippines between 2012 and 2017. Data collected from case report forms submitted to the National Reference Laboratory for Poliovirus and other Enteroviruses were used to determine the distribution and clinical findings of laboratory-confirmed CVA6 HFMD. Phylogenetic analyses of the complete viral protein 1 (VP1) and partial 3D polymerase (3Dpol) gene sequences were performed to determine the genotype and recombinant (RF) form of the selected samples. An increase in the detection rate of CVA6 among enterovirus-positive HFMD cases was observed from 61.9% (140/226) in 2012 to 88.1% (482/587) in 2017, with most cases coming from the Luzon island group. Among the detected cases, the majority were children, with a median age of 2 years old (interquartile range: 1.17-3.40). Respiratory-related morbidities were the commonly reported complications (7.9%; 72/907). Based on the VP1 and 3Dpol gene sequence analysis, the CVA6 strains in this study were classified as genotype D3b and RF-A group, respectively. This study elucidated that CVA6 was the most prevalent enterovirus serotype causing HFMD in the Philippines in 2012-2017, with genotype D3b/RF-A circulating within this period. This study highlights the importance of viral surveillance and molecular epidemiological analysis to broaden our understanding of HFMD in the Philippines.
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Affiliation(s)
- Janiza Lianne M Foronda
- Department of Virology, Research Institute for Tropical Medicine, Muntinlupa City, Philippines; Department of Medical Microbiology, College of Public Health, University of the Philippines, Manila City, Philippines
| | | | - Fresthel Monica M Climacosa
- Department of Medical Microbiology, College of Public Health, University of the Philippines, Manila City, Philippines
| | - Hitoshi Oshitani
- Department of Virology, Graduate School of Medicine, Tohoku University, Sendai, Japan
| | - Lea Necitas G Apostol
- Department of Virology, Research Institute for Tropical Medicine, Muntinlupa City, Philippines.
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Puenpa J, Saengdao N, Khanarat N, Korkong S, Chansaenroj J, Yorsaeng R, Wanlapakorn N, Poovorawan Y. Evolutionary and Genetic Recombination Analyses of Coxsackievirus A6 Variants Associated with Hand, Foot, and Mouth Disease Outbreaks in Thailand between 2019 and 2022. Viruses 2022; 15:73. [PMID: 36680113 PMCID: PMC9863931 DOI: 10.3390/v15010073] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 12/30/2022] Open
Abstract
Coxsackievirus (CV)-A6 infections cause hand, foot, and mouth disease (HFMD) in children and adults. Despite the serious public health threat presented by CV-A6 infections, our understanding of the mechanisms by which new CV-A6 strains emerge remains limited. This study investigated the molecular epidemiological trends, evolutionary dynamics, and recombination characteristics of CV-A6-associated HFMD in Thailand between 2019 and 2022. In the HFMD patient samples collected during the 4-year study period, we identified enterovirus (EV) RNA in 368 samples (48.7%), of which CV-A6 (23.7%) was the predominant genotype, followed by CV-A4 (6%), EV-A71 (3.7%), and CV-A16 (3.4%). According to the partial viral protein (VP) 1 sequences, all these CV-A6 strains belonged to the D3 clade. Based on the viral-RNA-dependent RNA polymerase (RdRp) gene, four recombinant forms (RFs), RF-A (147, 84.5%), RF-N (11, 6.3%), RF-H (1, 0.6%), and newly RF-Y (15, 8.6%), were identified throughout the study period. Results from the similarity plot and bootscan analyses revealed that the 3D polymerase (3Dpol) region of the D3/RF-Y subclade consists of sequences highly similar to CV-A10. We envisage that the epidemiological and evolutionarily insights presented in this manuscript will contribute to the development of vaccines to prevent the spread of CV-A6 infection.
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Affiliation(s)
- Jiratchaya Puenpa
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Nutsada Saengdao
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
- Department of Microbiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Nongkanok Khanarat
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Sumeth Korkong
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Jira Chansaenroj
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Ritthideach Yorsaeng
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Nasamon Wanlapakorn
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Yong Poovorawan
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
- FRS(T), The Royal Society of Thailand, Sanam Sueapa, Dusit, Bangkok 10300, Thailand
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Zhang M, Chen X, Wang W, Li Q, Xie Z. Genetic characteristics of Coxsackievirus A6 from children with hand, foot and mouth disease in Beijing, China, 2017-2019. INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2022; 106:105378. [PMID: 36257478 DOI: 10.1016/j.meegid.2022.105378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/07/2022] [Accepted: 10/14/2022] [Indexed: 11/13/2022]
Abstract
OBJECT To investigate the evolution and genetic characteristics of Coxsackievirus A6 (CVA6) which acted as the predominant pathogen of hand, foot and mouth disease (HFMD) in children in Beijing, China, 2017-2019. METHODS Throat swab specimens were collected for general Enterovirus (EV), enterovirus A71 (EV-A71) and CVA16 detection by Real-time PCR. These general EV-positive samples were identified by semi-nested RT-PCR method and sequencing. The CVA6 VP1 gene and genome sequences were amplified and sequenced. The phylogenetic, variation and recombination analyses were performed. RESULTS A total of 1721 HFMD patients were enrolled in this study, with the male to female ratio of 1.62:1. The majority of cases were less than five years, which accounted for 73.50%. The overall detection rate of EV was 88.32% (1520/1721). A total of 8 EV types were identified, including CVA6 (55.86%), CVA16 (26.32%), EV-A71 (2.24%), CVA10 (2.04%), CVA4 (1.05%), CVA5 (0.59%), CVA2 (0.33%), and CVA8 (0.07%), while 175 (11.51%) EV were untyped. The main pathogen of HFMD was CVA6 from 2017 to 2018, while CVA6 and CVA16 were the main causative pathogens in 2019. The nucleotide and amino acid sequence identities of the 120 CVA6 complete VP1 gene sequences in this study were 91.2%-100.0% and 97.7%-100.0%, respectively. Compared with the prototype strain (Gdula) of CVA6, the nucleotide and amino acid sequence identities were 81.7%-84% and 94.7%-96.3%, respectively. The phylogenetic tree indicated that all 120 CVA6 sequences belonged to sub-genotype D3, while 119 CVA6 sequences belonged to evolutionary branch D3a, except one from 2017 belonged to D3b. Recombination analysis based on the complete genome sequences showed that potential multiple recombination may have occurred in 2B and 3D protein coding regions with EV-A114. CONCLUSIONS The main pathogens of HFMD were CVA6 and CVA16 in Beijing, China, 2017-2019; while these CVA6, as recombination strains, belonged to the D3a evolutionary branch.
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Affiliation(s)
- Meng Zhang
- Beijing Key Laboratory of Pediatric Respiratory Infection diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, Research Unit of Critical Infection in Children, Chinese Academy of Medical Sciences, 2019RU016, Laboratory of Infection and Virology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China; Department of Pediatrics of Beijing, Boai Hospital at China Rehabilitation Research Centre, Rehabilitation School of Capital Medical University, Beijing 100068, China
| | - Xiangpeng Chen
- Beijing Key Laboratory of Pediatric Respiratory Infection diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, Research Unit of Critical Infection in Children, Chinese Academy of Medical Sciences, 2019RU016, Laboratory of Infection and Virology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Wei Wang
- Beijing Key Laboratory of Pediatric Respiratory Infection diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, Research Unit of Critical Infection in Children, Chinese Academy of Medical Sciences, 2019RU016, Laboratory of Infection and Virology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Qi Li
- Beijing Key Laboratory of Pediatric Respiratory Infection diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, Research Unit of Critical Infection in Children, Chinese Academy of Medical Sciences, 2019RU016, Laboratory of Infection and Virology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China
| | - Zhengde Xie
- Beijing Key Laboratory of Pediatric Respiratory Infection diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, Research Unit of Critical Infection in Children, Chinese Academy of Medical Sciences, 2019RU016, Laboratory of Infection and Virology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China.
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10
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Genomic Epidemiology and Phylodynamic Analysis of Enterovirus A71 Reveal Its Transmission Dynamics in Asia. Microbiol Spectr 2022; 10:e0195822. [PMID: 36200890 PMCID: PMC9603238 DOI: 10.1128/spectrum.01958-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [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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11
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Tomba Ngangas S, Bisseux M, Jugie G, Lambert C, Cohen R, Werner A, Archimbaud C, Henquell C, Mirand A, Bailly JL. Coxsackievirus A6 Recombinant Subclades D3/A and D3/H Were Predominant in Hand-Foot-And-Mouth Disease Outbreaks in the Paediatric Population, France, 2010–2018. Viruses 2022; 14:v14051078. [PMID: 35632819 PMCID: PMC9144281 DOI: 10.3390/v14051078] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/10/2022] [Accepted: 05/12/2022] [Indexed: 01/25/2023] Open
Abstract
Coxsackievirus A6 (CVA6) emerged as the most common enterovirus of seasonal outbreaks of hand-foot-and-mouth disease (HFMD). We investigated CVA6 genetic diversity among the clinical phenotypes reported in the paediatric population during sentinel surveillance in France between 2010 and 2018. CVA6 infection was confirmed in 981 children (mean age 1.52 years [IQR 1.17–2.72]) of whom 564 (58%) were males. Atypical HFMD was reported in 705 (72%) children, followed by typical HFMD in 214 (22%) and herpangina in 57 (6%) children. Throat specimens of 245 children were processed with a target-enrichment new-generation sequencing approach, which generated 213 complete CVA6 genomes. The genomes grouped within the D1 and D3 clades (phylogeny inferred with the P1 genomic region). In total, 201 genomes were classified among the recombinant forms (RFs) A, B, F, G, H, and N, and 12 genomes were assigned to 5 previously unreported RFs (R–V). The most frequent RFs were A (58%), H (19%), G (6.1%), and F (5.2%). The yearly number of RFs ranged between 1 (in 2012 and 2013) and 6 (2018). The worldwide CVA6 epidemic transmission began between 2005 and 2007, which coincided with the global spread of the recombinant subclade D3/RF-A.
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Affiliation(s)
- Stéphanie Tomba Ngangas
- Université Clermont Auvergne, LMGE CNRS 6023, UFR de Médecine et des Professions Paramédicales, 63001 Clermont-Ferrand, France; (S.T.N.); (M.B.); (G.J.); (C.A.); (C.H.); (A.M.)
| | - Maxime Bisseux
- Université Clermont Auvergne, LMGE CNRS 6023, UFR de Médecine et des Professions Paramédicales, 63001 Clermont-Ferrand, France; (S.T.N.); (M.B.); (G.J.); (C.A.); (C.H.); (A.M.)
- CHU Clermont-Ferrand, Centre National de Référence Des Entérovirus et Parechovirus, Laboratoire de Virologie, 63003 Clermont-Ferrand, France
| | - Gwendoline Jugie
- Université Clermont Auvergne, LMGE CNRS 6023, UFR de Médecine et des Professions Paramédicales, 63001 Clermont-Ferrand, France; (S.T.N.); (M.B.); (G.J.); (C.A.); (C.H.); (A.M.)
| | - Céline Lambert
- CHU Clermont-Ferrand, Service Biométrie et Médico-Economie—Direction de la Recherche Clinique et Innovation, 63003 Clermont-Ferrand, France;
| | - Robert Cohen
- Association Clinique et Thérapeutique Infantile du Val de Marne (ACTIV), 94000 Créteil, France;
| | - Andreas Werner
- Association Française de Pédiatrie Ambulatoire (AFPA), 45000 Orléans, France;
| | - Christine Archimbaud
- Université Clermont Auvergne, LMGE CNRS 6023, UFR de Médecine et des Professions Paramédicales, 63001 Clermont-Ferrand, France; (S.T.N.); (M.B.); (G.J.); (C.A.); (C.H.); (A.M.)
- CHU Clermont-Ferrand, Centre National de Référence Des Entérovirus et Parechovirus, Laboratoire de Virologie, 63003 Clermont-Ferrand, France
| | - Cécile Henquell
- Université Clermont Auvergne, LMGE CNRS 6023, UFR de Médecine et des Professions Paramédicales, 63001 Clermont-Ferrand, France; (S.T.N.); (M.B.); (G.J.); (C.A.); (C.H.); (A.M.)
- CHU Clermont-Ferrand, Centre National de Référence Des Entérovirus et Parechovirus, Laboratoire de Virologie, 63003 Clermont-Ferrand, France
| | - Audrey Mirand
- Université Clermont Auvergne, LMGE CNRS 6023, UFR de Médecine et des Professions Paramédicales, 63001 Clermont-Ferrand, France; (S.T.N.); (M.B.); (G.J.); (C.A.); (C.H.); (A.M.)
- CHU Clermont-Ferrand, Centre National de Référence Des Entérovirus et Parechovirus, Laboratoire de Virologie, 63003 Clermont-Ferrand, France
| | - Jean-Luc Bailly
- Université Clermont Auvergne, LMGE CNRS 6023, UFR de Médecine et des Professions Paramédicales, 63001 Clermont-Ferrand, France; (S.T.N.); (M.B.); (G.J.); (C.A.); (C.H.); (A.M.)
- Correspondence:
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Genomic surveillance of enterovirus associated with aseptic meningitis cases in southern Spain, 2015-2018. Sci Rep 2021; 11:21523. [PMID: 34728763 PMCID: PMC8564535 DOI: 10.1038/s41598-021-01053-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 10/20/2021] [Indexed: 12/12/2022] Open
Abstract
New circulating Enterovirus (EV) strains often emerge through recombination. Upsurges of recombinant non-polio enteroviruses (NPEVs) associated with neurologic manifestations such as EVA71 or Echovirus 30 (E30) are a growing public health concern in Europe. Only a few complete genomes of EVs circulating in Spain are available in public databases, making it difficult to address the emergence of recombinant EVs, understand their evolutionary relatedness and the possible implication in human disease. We have used metagenomic (untargeted) NGS to generate full-length EV genomes from CSF samples of EV-positive aseptic meningitis cases in Southern Spain between 2015 and 2018. Our analyses reveal the co-circulation of multiple Enterovirus B (EV-B) types (E6, E11, E13 and E30), including a novel E13 recombinant form. We observed a genetic turnover where emergent lineages (C1 for E6 and I [tentatively proposed in this study] for E30) replaced previous lineages circulating in Spain, some concomitant with outbreaks in other parts of Europe. Metagenomic sequencing provides an effective approach for the analysis of EV genomes directly from PCR-positive CSF samples. The detection of a novel, disease-associated, recombinant form emphasizes the importance of genomic surveillance to monitor spread and evolution of EVs.
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13
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Khan H, Khan A. Genome-wide population structure inferences of human coxsackievirus-A; insights the genotypes diversity and evolution. INFECTION GENETICS AND EVOLUTION 2021; 95:105068. [PMID: 34492386 DOI: 10.1016/j.meegid.2021.105068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 08/25/2021] [Accepted: 09/01/2021] [Indexed: 11/24/2022]
Abstract
Coxsackievirus-A (CV-A) is a causative agent of Hand Foot Mouth Disease (HFMD) worldwide. It belongs to the Human Enterovirus genus of the family Picornaviridae. The genomics data availability of CV-A samples, isolated from human host across different continental regions, provide an excellent opportunity to study its genetic composition, diversity, and evolutionary events. The complete genome sequences of 424 CV-A isolates were analyzed through a model-based population genetic approach implemented in the STRUCTURE program. Twelve genetically distinct sub-populations were identified for CV-A isolates with a marked Fst distinction of 0.76991 (P-value = 0.00000). Besides, genetically admixed strains were characterized in the G-Id, G-IIIb clusters constituted by the CV-A12 and CV-A6 enterovirus serotypes. The serotypes depicted inter/intra-genotype recombination and episodic positive selection signatures in the structural and non-structural protein-coding regions. The observed genetic composition of CV-A samples was also deduced by the phylogenetic tree analyses, where a uniform genetic structure was inferred for most of the CV-A genotypes. However, the CV-A6 serotype samples genetically stratified into three sub-populations that may lead to the emergence of new lineages in future. These informations may implicate in planning the effective strategies to combat the coxsackievirus-A-mediated infection.
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Affiliation(s)
- Hizbullah Khan
- Department of Biochemistry, Abdul Wali Khan University Mardan, Mardan 23200, Khyber Pakhtunkhwa, Pakistan
| | - Asifullah Khan
- Department of Biochemistry, Abdul Wali Khan University Mardan, Mardan 23200, Khyber Pakhtunkhwa, Pakistan.
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14
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Rocha LCD, Estofolete CF, Milhim BHGDA, Augusto MT, Zini N, Silva GCDD, Ferraz-Junior HC, Brienze VMS, Liso E, Cunha MS, Sabino EC, da Costa AC, Nogueira ML, Luchs A, Terzian ACB. Enteric viruses circulating in undiagnosed central nervous system infections at tertiary hospital in São José do Rio Preto, São Paulo, Brazil. J Med Virol 2021; 93:3539-3548. [PMID: 32579291 DOI: 10.1002/jmv.26216] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 06/15/2020] [Accepted: 06/20/2020] [Indexed: 12/18/2022]
Abstract
Enterovirus (EV) is commonly associated with central nervous system (CNS) syndromes. Recently, gastroenteric viruses, including rotavirus (RVA), human astrovirus (HAstV), and norovirus (NoV), have also been associated with CNS neurological disorders. The aim of the present study was to investigate the presence of EV, RVA, HAst, and NoV associated to CNS infections with undiagnosed etiology in Northwest region of São Paulo State, Brazil, and to conduct the molecular characterization of the positive samples detected. A total of 288 cerebrospinal fluid samples collected from July to December 2017 were tested for EV and NoV by quantitative real-time polymerase chain reaction (RT-qPCR), HAstV by conventional RT-PCR, and RVA by enzyme-linked immunosorbent assay. Positive-EV samples were inoculated in cells lines, amplified by RT-PCR and sequenced. RVA, NoV, and HAstV were not detected. EV infection was detected in 5.5% (16/288), and five samples successful genotyped: echovirus 3 (E3) (1/5), coxsackie virus A6 (CVA6) (1/5), and coxsackie virus B4 (CVB4) (3/5). Meningitis was the main syndrome observed (12/16; 75%). CVA6, CVB4, and E3 were identified associated with aseptic meningitis. Reports of CVA6 associated with aseptic meningitis are rare, E3 had not been previously reported in Brazil, and epidemiological data on CVB4 in the country is virtually unknown. The present investigation illustrates the circulation of diverse EV types in a small regional sample set and in a short period of time, highlighting the importance of an active EV surveillance system in CNS infections. Enhanced understanding of undiagnosed CNS infections will assist in public health and health care planning.
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Affiliation(s)
| | | | | | | | - Nathalia Zini
- São José do Rio Preto School of Medicine (FAMERP), São Paulo, Brazil
| | | | | | | | | | - Mariana Sequetin Cunha
- Vector Borne Disease Laboratory, Virology Center, Adolfo Lutz Institute, São Paulo, Brazil
| | - Ester Cerdeira Sabino
- LIM/46, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
- Institute of Tropical Medicine, University of São Paulo, São Paulo, Brazil
| | | | | | - Adriana Luchs
- Enteric Disease Laboratory, Virology Center, Adolfo Lutz Institute, São Paulo, Brazil
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15
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Jiang Z, Zhang Y, Lin H, Cheng Q, Lu X, Liu W, Zhou R, Zhong B, Tian X. A 10-Day-Old Murine Model of Coxsackievirus A6 Infection for the Evaluation of Vaccines and Antiviral Drugs. Front Immunol 2021; 12:665197. [PMID: 34054834 PMCID: PMC8155526 DOI: 10.3389/fimmu.2021.665197] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 04/26/2021] [Indexed: 11/13/2022] Open
Abstract
Coxsackievirus A6 (CVA6) is recognized as a major enterovirus type that can cause severe hand, foot, and mouth disease and spread widely among children. Vaccines and antiviral drugs may be developed more effectively based on a stable and easy-to-operate CVA6 mouse infection model. In this study, a wild CVA6-W strain was sub-cultured in newborn mice of different ages (in days), for adaptation. Therefore, a CVA6-A mouse-adapted strain capable of stably infecting the mice was generated, and a fatal model was built. As the result indicated, CVA6-A could infect the 10-day-old mice to generate higher levels of IFN-γ, IL-6, and IL-10. The mice infected with CVA6-A were treated with IFN-α1b at a higher dose, with complete protection. Based on this strain, an animal model with active immunization was built to evaluate antiviral protection by active immunization. The three-day-old mice were pre-immunized with inactivated CVA6 thereby generating IgM and IgG antibodies within 7 days that enabled complete protection of the pre-immunized mice following the CVA6 virus challenge. There were eight mutations in the genome of CVA6-A than in that of CVA6-W, possibly attributed to the virulence of CVA6 in mice. Briefly, the CVA6 infection model of the 10-day-old mice built herein, may serve as an applicable preclinical evaluation model for CVA6 antiviral drugs and vaccine study.
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Affiliation(s)
- Zaixue Jiang
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China.,Dongguan Institute of Paediatrics, Dongguan Children's Hospital, The Eighth People's Hospital of Dongguan City, Guangdong Medical University, Dongguan, China
| | - Yaozhong Zhang
- Dongguan Institute of Paediatrics, Dongguan Children's Hospital, The Eighth People's Hospital of Dongguan City, Guangdong Medical University, Dongguan, China
| | - Huayuan Lin
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Qingqiu Cheng
- Dongguan Institute of Paediatrics, Dongguan Children's Hospital, The Eighth People's Hospital of Dongguan City, Guangdong Medical University, Dongguan, China
| | - Xiaomei Lu
- Dongguan Institute of Paediatrics, Dongguan Children's Hospital, The Eighth People's Hospital of Dongguan City, Guangdong Medical University, Dongguan, China
| | - Wenkuan Liu
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Rong Zhou
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Baimao Zhong
- Dongguan Institute of Paediatrics, Dongguan Children's Hospital, The Eighth People's Hospital of Dongguan City, Guangdong Medical University, Dongguan, China
| | - Xingui Tian
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
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16
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Martínez-López N, Muñoz-Almagro C, Launes C, Navascués A, Imaz-Pérez M, Reina J, Romero MP, Calvo C, Ruiz-García M, Megias G, Valencia-Ramos J, Otero A, Cabrerizo M. Surveillance for Enteroviruses Associated with Hand, Foot, and Mouth Disease, and Other Mucocutaneous Symptoms in Spain, 2006-2020. Viruses 2021; 13:v13050781. [PMID: 33924875 PMCID: PMC8146579 DOI: 10.3390/v13050781] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/20/2021] [Accepted: 04/23/2021] [Indexed: 12/12/2022] Open
Abstract
Hand, foot, and mouth disease (HFMD) is a mild illness caused by enteroviruses (EV), although in some Asian countries, large outbreaks have been reported in the last 25 years, with a considerable incidence of neurological complications. This study describes epidemiological and clinical characteristics of EV infections involved in HFMD and other mucocutaneous symptoms from 2006 to 2020 in Spain. EV-positive samples from 368 patients were included. EV species A were identified in 85.1% of those typed EV. Coxsackievirus (CV) A6 was the prevalent serotype (60.9%), followed by EV-A71 (9.9%) and CVA16 (7.7%). Infections affected children (1-6 years old) mainly, and show seasonality with peaks in spring-summer and autumn. Clinical data indicated few cases of atypical HFMD as well as those with neurological complications (associated with the 2016 EV-A71 outbreak). Phylogenetic analysis of CVA6 VP1 sequences showed different sub-clusters circulating from 2010 to present. In conclusion, HFMD or exanthemas case reporting has increased in Spain in recent years, probably associated with an increase in circulation of CVA6, although they did not seem to show greater severity. However, EV surveillance in mucocutaneous manifestations should be improved to identify the emergence of new types or variants causing outbreaks and more severe pathologies.
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Affiliation(s)
- Nieves Martínez-López
- Enterovirus Unit, National Centre for Microbiology, Instituto de Salud Carlos III, 28220 Madrid, Spain; (N.M.-L.); (A.O.)
| | - Carmen Muñoz-Almagro
- Microbiological and Paediatric Departments, Hospital San Joan de Déu, 08950 Barcelona, Spain; (C.M.-A.); (C.L.)
| | - Cristian Launes
- Microbiological and Paediatric Departments, Hospital San Joan de Déu, 08950 Barcelona, Spain; (C.M.-A.); (C.L.)
| | - Ana Navascués
- Microbiological Department, Complejo Hospitalario de Navarra, 31008 Navarra, Spain;
| | - Manuel Imaz-Pérez
- Microbiological Department, Hospital de Basurto, 48013 Bilbao, Spain;
| | - Jordi Reina
- Microbiological Department, Hospital Son Espases, 07020 Palma de Mallorca, Spain;
| | - María Pilar Romero
- Microbiological and Paediatric Departments, Hospital La Paz, 28220 Madrid, Spain; (M.P.R.); (C.C.)
| | - Cristina Calvo
- Microbiological and Paediatric Departments, Hospital La Paz, 28220 Madrid, Spain; (M.P.R.); (C.C.)
| | | | - Gregoria Megias
- Microbiological and Paediatrics Department, Complejo Hospitalario de Burgos, 09006 Burgos, Spain; (G.M.); (J.V.-R.)
| | - Juan Valencia-Ramos
- Microbiological and Paediatrics Department, Complejo Hospitalario de Burgos, 09006 Burgos, Spain; (G.M.); (J.V.-R.)
| | - Almudena Otero
- Enterovirus Unit, National Centre for Microbiology, Instituto de Salud Carlos III, 28220 Madrid, Spain; (N.M.-L.); (A.O.)
| | - María Cabrerizo
- Enterovirus Unit, National Centre for Microbiology, Instituto de Salud Carlos III, 28220 Madrid, Spain; (N.M.-L.); (A.O.)
- Correspondence: ; Tel.: +34-918-223-663
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17
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Lu H, Hong M, Zhang Y, Xiao J, Zhang M, Zhang K, Song Y, Han Z, Yang Q, Wang D, Yan D, Zhu S, Xu W. A novel interspecies recombinant enterovirus (Enterovirus A120) isolated from a case of acute flaccid paralysis in China. Emerg Microbes Infect 2021; 9:1733-1743. [PMID: 32672504 PMCID: PMC7473298 DOI: 10.1080/22221751.2020.1796527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
EV-A120 is a recently identified serotype of the enterovirus A species. Only one full-length genomic sequence is currently available in GenBank, and very few studies have been conducted on EV-A120 globally. Thus, additional information and research on EV-A120 are needed to explore its genetic characteristics, phylogeny, and relationship with enteroviral disease. In this study, we report the phylogenetic characteristics of a EV-A120 strain (Q0082/XZ/CHN/2000) from Tibet, China. The amino acid sequence similarity and nucleotide sequence similarity of the full-length genomic sequence of this EV-A120 strain and the EV-A120 prototype strain were 96.3% and 79.9%, respectively, showing an evolutionary trend. Recombination analysis found intraspecies recombination in the 5′ -UTR, 2B, 2C, and 3D regions. Serum neutralization testing of the EV-A120 (Q0082) strain was also carried out. Low serum-positive rates and geometric mean titres (GMTs) indicated that the extent of EV-A120 transmission and exposure in the population was very limited compared with that in the outbreaks of EV-A71 and CV-A16 in China since 2008. The EV-A120 strain (Q0082) is non-temperature sensitive, indicating its potential to spread in the population. In summary, this study reports the full-length genomic sequence of EV-A120 and provides important information for its global molecular epidemiology.
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Affiliation(s)
- Huanhuan Lu
- WHO WPRO Regional Polio Reference Laboratory, National Laboratory for Poliomyelitis and National Health Commission Key Laboratory for Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Mei Hong
- Tibet Center for Disease Control and Prevention, Lhasa City, People's Republic of China
| | - Yong Zhang
- WHO WPRO Regional Polio Reference Laboratory, National Laboratory for Poliomyelitis and National Health Commission Key Laboratory for Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China.,Center for Biosafety Mega-Science, Chinese Academy of Sciences, Beijing, People's Republic of China
| | - Jinbo Xiao
- WHO WPRO Regional Polio Reference Laboratory, National Laboratory for Poliomyelitis and National Health Commission Key Laboratory for Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Man Zhang
- WHO WPRO Regional Polio Reference Laboratory, National Laboratory for Poliomyelitis and National Health Commission Key Laboratory for Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Keyi Zhang
- WHO WPRO Regional Polio Reference Laboratory, National Laboratory for Poliomyelitis and National Health Commission Key Laboratory for Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Yang Song
- WHO WPRO Regional Polio Reference Laboratory, National Laboratory for Poliomyelitis and National Health Commission Key Laboratory for Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Zhenzhi Han
- WHO WPRO Regional Polio Reference Laboratory, National Laboratory for Poliomyelitis and National Health Commission Key Laboratory for Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Qian Yang
- WHO WPRO Regional Polio Reference Laboratory, National Laboratory for Poliomyelitis and National Health Commission Key Laboratory for Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Dongyan Wang
- WHO WPRO Regional Polio Reference Laboratory, National Laboratory for Poliomyelitis and National Health Commission Key Laboratory for Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Dongmei Yan
- WHO WPRO Regional Polio Reference Laboratory, National Laboratory for Poliomyelitis and National Health Commission Key Laboratory for Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Shuangli Zhu
- WHO WPRO Regional Polio Reference Laboratory, National Laboratory for Poliomyelitis and National Health Commission Key Laboratory for Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Wenbo Xu
- WHO WPRO Regional Polio Reference Laboratory, National Laboratory for Poliomyelitis and National Health Commission Key Laboratory for Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, People's Republic of China.,Center for Biosafety Mega-Science, Chinese Academy of Sciences, Beijing, People's Republic of China
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18
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Bujaki E, Farkas Á, Rigó Z, Takács M. Distribution of enterovirus genotypes detected in clinical samples in Hungary, 2010-2018. Acta Microbiol Immunol Hung 2020; 67:201-208. [PMID: 33295885 DOI: 10.1556/030.2020.01200] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 06/08/2020] [Indexed: 01/01/2023]
Abstract
This report provides the findings of a retrospective surveillance study on the emergence and circulation of enteroviruses with their associated clinical symptoms over a nine-year period detected at the National Enterovirus Reference Laboratory in Hungary between 2010-2018.Enterovirus (EV) detection and genotyping were performed directly from clinical samples. From 4,080 clinical specimens 25 EV types were identified with a median age of patients of 5 years and 68% of all cases affected children aged 10 years or younger, although infections occurred in all age-groups. In 130 cases neurological symptoms were recorded, in 123 cases the infection presented in skin related signs including hand, foot, and mouth disease (HFMD), herpangina and rash. In 2010 EV-A71 was found to cause the majority of diagnosed EV infections while in 2011 and from 2014-2018, Coxsackievirus (CV)-A6 was identified most often. Echovirus E6 accounted for the most cases in 2012 and Echovirus 30 dominated in 2013. EV-D68 was identified only in 2010 and 2013.Widespread circulation of several EV-A and EV-B viruses with occasional occurrence of EV-C and EV-D was detected. The ability of EVs to cause severe infections in sporadic cases and regular outbreaks highlight the importance of continued monitoring of circulating EV types.
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Affiliation(s)
- Erika Bujaki
- 1Department of Virology, National Public Health Center, Budapest, Hungary
| | - Ágnes Farkas
- 1Department of Virology, National Public Health Center, Budapest, Hungary
| | - Zita Rigó
- 1Department of Virology, National Public Health Center, Budapest, Hungary
| | - Mária Takács
- 1Department of Virology, National Public Health Center, Budapest, Hungary
- 2Institute of Medical Microbiology, Semmelweis University, Budapest, Hungary
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19
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Brown DM, Zhang Y, Scheuermann RH. Epidemiology and Sequence-Based Evolutionary Analysis of Circulating Non-Polio Enteroviruses. Microorganisms 2020; 8:microorganisms8121856. [PMID: 33255654 PMCID: PMC7759938 DOI: 10.3390/microorganisms8121856] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/13/2020] [Accepted: 11/17/2020] [Indexed: 02/07/2023] Open
Abstract
Enteroviruses (EVs) are positive-sense RNA viruses, with over 50,000 nucleotide sequences publicly available. While most human infections are typically associated with mild respiratory symptoms, several different EV types have also been associated with severe human disease, especially acute flaccid paralysis (AFP), particularly with endemic members of the EV-B species and two pandemic types—EV-A71 and EV-D68—that appear to be responsible for recent widespread outbreaks. Here we review the recent literature on the prevalence, characteristics, and circulation dynamics of different enterovirus types and combine this with an analysis of the sequence coverage of different EV types in public databases (e.g., the Virus Pathogen Resource). This evaluation reveals temporal and geographic differences in EV circulation and sequence distribution, highlighting recent EV outbreaks and revealing gaps in sequence coverage. Phylogenetic analysis of the EV genus shows the relatedness of different EV types. Recombination analysis of the EV-A species provides evidence for recombination as a mechanism of genomic diversification. The absence of broadly protective vaccines and effective antivirals makes human enteroviruses important pathogens of public health concern.
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Affiliation(s)
- David M Brown
- Department of Synthetic Biology, J. Craig Venter Institute, Rockville, MD 20850, USA
| | - Yun Zhang
- Department of Informatics, J. Craig Venter Institute, La Jolla, CA 92037, USA
| | - Richard H Scheuermann
- Department of Informatics, J. Craig Venter Institute, La Jolla, CA 92037, USA
- Department of Pathology, University of California San Diego, La Jolla, CA 92093, USA
- La Jolla Institute for Immunology, La Jolla, CA 92065, USA
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20
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Sub-genotype change and recombination of coxsackievirus A6s may be the cause of it being the predominant pathogen for HFMD in children in Beijing, as revealed by analysis of complete genome sequences. Int J Infect Dis 2020; 99:156-162. [PMID: 32663604 DOI: 10.1016/j.ijid.2020.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 06/29/2020] [Accepted: 07/01/2020] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To investigate why coxsackievirus A6 (CVA6) has replaced enterovirus A71 (EV71) and coxsackievirus A16 (CVA16), which used to be the most predominant etiological agents, for hand, foot and mouth disease (HFMD) in children in Beijing, China. METHODS Sixty-four CVA6-positive samples were identified from 2010 to 2016 and selected for whole genome sequence amplification and analysis. RESULTS It was demonstrated that the whole genome sequences of CVA6s in this study were 7432-7435 nucleotides in length, and the different lengths were only in the 5'UTR region. The phylogenetic tree analysis of the full-length VP1 region of CVA6s indicated that the prevalent CVA6s in Beijing changed from the previous D2 sub-genotype to the D3 sub-genotype in 2013. In this study, two recombinant forms (RFs)- RF-C and RF-D - of CVA6 mainly appeared in 2010 and 2011. Since 2013, three recombinant CVA6 variants - RF-A, J and L - have been prevalent in children with HFMD in Beijing. The recombination region of RF-J was located at the 2C region, while RF-L had a new recombination point in the 3D region. The recombination of prevalent CVA6s in Beijing from 2013 to 2016 occurred within non-capsid regions of the genome, especially the P2 and P3 regions. CONCLUSIONS The sub-genotype change and recombination of CVA6s indicated from this study may explain why CVA6 has become the predominant pathogen causing HFMD since 2013.
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21
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Song Y, Zhang Y, Han Z, Xu W, Xiao J, Wang X, Wang J, Yang J, Yu Q, Yu D, Chen J, Huang W, Li J, Xie T, Lu H, Ji T, Yang Q, Yan D, Zhu S, Xu W. Genetic recombination in fast-spreading coxsackievirus A6 variants: a potential role in evolution and pathogenicity. Virus Evol 2020; 6:veaa048. [PMID: 34804589 PMCID: PMC8597624 DOI: 10.1093/ve/veaa048] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Hand, foot, and mouth disease (HFMD) is a common global epidemic. From 2008
onwards, many HFMD outbreaks caused by coxsackievirus A6 (CV-A6) have been
reported worldwide. Since 2013, with a dramatically increasing number of
CV-A6-related HFMD cases, CV-A6 has become the predominant HFMD pathogen in
mainland China. Phylogenetic analysis based on the VP1 capsid
gene revealed that subtype D3 dominated the CV-A6 outbreaks. Here, we performed
a large-scale (near) full-length genetic analysis of global and Chinese CV-A6
variants, including 158 newly sequenced samples collected extensively in
mainland China between 2010 and 2018. During the global transmission of subtype
D3 of CV-A6, the noncapsid gene continued recombining, giving rise to a series
of viable recombinant hybrids designated evolutionary lineages, and each lineage
displayed internal consistency in both genetic and epidemiological features. The
emergence of lineage –A since 2005 has triggered CV-A6 outbreaks
worldwide, with a rate of evolution estimated at
4.17 × 10−3 substitutions
site-1 year−1 based on a
large number of monophyletic open reading frame sequences, and created a series
of lineages chronologically through varied noncapsid recombination events. In
mainland China, lineage –A has generated another two novel widespread
lineages (–J and –L) through recombination within the
enterovirus A gene pool, with robust estimates of occurrence time. Lineage
–A, –J, and –L infections presented dissimilar clinical
manifestations, indicating that the conservation of the CV-A6 capsid gene
resulted in high transmissibility, but the lineage-specific noncapsid gene might
influence pathogenicity. Potentially important amino acid substitutions were
further predicted among CV-A6 variants. The evolutionary phenomenon of noncapsid
polymorphism within the same subtype observed in CV-A6 was uncommon in other
leading HFMD pathogens; such frequent recombination happened in fast-spreading
CV-A6, indicating that the recovery of deleterious genomes may still be ongoing
within CV-A6 quasispecies. CV-A6-related HFMD outbreaks have caused a
significant public health burden and pose a great threat to children’s
health; therefore, further surveillance is greatly needed to understand the full
genetic diversity of CV-A6 in mainland China.
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Affiliation(s)
- Yang Song
- WHO WPRO Regional Polio Reference Laboratory, National Health Commission Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing, 102206, China
| | - Yong Zhang
- WHO WPRO Regional Polio Reference Laboratory, National Health Commission Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing, 102206, China.,Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, Hubei Province, China
| | - Zhenzhi Han
- WHO WPRO Regional Polio Reference Laboratory, National Health Commission Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing, 102206, China
| | - Wen Xu
- Yunnan Center for Disease Control and Prevention, Kunming, Yunnan Province, China
| | - Jinbo Xiao
- WHO WPRO Regional Polio Reference Laboratory, National Health Commission Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing, 102206, China
| | - Xianjun Wang
- Shandong Center for Disease Control and Prevention, Jinan, Shandong Province, China
| | - Jianxing Wang
- Shandong Center for Disease Control and Prevention, Jinan, Shandong Province, China
| | - Jianfang Yang
- Shanxi Center for Disease Control and Prevention, Taiyuan, Shanxi Province, China
| | - Qiuli Yu
- Hebei Center for Disease Control and Prevention, Shijiazhuang, Hebei Province, China
| | - Deshan Yu
- Gansu Center for Disease Control and Prevention, Lanzhou, Gansu Province, China
| | - Jianhua Chen
- Gansu Center for Disease Control and Prevention, Lanzhou, Gansu Province, China
| | - Wei Huang
- Chongqing Center for Disease Control and Prevention, Chongqing City, China
| | - Jie Li
- Beijing Center for Disease Control and Prevention, Beijing City, China
| | - Tong Xie
- Tianjin Center for Disease Control and Prevention, Tianjin City, China
| | - Huanhuan Lu
- WHO WPRO Regional Polio Reference Laboratory, National Health Commission Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing, 102206, China
| | - Tianjiao Ji
- WHO WPRO Regional Polio Reference Laboratory, National Health Commission Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing, 102206, China
| | - Qian Yang
- WHO WPRO Regional Polio Reference Laboratory, National Health Commission Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing, 102206, China
| | - Dongmei Yan
- WHO WPRO Regional Polio Reference Laboratory, National Health Commission Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing, 102206, China
| | - Shuangli Zhu
- WHO WPRO Regional Polio Reference Laboratory, National Health Commission Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing, 102206, China
| | - Wenbo Xu
- WHO WPRO Regional Polio Reference Laboratory, National Health Commission Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing, 102206, China.,Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, Hubei Province, China.,Anhui University of Science and Technology, Anhui Province, China
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22
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Brouwer L, Benschop KS, Nguyen D, Kamau E, Pajkrt D, Simmonds P, Wolthers KC. Recombination Analysis of Non-Poliovirus Members of the Enterovirus C Species; Restriction of Recombination Events to Members of the Same 3DPol Cluster. Viruses 2020; 12:v12070706. [PMID: 32629843 PMCID: PMC7412211 DOI: 10.3390/v12070706] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 06/23/2020] [Indexed: 12/13/2022] Open
Abstract
Enteroviruses (EVs) are highly prevalent viruses worldwide. Recombination is known to occur frequently in EVs belonging to species Enterovirus A, Enterovirus B, and Enterovirus C. Although many recombinant vaccine-derived poliovirus (VDPV) strains have been reported, our knowledge on recombination in non-polio EVs in the species Enterovirus C is limited. Here, we combined a dataset consisting of 11 newly generated full-length Enterovirus C sequences and 180 publicly available sequences to study recombination dynamics in non-polio EVs. To identify recombination patterns, maximum likelihood phylogenetic trees of different genomic regions were constructed, and segregation analyses were performed. Recombination was observed between members of the same 3DPol cluster, but was rarely observed between members of different clusters. We hypothesize that this restriction may have arisen through their different compartmentalization in respiratory and enteric tracts related to differences in cellular tropisms so that the opportunity to recombine may not be available.
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Affiliation(s)
- Lieke Brouwer
- Department of Medical Microbiology, Academic Medical Center (AMC), Amsterdam University Medical Centers (Amsterdam UMC), 1105AZ Amsterdam, The Netherlands;
- Correspondence:
| | - Kimberley S.M. Benschop
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment (RIVM), 3721MA Bilthoven, The Netherlands;
| | - Dung Nguyen
- Nuffield Department of Medicine, University of Oxford, Oxford OX1 3SY, UK; (D.N.); (E.K.); (P.S.)
| | - Everlyn Kamau
- Nuffield Department of Medicine, University of Oxford, Oxford OX1 3SY, UK; (D.N.); (E.K.); (P.S.)
| | - Dasja Pajkrt
- Department of Pediatric Infectious Diseases, Academic Medical Center (AMC), Amsterdam University Medical Centers (Amsterdam UMC), 1105AZ Amsterdam, The Netherlands;
| | - Peter Simmonds
- Nuffield Department of Medicine, University of Oxford, Oxford OX1 3SY, UK; (D.N.); (E.K.); (P.S.)
| | - Katja C. Wolthers
- Department of Medical Microbiology, Academic Medical Center (AMC), Amsterdam University Medical Centers (Amsterdam UMC), 1105AZ Amsterdam, The Netherlands;
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23
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Zhao TS, Du J, Sun DP, Zhu QR, Chen LY, Ye C, Wang S, Liu YQ, Cui F, Lu QB. A review and meta-analysis of the epidemiology and clinical presentation of coxsackievirus A6 causing hand-foot-mouth disease in China and global implications. Rev Med Virol 2019; 30:e2087. [PMID: 31811676 DOI: 10.1002/rmv.2087] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 09/09/2019] [Accepted: 09/14/2019] [Indexed: 12/22/2022]
Abstract
Coxsackievirus A6 (CV-A6) has been associated with increasingly occurred sporadic hand-foot-mouth disease (HFMD) cases and outbreak events in many countries. In order to understand epidemiological characteristics of CV-A6, we collected the information describing HFMD caused by CV-A6 to describe the detection rate, severe rate and onychomadesis rate, which is defined as one or more nails defluvium, caused by CV-A6 from 2007 to 2017. The results showed that there was an outbreak of CV-A6 every other year, and overall trend of the epidemic of CA6-associated HFMD was increasing in China. The detection rate of CV-A6 in other countries was 32.0% (95% CI: 25.0%~40.0%) before 2013 and 28.0% (95% CI: 20.0%~36.0%) after 2013, respectively. Although the severe rate of HFMD caused by CV-A6 was low (0.10%, 95% CI: 0.01%~0.20%), CV-A6 can cause a high incidence of onychomadesis (28.0%, 95%CI: 21.9%-34.3%). Thus, it would be worthwhile to research and develop an effective multivalent vaccine for CV-A6 to achieve a more powerful prevention of HMFD.
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Affiliation(s)
- Tian-Shuo Zhao
- Department of Laboratorial Science and Technology, School of Public Health, Peking University, Beijing, People's Republic of China.,Vaccine Research Center, School of Public Health, Peking University, Beijing, People's Republic of China
| | - Juan Du
- Department of Laboratorial Science and Technology, School of Public Health, Peking University, Beijing, People's Republic of China.,Vaccine Research Center, School of Public Health, Peking University, Beijing, People's Republic of China
| | - Da-Peng Sun
- Institute for Viral Disease Control and Prevention, Shandong Provincial Key Laboratory of Communicable Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, People's Republic of China
| | - Quan-Rong Zhu
- Department of Laboratorial Science and Technology, School of Public Health, Peking University, Beijing, People's Republic of China.,Vaccine Research Center, School of Public Health, Peking University, Beijing, People's Republic of China
| | - Lin-Yi Chen
- Department of Laboratorial Science and Technology, School of Public Health, Peking University, Beijing, People's Republic of China.,Vaccine Research Center, School of Public Health, Peking University, Beijing, People's Republic of China
| | - Chen Ye
- Department of Laboratorial Science and Technology, School of Public Health, Peking University, Beijing, People's Republic of China.,Vaccine Research Center, School of Public Health, Peking University, Beijing, People's Republic of China
| | - Shuai Wang
- Department of Laboratorial Science and Technology, School of Public Health, Peking University, Beijing, People's Republic of China.,Vaccine Research Center, School of Public Health, Peking University, Beijing, People's Republic of China
| | - Ya-Qiong Liu
- Department of Laboratorial Science and Technology, School of Public Health, Peking University, Beijing, People's Republic of China.,Vaccine Research Center, School of Public Health, Peking University, Beijing, People's Republic of China
| | - Fuqiang Cui
- Department of Laboratorial Science and Technology, School of Public Health, Peking University, Beijing, People's Republic of China.,Vaccine Research Center, School of Public Health, Peking University, Beijing, People's Republic of China
| | - Qing-Bin Lu
- Department of Laboratorial Science and Technology, School of Public Health, Peking University, Beijing, People's Republic of China.,Vaccine Research Center, School of Public Health, Peking University, Beijing, People's Republic of China
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24
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Han Z, Zhang Y, Huang K, Wang J, Tian H, Song Y, Yang Q, Yan D, Zhu S, Yao M, Wang X, Xu W. Two Coxsackievirus B3 outbreaks associated with hand, foot, and mouth disease in China and the evolutionary history worldwide. BMC Infect Dis 2019; 19:466. [PMID: 31126252 PMCID: PMC6534883 DOI: 10.1186/s12879-019-4107-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Accepted: 05/17/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Coxsackievirus B3 (CV-B3) is usually associated with aseptic meningitis and myocarditis; however, the association between CV-B3 and hand, foot, and mouth disease (HFMD) has not been clearly demonstrated, and the phylogenetic dynamics and transmission history of CV-B3 have not been well summarized. METHOD Two HFMD outbreaks caused by CV-B3 were described in Hebei Province in 2012 and in Shandong Province in 2016 in China. To analyze the epidemiological features of two CV-B3 outbreaks, a retrospective analysis was conducted. All clinical specimens from CV-B3 outbreaks were collected and disposed according to the standard procedures supported by the WHO Global Poliovirus Specialized Laboratory. EV genotyping and phylogenetic analysis were performed to illustrate the genetic characteristics of CV-B3 in China and worldwide. RESULTS Two transmissible lineages (lineage 2 and 3) were observed in Northern China, which acted as an important "reservoir" for the transmission of CV-B3. Sporadic exporting and importing of cases were observed in almost all regions. In addition, the global sequences of CV-B3 showed a tendency of geographic-specific clustering, indicating that geographic-driven adaptation plays a major role in the diversification and evolution of CV-B3. CONCLUSIONS Overall, our study indicated that CV-B3 is a causative agent of HFMD outbreak and revealed the phylogenetic dynamics of CV-B3 worldwide, as well as provided an insight on CV-B3 outbreaks for effective intervention and countermeasures.
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Affiliation(s)
- Zhenzhi Han
- WHO WPRO Regional Polio Reference Laboratory and National Health Commission Key Laboratory of biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing, 102206, People's Republic of China
| | - Yong Zhang
- WHO WPRO Regional Polio Reference Laboratory and National Health Commission Key Laboratory of biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing, 102206, People's Republic of China.
| | - Keqiang Huang
- WHO WPRO Regional Polio Reference Laboratory and National Health Commission Key Laboratory of biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing, 102206, People's Republic of China
| | - Jianxing Wang
- Shandong Center for Disease Control and Prevention, Jinan City, Shandong Province, People's Republic of China
| | - Huifang Tian
- Shijiazhuang Center for Disease Control and Prevention, Shijiazhuang City, Hebei Province, People's Republic of China
| | - Yang Song
- WHO WPRO Regional Polio Reference Laboratory and National Health Commission Key Laboratory of biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing, 102206, People's Republic of China
| | - Qian Yang
- WHO WPRO Regional Polio Reference Laboratory and National Health Commission Key Laboratory of biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing, 102206, People's Republic of China
| | - Dongmei Yan
- WHO WPRO Regional Polio Reference Laboratory and National Health Commission Key Laboratory of biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing, 102206, People's Republic of China
| | - Shuangli Zhu
- WHO WPRO Regional Polio Reference Laboratory and National Health Commission Key Laboratory of biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing, 102206, People's Republic of China
| | - Mingxiao Yao
- Shandong Center for Disease Control and Prevention, Jinan City, Shandong Province, People's Republic of China
| | - Xianjun Wang
- Shandong Center for Disease Control and Prevention, Jinan City, Shandong Province, People's Republic of China
| | - Wenbo Xu
- WHO WPRO Regional Polio Reference Laboratory and National Health Commission Key Laboratory of biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing, 102206, People's Republic of China.,Anhui University of Science and Technology, Hefei City, Anhui Province, People's Republic of China
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25
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Wang M, Li J, Yao MX, Zhang YW, Hu T, Carr MJ, Duchêne S, Zhang XC, Zhang ZJ, Zhou H, Tong YG, Ding SJ, Wang XJ, Shi WF. Genome Analysis of Coxsackievirus A4 Isolates From Hand, Foot, and Mouth Disease Cases in Shandong, China. Front Microbiol 2019; 10:1001. [PMID: 31134033 PMCID: PMC6513881 DOI: 10.3389/fmicb.2019.01001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/18/2019] [Indexed: 01/12/2023] Open
Abstract
Coxsackievirus A4 (CVA4) is one of the most prevalent pathogens associated with hand, foot and mouth disease (HFMD), an acute febrile illness in children, and is also associated with acute localized exanthema, myocarditis, hepatitis and pancreatitis. Despite this, limited CVA4 genome sequences are currently available. Herein, complete genome sequences from CVA4 strains (n = 21), isolated from patients with HFMD in Shandong province, China between 2014 and 2016, were determined and phylogenetically characterized. Phylogenetic analysis of the VP1 gene from a larger CVA4 collection (n = 175) showed that CVA4 has evolved into four separable genotypes: A, B, C, and D; and genotype D could be further classified in to two sub-genotypes: D1 and D2. Each of the 21 newly described genomes derived from isolates that segregated with sub-genotype D2. The CVA4 genomes displayed significant intra-genotypic genetic diversity with frequent synonymous substitutions occurring at the third codon positions, particularly within the P2 region. However, VP1 was relatively stable and therefore represents a potential target for molecular diagnostics assays and also for the rational design of vaccine epitopes. The substitution rate of VP1 was estimated to be 5.12 × 10-3 substitutions/site/year, indicative of ongoing CVA4 evolution. Mutations at amino acid residue 169 in VP1 gene may be responsible for differing virulence of CVA4 strains. Bayesian skyline plot analysis showed that the population size of CVA4 has experienced several dynamic fluctuations since 1948. In summary, we describe the phylogenetic and molecular characterization of 21 complete genomes from CVA4 isolates which greatly enriches the known genomic diversity of CVA4 and underscores the need for further surveillance of CVA4 in China.
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Affiliation(s)
- Min Wang
- Key Laboratory of Etiology and Epidemiology of Emerging Infectious Diseases in Universities of Shandong, Taishan Medical College, Tai'an, China
| | - Juan Li
- Key Laboratory of Etiology and Epidemiology of Emerging Infectious Diseases in Universities of Shandong, Taishan Medical College, Tai'an, China
| | - Ming-Xiao Yao
- Shandong Provincial Key Laboratory of Communicable Disease Control and Prevention, Institute for Viral Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Ya-Wei Zhang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Tao Hu
- Key Laboratory of Etiology and Epidemiology of Emerging Infectious Diseases in Universities of Shandong, Taishan Medical College, Tai'an, China
| | - Michael J Carr
- Global Station for Zoonosis Control, Global Institution for Collaborative Research and Education, Hokkaido University, Sapporo, Japan.,National Virus Reference Laboratory, School of Medicine, University College Dublin, Dublin, Ireland
| | - Sebastián Duchêne
- Department of Biochemistry and Molecular Biology, Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Parkville, VIC, Australia
| | - Xing-Cheng Zhang
- Key Laboratory of Etiology and Epidemiology of Emerging Infectious Diseases in Universities of Shandong, Taishan Medical College, Tai'an, China
| | - Zhen-Jie Zhang
- Key Laboratory of Etiology and Epidemiology of Emerging Infectious Diseases in Universities of Shandong, Taishan Medical College, Tai'an, China
| | - Hong Zhou
- Key Laboratory of Etiology and Epidemiology of Emerging Infectious Diseases in Universities of Shandong, Taishan Medical College, Tai'an, China
| | - Yi-Gang Tong
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Shu-Jun Ding
- Shandong Provincial Key Laboratory of Communicable Disease Control and Prevention, Institute for Viral Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Xian-Jun Wang
- Shandong Provincial Key Laboratory of Communicable Disease Control and Prevention, Institute for Viral Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Wei-Feng Shi
- Key Laboratory of Etiology and Epidemiology of Emerging Infectious Diseases in Universities of Shandong, Taishan Medical College, Tai'an, China
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26
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High Permissiveness for Genetic Exchanges between Enteroviruses of Species A, including Enterovirus 71, Favors Evolution through Intertypic Recombination in Madagascar. J Virol 2019; 93:JVI.01667-18. [PMID: 30602612 DOI: 10.1128/jvi.01667-18] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 12/18/2018] [Indexed: 12/30/2022] Open
Abstract
Human enteroviruses of species A (EV-A) are the leading cause of hand-foot-and-mouth disease (HFMD). EV-A71 is frequently implicated in HFMD outbreaks and can also cause severe neurological manifestations. We investigated the molecular epidemiological processes at work and the contribution of genetic recombination to the evolutionary history of EV-A in Madagascar, focusing on the recently described EV-A71 genogroup F in particular. Twenty-three EV-A isolates, collected mostly in 2011 from healthy children living in various districts of Madagascar, were characterized by whole-genome sequencing. Eight different types were identified, highlighting the local circulation and diversity of EV-A. Comparative genome analysis revealed evidence of frequent recent intra- and intertypic genetic exchanges between the noncapsid sequences of Madagascan EV-A isolates. The three EV-A71 isolates had different evolutionary histories in terms of recombination, with one isolate displaying a mosaic genome resulting from recent genetic exchanges with Madagascan coxsackieviruses A7 and possibly A5 and A10 or common ancestors. The engineering and characterization of recombinants generated from progenitors belonging to different EV-A types or EV-A71 genogroups with distantly related nonstructural sequences indicated a high level of permissiveness for intertypic genetic exchange in EV-A. This permissiveness suggests that the primary viral functions associated with the nonstructural sequences have been highly conserved through the diversification and evolution of the EV-A species. No outbreak of disease due to EV-A has yet been reported in Madagascar, but the diversity, circulation, and evolution of these viruses justify surveillance of EV-A circulation and HFMD cases to prevent possible outbreaks due to emerging strains.IMPORTANCE Human enteroviruses of species A (EV-A), including EV-A71, are the leading cause of hand-foot-and-mouth disease (HFMD) and may also cause severe neurological manifestations. We investigated the circulation and molecular evolution of EV-A in Madagascar, focusing particularly on the recently described EV-A71 genogroup F. Eight different types, collected mostly in 2011, were identified, highlighting the local circulation and diversity of EV-A. Comparative genome analysis revealed evidence of frequent genetic exchanges between the different types of isolates. The three EV-A71 isolates had different evolutionary histories in terms of recombination. The engineering and characterization of recombinants involving progenitors belonging to different EV-A types indicated a high degree of permissiveness for genetic exchange in EV-A. No outbreak of disease due to EV-A has yet been reported in Madagascar, but the diversity, circulation, and evolution of these viruses justify the surveillance of EV-A circulation to prevent possible HFMD outbreaks due to emerging strains.
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27
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Anh NT, Nhu LNT, Van HMT, Hong NTT, Thanh TT, Hang VTT, Ny NTH, Nguyet LA, Phuong TTL, Nhan LNT, Hung NT, Khanh TH, Tuan HM, Viet HL, Nam NT, Viet DC, Qui PT, Wills B, Sabanathan S, Chau NVV, Thwaites L, Rogier van Doorn H, Thwaites G, Rabaa MA, Van Tan L. Emerging Coxsackievirus A6 Causing Hand, Foot and Mouth Disease, Vietnam. Emerg Infect Dis 2019; 24:654-662. [PMID: 29553326 PMCID: PMC5875260 DOI: 10.3201/eid2404.171298] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Hand, foot and mouth disease (HFMD) is a major public health issue in Asia and has global pandemic potential. Coxsackievirus A6 (CV-A6) was detected in 514/2,230 (23%) of HFMD patients admitted to 3 major hospitals in southern Vietnam during 2011–2015. Of these patients, 93 (18%) had severe HFMD. Phylogenetic analysis of 98 genome sequences revealed they belonged to cluster A and had been circulating in Vietnam for 2 years before emergence. CV-A6 movement among localities within Vietnam occurred frequently, whereas viral movement across international borders appeared rare. Skyline plots identified fluctuations in the relative genetic diversity of CV-A6 corresponding to large CV-A6–associated HFMD outbreaks worldwide. These data show that CV-A6 is an emerging pathogen and emphasize the necessity of active surveillance and understanding the mechanisms that shape the pathogen evolution and emergence, which is essential for development and implementation of intervention strategies.
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28
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Nikolaidis M, Mimouli K, Kyriakopoulou Z, Tsimpidis M, Tsakogiannis D, Markoulatos P, Amoutzias GD. Large-scale genomic analysis reveals recurrent patterns of intertypic recombination in human enteroviruses. Virology 2019; 526:72-80. [DOI: 10.1016/j.virol.2018.10.006] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 10/04/2018] [Accepted: 10/04/2018] [Indexed: 12/21/2022]
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Severe atypical hand-foot-and-mouth disease in adults due to coxsackievirus A6: Clinical presentation and phylogenesis of CV-A6 strains. J Clin Virol 2018; 110:1-6. [PMID: 30472520 DOI: 10.1016/j.jcv.2018.11.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 11/10/2018] [Accepted: 11/16/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Typically, hand-foot-and-mouth disease (HFMD) is a mild childhood illness associated with coxsackievirus (CV)-A16, CV-A6, enterovirus (EV)-A71. OBJECTIVES To identify the viral agents associated with severe cases of atypical HFMD in Italy. STUDY DESIGN Epidemiologically unrelated cases of severe atypical HFMD admitted to the Emergency Room (ER) of IRCCS San Martino IST (Genoa, Italy) in 2014-2016 were investigated. Serologic screening for viral positivity was performed against exanthem-inducing agents. Ten cases with serology indicative of recent EV infection were selected. Molecular assays were used to detect viral genomes in blood [EVs, Parvovirus B19 (PVB19), herpesviruses (CMV; EBV, HHV-6, -7, -8)]. RESULTS CV-A6 was detected in 10 cases of severe atypical HFMD. Two cases were also infected with PVB19. Herpesviruses were not detected. Phylogenetic analysis mapped the CV-A6 strains into a single cluster related to two recent isolates from a German and an Asian child. Fever, systemic symptoms, severe vasculitis-like rash, and enanthem were predominant at presentation. Spontaneous recovery occurred in 1-3 weeks. CONCLUSIONS CV-A6 is emerging as a frequent cause of severe atypical HFMD in Italian adults. This viral agent is disseminating worldwide. Dermatologists must identify the manifold alterations caused by EVs and understand the diagnostic power of current virology methods.
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Molecular epidemiology of coxsackievirus A6 circulating in Hong Kong reveals common neurological manifestations and emergence of novel recombinant groups. J Clin Virol 2018; 108:43-49. [PMID: 30237097 DOI: 10.1016/j.jcv.2018.09.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 08/21/2018] [Accepted: 09/07/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Coxsackievirus A6 (CV-A6) represents the predominant enterovirus serotype in Hong Kong, but its epidemiology in our population was unknown. OBJECTIVES To examine the clinical and molecular epidemiology of CV-A6 and detect emerging recombinant strains in Hong Kong. STUDY DESIGN Nasopharyngeal aspirates (NPAs) from patients with febrile or respiratory illness were subject to RT-PCR for CV-A6 and sequencing of 5'-NCR and VP1. CV-A6-positive samples were further subject to 2C and 3D gene sequencing. Complete genome sequencing was performed on potential recombinant strains. RESULTS Thirty-six (0.35%) NPAs were positive for CV-A6 by 5'-NCR RT-PCR and sequencing, 28 of which confirmed by partial VP1 gene sequencing. Among the 28 patients (mainly young children) with CV-A6 infection, hand-foot-and-mouth disease (HFMD) (43%), herpangina (18%) and tonsillitis (11%) were the most common diagnoses. Seven (25%) patients had neurological manifestations, including febrile seizures, encephalitis and meningitis. VP1 gene analysis showed that 24 CV-A6 strains circulating in Hong Kong belonged to genotype D5, while 4 strains belonged to D4. Further 2C and 3D gene analysis revealed eight potential recombinant strains. Genome sequencing of five selected strains confirmed four recombinant strains: HK459455/2013 belonging to recombination group RJ arisen from CV-A6/CV-A4, HK458288/2015 and HK446377/2015 representing novel group RL arisen from CV-A6/CV-A4, and HK462069/2015 representing novel group RM arisen from CV-A6/EV-A71. Recombination breakpoints located at 3D were identified in the latter three recombinant strains, with HK462069/2015 (from a child with encephalitis) having acquired 3D region from EV-A71. CONCLUSIONS We identified novel recombinant CV-A6 strains in Hong Kong, with 3D being a common recombination site.
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31
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Lukashev AN, Vakulenko YA, Turbabina NA, Deviatkin AA, Drexler JF. Molecular epidemiology and phylogenetics of human enteroviruses: Is there a forest behind the trees? Rev Med Virol 2018; 28:e2002. [PMID: 30069956 DOI: 10.1002/rmv.2002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 06/28/2018] [Accepted: 07/01/2018] [Indexed: 11/05/2022]
Abstract
Enteroviruses are among the best studied small non-enveloped enteric RNA viruses. Most enteroviruses are easy to isolate in cell culture, and many non-polio enterovirus strains were archived worldwide as a byproduct of the WHO poliovirus surveillance system. Common outbreaks and epidemics, most prominently the epidemic of hand-foot-and-mouth disease with severe neurological complications in East and South-East Asia, justify practical interest of non-polio enteroviruses. As a result, there are over 50 000 enterovirus nucleotide sequences available in GenBank. Technical possibilities have been also improving, as Bayesian phylogenetic methods with an integrated molecular clock were introduced a decade ago and provided unprecedented opportunities for phylogenetic analysis. As a result, hundreds of papers were published on the molecular epidemiology of enteroviruses. This review covers the modern methodology, structure, and biases of the sequence dataset available in GenBank. The relevance of the subtype classification, findings of co-circulation of multiple genetic variants, previously unappreciated complexity of viral populations, and global evolutionary patterns are addressed. The most relevant conclusions and prospects for further studies on outbreak emergence mechanisms are discussed.
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Affiliation(s)
- Alexander N Lukashev
- Martsinovsky Institute of Medical Parasitology, Tropical and Vector Borne Diseases, Sechenov University, Moscow, Russia.,Chumakov Federal Scientific Center for Research and Development of Immune-and-Biological Preparations, Moscow, Russia
| | - Yulia A Vakulenko
- Martsinovsky Institute of Medical Parasitology, Tropical and Vector Borne Diseases, Sechenov University, Moscow, Russia.,Virology Department, Biological Faculty, Lomonosov Moscow State University, Moscow, Russia
| | - Natalia A Turbabina
- Martsinovsky Institute of Medical Parasitology, Tropical and Vector Borne Diseases, Sechenov University, Moscow, Russia
| | | | - Jan Felix Drexler
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Institute of Virology, Berlin, Germany
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32
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Divergent Pathogenic Properties of Circulating Coxsackievirus A6 Associated with Emerging Hand, Foot, and Mouth Disease. J Virol 2018; 92:JVI.00303-18. [PMID: 29563294 DOI: 10.1128/jvi.00303-18] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/16/2018] [Indexed: 12/18/2022] Open
Abstract
Coxsackievirus A6 (CV-A6) is an emerging pathogen associated with hand, foot, and mouth disease (HFMD). Its genetic characterization and pathogenic properties are largely unknown. Here, we report 39 circulating CV-A6 strains isolated in 2013 from HFMD patients in northeast China. Three major clusters of CV-A6 were identified and related to CV-A6, mostly from Shanghai, indicating that domestic CV-A6 strains were responsible for HFMD emerging in northeast China. Four full-length CV-A6 genomes representing each cluster were sequenced and analyzed further. Bootscanning tests indicated that all four CV-A6-Changchun strains were most likely recombinants between the CV-A6 prototype Gdula and prototype CV-A4 or CV-A4-related viruses, while the recombination pattern was related to, yet distinct from, the strains isolated from other regions of China. Furthermore, different CV-A6 strains showed different capabilities of viral replication, release, and pathogenesis in a mouse model. Further analyses indicated that viral protein 2C contributed to the diverse pathogenic abilities of CV-A6 by causing autophagy and inducing cell death. To our knowledge, this study is the first to report lethal and nonlethal strains of CV-A6 associated with HFMD. The 2C protein region may play a key role in the pathogenicity of CV-A6 strains.IMPORTANCE Hand, foot, and mouth disease (HFMD) is a major and persistent threat to infants and children. Besides the most common pathogens, such as enterovirus A71 (EV-A71) and coxsackievirus A16 (CV-A16), other enteroviruses are increasingly contributing to HFMD. The present study focused on the recently emerged CV-A6 strain. We found that CV-A6 strains isolated in Changchun City in northeast China were associated with domestic origins. These Changchun viruses were novel recombinants of the CV-A6 prototype Gdula and CV-A4. Our results imply that measures to control CV-A6 transmission are urgently needed. Further analyses revealed differing pathogenicities in strains isolated in a neonatal mouse model. One of the possible causes has been narrowed down to the viral protein 2C, using phylogenetic studies, viral sequences, and direct tests on cultured human cells. Thus, the viral 2C protein is a promising target for antiviral drugs to prevent CV-A6-induced tissue damage.
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