Analysis of enterovirus infection type among acute respiratory tract infection cases in Luohe City, Henan Province from 2017 to 2021 / 中华预防医学杂志

Objective: To understand the infection status of Enterovirus (EV) in cases of acute respiratory infections (ARIs) in Luohe City, Henan Province from 2017 to 2021, and analyze the prevalence and type composition of EV in ARIs. Methods: From October 2017 to May 2021, pharyngeal swab samples were collected from 1 828 patients with ARIs in Luohe Central Hospital and the clinical epidemiological data of these cases were also collected. EV-positive samples were identified by Quantitative Real-time Polymerase Chain Reaction (qPCR). The 5'-untranslated region (5'UTR) was amplified by Reverse Transcription-Polymerase Chain Reaction (RT-PCR). The results of 5'UTR region were initially typed by Enterovirus Genotyping Tool Version 1.0. Based on the typing results, the full-length of VP1 region was amplified by RT-PCR. The EV typing was identified again by VP1 region. Results: Among 1 828 cases of ARIs, 56.7% (1 036) were males. The median (Q1, Q3) age was about 3 (1, 5) years. Patients under 5 years old accounted for 71.6% (1 309 cases). Among all cases, a total of 71 EV-positive samples were identified by qPCR, with a detection rate of 3.88% (71/1 828). The EV detection rates for men and women were 3.28% (34/1 036) and 4.67% (37/792), without statistically significant differences (χ2=2.32, P=0.14). The EV detection rates for 2 to <6 years, 6 months to <2 years, 6 to <10 years, and <6 months were 6.29% (48/763), 3.00% (18/600), 2.52% (4/159), and 1.67% (1/60) (χ2=27.91, P<0.001). The EV detection rate was 0.92% (3/326) in autumn and winter of 2017. The EV detection rates were 1.18% (6/508), 2.47% (12/485) and 8.31% (34/409) in each year from 2018 to 2020, with an increasing trend year by year(χ2trend=29.76, P<0.001). The main prevalent seasons were summer and autumn. The detection rate in spring of 2021 was 4.00% (4/100). A total of 12 types were identified and classified as CVA2, CVA4, CVA5, CVA6, CVA10, CVB3, CVB5, E5, E11, E30, PV-1, and EV-D68. The types of CVA2, CVA10, CVA6, and CVB3 were the dominant phenotypes. In 59 sample of EV typing, the main clinical manifestation was upper respiratory tract infection (36/59, 61.01%). The dominant types detected in upper respiratory tract infections were CVA10 (10/36, 27.78%), CVA6 (9/36, 25.00%) and CVB3 (8/36, 22.22%). The dominant type detected in lower respiratory tract infections was CVA2 (7/19, 36.84%). Conclusion: In Luohe City, Henan Province from 2017 to 2021, EV infection in ARIs cases has clear seasonal and age-specific patterns, and the dominant types of upper and lower respiratory tract infections are different.

Epidemiological characteristics of hand, foot and mouth disease among people aged 6 and over in Beijing, 2011-2020 / 中华流行病学杂志

Objective: To analyze the epidemiological characteristics of hand, foot and mouth disease (HFMD) among people ≥6 years old in Beijing from 2011 to 2020. Methods: The incidence data of HFMD cases from 2011 to 2020 were collected from the National Notifiable Infectious Disease Reporting System of China Information for Disease Control and Prevention and the etiological surveillance of HFMD in 29 sentinel hospitals from 16 districts of Beijing. Descriptive epidemiological methods were used to analyze the distributions, pathogen constituents, and changes of HFMD cases in Beijing people ≥6 years old. Results: From 2011 to 2020, a total of 38 183 cases of HFMD were reported among people ≥6 years old in Beijing, of which 46 (0.12%) cases were severe. The average annual reported incidence was 19.04/100 000. The ratio of males to females were 1.37∶1(22 064∶16 119). The proportion of HFMD in people ≥6 years old increased from 7.56%(2 606/34 488) in 2011 to 24.54% (546/2 225) in 2020. The average incidence of HFMD was higher in Shunyi district, Yanqing district, and Tongzhou district than in other districts in Beijing. The positive rate of enterovirus in sentinel surveillance was 66.78% (1 976/2 959), the proportion of enterovirus group A 71 (EV-A71) was 45.29% (101/223) in 2014, no EV-A71 positive was detected in 2020, and the proportion of Coxsackievirus A 6 (CV-A6) increased from 15.11% (34/225) in 2016 to 81.08% (60/74) in 2020. Conclusions: From 2011 to 2020, the proportion of cases with HFMD in people ≥6 years old in Beijing increased yearly, and the proportion of EV-A71 positive patients decreased basically. Since 2016, CV-A6 has gradually become the dominant pathogen. More attention should be paid to the epidemic situation and dynamic pathogen changes of hand foot mouth disease in people ≥6 years old.

Meningoencefalitis: etiología infecciosa en pacientes pediátricos de un hospital de referencia / Meningoencephalitis: infectious etiology in pediatric patients at a reference hospital

Resumen Introducción: Las causas de meningoencefalitis, meningitis o encefalitis pueden ser infecciosas o no infecciosas. Para el diagnóstico microbiológico se requieren cultivos y pruebas moleculares. El objetivo del estudio fue describir las causas infecciosas de meningoencefalitis y su presentación clínica. Métodos: Estudio transversal realizado en el Hospital Civil de Guadalajara Dr. Juan I. Menchaca. Se incluyeron pacientes mayores de 28 días de vida con síndrome de meningitis, encefalitis o meningoencefalitis. Se identificó la etiología infecciosa mediante cultivos, tinciones de Gram y pruebas moleculares de líquido cefalorraquídeo. Se compararon las características de pacientes con y sin diagnóstico etiológico. Resultados: Se incluyeron en el estudio 50 pacientes con meningoencefalitis (n = 25), meningitis (n = 19) o encefalitis (n = 6). La mediana de edad fue de un año y el 62% de los pacientes fueron de sexo masculino. Se realizó diagnóstico etiológico infeccioso en el 42%: el 65.2% (n = 15) se debió a virus y el 34.8% (n = 8) a bacterias. En los pacientes con diagnóstico etiológico, se presentó un mayor número de leucocitos en líquido cefalorraquídeo (92 leu/mm3 vs. 12 leu/mm3, p = 0.001). Fue más frecuente el antecedente de gastroenteritis (razón de momios [RM]: 3.5; intervalo de confianza al 95% [IC 95%]: 1.007-12.1; p = 0.04) y ante la exploración, fue más frecuente la rigidez de cuello (RM: 3.8; IC 95%: 1-15.2; p = 0.04). Conclusiones: El 42% de los pacientes con meningitis, encefalitis o meningoencefalitis tuvieron diagnóstico etiológico infeccioso. La causa más frecuente fue el enterovirus.

Abstract Background: The etiologies of meningoencephalitis, meningitis or encephalitis may be infectious or non-infectious. For the microbiological diagnosis it is necessary to perform cultures and molecular tests. The objective of this study was to describe the infectious causes of meningoencephalitis and their clinical presentation. Methods: Cross-sectional study performed at the Hospital Civil de Guadalajara Dr. Juan I. Menchaca. Patients older than 28 days of life with meningitis, encephalitis or meningoencephalitis syndrome were included in the study. Infectious etiology was identified through cultures, Gram stains, and molecular tests of cerebrospinal fluid. The characteristics of patients with and without etiological diagnosis were compared. Results: Fifty patients with meningoencephalitis (n = 25), meningitis (n = 19) or encephalitis (n = 6) were included in the study. The mean age was one year and 62% were male. An infectious etiological diagnosis was performed in 42%; 65.2 % (n = 15) were viruses and 34.8% (n = 8) bacteria. In patients with etiological diagnosis, a higher number of leukocytes were found in cerebrospinal fluid (92 leu/mm3 vs. 12 leu/mm3, p = 0.001); the history of gastroenteritis was more frequent (odds ratio [OR]: 3.5; 95% confidence interval (CI): 1.007-12.1; p = 0.04) and upon examination, neck stiffness was more common (OR: 3.8; 95% CI: 1-15.2; p = 0.04). Conclusions: 42 % of the patients with meningitis, encephalitis or meningoencephalitis had an infectious etiological diagnosis; the most frequent cause was enterovirus.

Virus más frecuentemente aislados en la exacerbación de asma y su correlación con nivelesde eosinófilos e inmunoglobulina E sérica total / Most commonly isolated viruses in asthma exacerbation and their correlation with eosinophil and total serum immunoglobulin E levels

Antecedentes. Las exacerbaciones de asma continúan siendo una causa de hospitalización en el Servicio de Urgencias. Los desencadenantesson alérgenos e infecciones, principalmente, de tipo viral. El objetivo fue determinar la relación entre los virus detectados durante la exacerbación asmática y los niveles de eosinófilos e inmunoglobulina E (IgE) sérica en pacientes pediátricos. Población y métodos. Estudio transversal analítico. Se incluyeron niños de cinco a quince años atendidos en Urgencias de Pediatría con exacerbación de asma, en el período de marzo de 2013 a febrero de 2016. Se obtuvo ácido ribonucleico viral en el aspirado nasofaríngeo con el kit CLART PneumoVir. Se cuantificaron los eosinófilos en la sangre periférica y los niveles de IgE sérica total. Se consideró eosinofilia un conteo ≥ 0,4 x 103/mm3 e IgE elevada, ≥ 350 UI/L. Se realizó la correlación de Pearson. Se definió significancia con valor de p ≤ 0,05.Resultados. De 211 niños con exacerbación de asma, en el 20%, se aisló un virus. Los virus aislados más frecuentemente fueron el rinovirus, el enterovirus y el virus sincitial respiratorio. Se encontró una correlación entre los niveles de eosinófilos e IgE sérica total en los niños con exacerbación de asma y rinovirus de 0,89, con una p= 0,0001.Conclusiones. Las infecciones por rinovirus, enterovirus y virus sincitial respiratorio son más frecuentes en las exacerbaciones de asma en menores de 15 años. Se observó una correlación entre los niveles de eosinófilos e IgE en presencia de rinovirus.

Background. Asthma exacerbations are still a cause of hospitalization at the Emergency Department. The triggers of asthma exacerbations include allergens and infections ­mostly viral­. The objective of this study was to establish the relationship between viruses detected during an asthma exacerbation and eosinophil and serum immunoglobulin E (IgE) levels in pediatric patients. Population and methods. Cross-sectional. analytical study. Children aged 5-15 years seen at the Pediatric Emergency Department with an asthma exacerbation in the period between March 2013 and February 2016 were included. Viral ribonucleic acid was extracted from nasopharyngeal aspirates using the CLART Pneumo Vir kit. Eosinophil levels were measured in peripheral blood and total IgE levels, in serum. Eosinophilia was defined as a count ≥ 0.4 x 103/mm3 and high IgE. as a level ≥ 350 IU/L. The Pearson's correlation was carried out. A value of p ≤ 0.05 was considered significant.Results. Out of 211 children with asthma exacerbation, a virus was isolated in 20%. The most commonly isolated viruses were rhinovirus. enterovirus, and respiratory syncytial virus. A correlation of 0.89 was established between eosinophil and total serum IgE levels in children with asthma exacerbation and rhinovirus, with a p value of 0.0001. Conclusions. Rhinovirus, enterovirus, and respiratory syncytial virus were the most common viruses in asthma exacerbations in children younger than 15 years. A correlation was established between eosinophil and IgE levels in the presence of rhinovirus.

Vigilancia epidemiológica para la identificación de casos de infección respiratoria aguda por enterovirus D68 en niños en un hospital de tercer nivel de atención durante 2014-2016 / Surveillance for the identification of cases of acute respiratory infection by enterovirus D68 in children in a tertiary level care hospital during 2014-2016

Resumen Introducción: La reemergencia de las infecciones por Enterovirus D68 (EV-D68) se reportó en los EE.UU. desde agosto-octubre de 2014 (691 casos). En México, un brote se reportó en el Instituto Nacional de Enfermedades Respiratorias (24 casos). Se presentan los resultados de la vigilancia epidemiológica en un hospital pediátrico nacional de tercer nivel para Enterovirus sp. (EV) y otros virus respiratorios. Método: Tras la alerta emitida por la reemergencia del EV-D68 en 2014, la vigilancia epidemiológica -que solo detectaba virus respiratorios mediante PCR en pacientes con enfermedad tipo influenza mediante toma de hisopados nasofaríngeos- se expandió para incluir niños con exacerbación de asma o dificultad respiratoria aguda. Las muestras positivas para EV fueron confirmadas y tipificadas por secuenciación. Posteriormente, se utilizó secuenciación de siguiente generación para obtener el genoma viral completo. Resultados: De 1705 muestras, 13 fueron positivas para EV. Los pacientes con EV presentaron la siguiente comorbilidad: enfermedad pulmonar crónica (7.7%), enfermedad neoplásica (15.4%), asma/rinitis alérgica (23%), neumonías de repetición (23%), y otras (23%). De las 13 muestras positivas para EV, tres resultaron positivas para EV-D68. Dichos casos requirieron ventilación mecánica invasiva, no tuvieron afectación neurológica y sobrevivieron. Conclusiones: La afectación por EV-D68 de la población estudiada fue menor que lo reportado en México durante el mismo periodo. Los casos de infección por EV-D68 presentan diversa comorbilidad, aunque escasas enfermedades pulmonares, lo cual pudiera explicar la baja tasa de ataque. La presencia del sistema de vigilancia epidemiológica establecido y la prevención de infecciones pudieron haber contenido el brote.

Abstract Background: The reemergence of enterovirus D68 (EV-D68) infections in the United States was reported from August-October 2014 (691 cases). In Mexico, an outbreak at the National Institute of Respiratory Diseases was reported (24 cases). The results of epidemiological surveillance of Enterovirus sp. (EV) and other respiratory viruses in a national pediatric tertiary care level hospital are presented. Methods: Following the alert issued by the reemergence of EV-D68 in 2014, epidemiological surveillance -which only detected respiratory viruses by PCR in patients with influenza-like illness using nasopharyngeal swabs- expanded to include children with asthma exacerbation or acute respiratory distress. Positive samples to EV were confirmed and typed by sequencing. Subsequent sequencing was used to obtain the complete viral genome. Results: Of 1705 samples, 13 were positive to EV. Patients with EV presented the following comorbidities: chronic lung disease (7.7%), neoplastic disease (15.4%), allergic asthma/rhinitis (23%), recurrent pneumonia (23%), and other (23%). Of the 13 samples positive for EV, three were positive for EV-D68. These cases required invasive mechanical ventilation, presented no neurological involvement and survived. Conclusions: The impact of the population studied by EV-D68 was lower than that reported in Mexico during the same period. Cases of EV-D68 infection had multiple comorbidities, but few pulmonary comorbidities, which could explain the low attack rate. The epidemiological surveillance and infection prevention system may have contained the outbreak.

First reported enterovirus D68 infection in pediatric patients from the Caribbean region: evidence of spread from the U.S. outbreak / Primeros casos notificados en el Caribe de infección por enterovirus D68 en pacientes pediátricos: pruebas de la propagación del brote de los Estados Unidos

ABSTRACT The 2014 enterovirus D68 (EV-D68) outbreak in the United States raised concerns about the introduction of the virus in the Caribbean region. The objective of this study was to provide rapid evidence of the introduction of EV-D68 strains in the Caribbean region during the 2014 outbreak in the United States, using a relatively simple phylogenetic approach. From October 2014 to May 2015, four EV-D68 cases from two countries (Bermuda and Dominica) were detected at the regional referral laboratory at the Caribbean Public Health Agency (Port of Spain, Trinidad and Tobago) based on molecular testing of respiratory specimens. All cases were children presenting to hospitals with moderate respiratory distress. No cases of acute flaccid paralysis were detected. Phylogenetic analysis of the Caribbean strains showed more than 99% similarity with the 2014 U.S.-outbreak strain, providing evidence of the introduction and circulation of the virus in the region.(AU)

RESUMEN El brote de enterovirus D68 (EV-D68) registrado en el 2014 en los Estados Unidos suscitó preocupación acerca de la introducción del virus en el Caribe. El objetivo de este estudio fue aportar pruebas rápidas, mediante la adopción de un enfoque filogénico relativamente sencillo, de que durante ese brote ingresaron en el Caribe cepas del EV-D68. Entre octubre del 2014 y mayo del 2015, el laboratorio regional de referencia ubicado en el Organismo de Salud Pública del Caribe (Puerto España, Trinidad y Tabago) detectó cuatro casos de EV-D68 provenientes de dos países (Bermudas y Dominica) mediante el análisis molecular de muestras respiratorias. Todos los casos correspondían a niños que acudieron al hospital con dificultad respiratoria moderada. No se detectó ningún caso de parálisis flácida aguda. El análisis filogénico de las cepas encontradas en el Caribe demostró una semejanza superior al 99 % con la cepa responsable del brote del 2014 en los Estados Unidos, lo que demuestra la introducción y la circulación del virus en la región.(AU)

Identificación de virus respiratorios en pacientes pediátricos con infecciones respiratorias en el Hospital Carlos Van Buren, Valparaíso: época estival 2011-2012 / Identification of respiratory viruses in pediatric patients with respiratory tract infections from Carlos Van Buren Hospital, Valparaíso: 2011-2012 summer season

INTRODUCCIÓN: En pediatría, las infecciones respiratorias agudas (IRA) constituyen globalmente una importante causa de morbimortalidad. Los principales agentes etiológicos son los virus respiratorio sincicial, parainfluenza (PIV), influenza y adenovirus. Actualmente existen pruebas de diagnóstico molecular que permiten identificar agentes no convencionales. En este estudio se propuso estudiar la presencia de: PIV, coronavirus (COV), rinovirus (RV) y enterovirus humano (EV), utilizando reacción en cadena de polimerasa previa transcriptasa reversa (RCP-TR) en muestras de niños hospitalizados en el Hospital Carlos Van Buren, negativas a inmunofluorescencia (IF) paravirus respiratorios. MATERIALES Y MÉTODOS: Se analizaron un total de 82 muestras de aspirado nasofaríngeo de pacientes menores de 5 años hospitalizados por IRA en el Hospital Carlos Van Buren, negativos a IF, recolectadas entre Diciembre del 2011y Marzo del 2012. Se utilizó una RCP-TR anidada de tipo múltiplex específica para virus PIV (1, 2, 3, 4AB), COV-OC43 y 229E, y genérica para RV y EV. RESULTADOS: Los virus más frecuentes fueron los PIV, siendo identificados en 9 (10 por ciento) muestras, siendo: un 2 por ciento (n=2) PIV-2, un 7 por ciento (n=6) PIV-3 y un 1 por ciento (n=1) PIV-4AB. Además se detectó COV-OC43 en un 2 por ciento (n=2), RV y EV en un 6 por ciento (n=5). No se detectaron co-infecciones con dos o más virus. No hubo asociación entre edad de los niños y tipo de infección viral. DISCUSIÓN: Se describió la presencia de estos virus respiratorios en niños con IRA. Se logró detectar falsos negativos para PIV y se demostró la existencia de COV, RV y EV en la región.

INTRODUCTION: Acute Respiratory infection (ARI) is a major cause of morbidity and mortality worldwide in pediatrics. The main etiological agents are respiratory syncytial virus, parainfluenzavirus (PIV), influenza virus and adenovirus. Currently there are molecular diagnostic tests that have helped to identify unconventional agents. Our aim was to study the presence of: PIV, coronavirus (hCoV), rhinovirus (hRV) and human enterovirus (hEV), by using Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) in samples of hospitalized children on Carlos Van Buren Hospital negative to immunofluorescence (IF) for respiratory viruses. MATERIALS AND METHODS: A total of 82nasopharyngeal aspirate samples, negative to IF, were collected from children under five years old hospitalized due to ARI at Carlos Van Buren Hospital, between December 2011 and March2012. A Multiplex nested RT-PCR designed for the specifically detection of PIV (1, 2, 3, 4AB), hCoV (OC43 and 229E) and generic detection of RV and EV was used. RESULTS: Parainfluenza was the most frequently identified virus (n=9, 10 percent) specifically PIV-2 (n=2, 2 percent), PIV-3 (n=6, 7 percent) and PIV-4AB (n=1, 1 percent). Followed by hRV and hEV (n=5, 6 percent) and hCoV-OC43 (n=2, 2 percent). There were no co-infections with two or more viruses. There was no correlation between age and type of infection. DISCUSSION: This study described the prevalence of these respiratory viruses in pediatric patients with ARI. It was possible to detect false negative results for parainfluenza virus and also to demonstrate the existence of hCoV, hRV and hEV in the region.

Enterovirus infections and type 1 diabetes mellitus: is there any relationship?

Several health organizations have classified diabetes mellitus, a metabolic syndrome, as the epidemic of the century, since it affects millions of people worldwide and is one of the top ten causes of death. Type 1 diabetes is considered to be an autoimmune disease, in which autoaggressive T cells infiltrate the islets of Langerhans in the pancreas, leading to the destruction of insulin producing beta cells. The risk of the disease is modulated by genetic factors, mainly genes coding for human leukocyte antigens (HLA). However, the incidence of this disease has increased significantly during the recent decades, which cannot be explained only by genetic factors. Environmental perturbations have also been associated to the development of diabetes. Among these factors, viral triggers have been implicated; particularly enteroviruses, which have been associated to the induction of the disease. Supporting the hypothesis, numerous lines of evidence coming from mouse models and patients with this type of diabetes have shown the association. The present review aims to provide some understanding of how type 1 diabetes occurs and the possible role of enterovirus in this pathology.

Infecciones del sistema nervioso central por enterovirus en niños atendidos en un hospital de Lima, Perú / Enteroviral central nervous system infections in children treated at a hospital in Lima, Peru

Objetivos. Determinar la frecuencia y las características clínicas de las infecciones del sistema nervioso central por enterovirus en niños atendidos en el Hospital Nacional Cayetano Heredia de Lima, Perú. Materiales y métodos. Se realizó un estudio prospectivo y descriptivo desde abril 2008 hasta marzo 2010. Se enrolaron pacientes de un mes a 14 años con diagnóstico clínico de encefalitis o meningitis asépticas. Se investigó la presencia de enterovirus, virus herpes simple 1 (VHS-1), virus herpes simple 2 (VHS-2) y virus varicela-zoster (VZV) mediante reacción en cadena de polimerasa (PCR). Resultados. Se enrolaron 97 pacientes de los cuales 69 por ciento presentaron encefalitis aguda y 31 por ciento meningitis aguda. Se identificó enterovirus en 52,6 por ciento del total de infecciones agudas no bacterianas del sistema nervioso central; encontrándose en 83,3 por ciento de las meningitis y en 38,8 por ciento de las encefalitis. No hubo casos de infección por VHS-1, VHS-2 ni VZV. Las infecciones por enterovirus alcanzaron el 82,9 por ciento en los meses cálidos de noviembre a enero y el 28,6 por ciento en los meses fríos de mayo a julio. Conclusiones. Los enterovirus fueron los principales agentes etiológicos en las encefalitis y meningitis asépticas agudas en pacientes pediátricos de Lima, Perú. Los enterovirus tienen un comportamiento epidemiológico estacional con un claro aumento del número de casos en los meses de verano. Resulta útil tener disponible un método de diagnóstico rápido, como una ayuda para el manejo de las infecciones agudas del sistema nervioso.

Objectives. To determine the frequency and clinical features of central nervous system infections caused by enterovirus in children treated at the Hospital Nacional Cayetano Heredia in Lima, Peru. Materials and methods. A prospective, descriptive study was performed from April 2008 to March 2010. Patients aged 1 month - 14 years with clinical diagnosis of encephalitis or aseptic meningitis were included. We investigated the presence of enterovirus, herpes simplex virus 1 (HSV-1), herpes simplex virus 2 (HSV-2) and varicella-zoster virus (VZV) by polymerase chain reaction (PCR). Results. 97 patients were included, out of which 69 percent had acute encephalitis and 31 percent acute meningitis. Enteroviruses were identified in 52,6 percent of all acute non-bacterial central nervous system infections; corresponding to 83,3 percent of meningitis and 38,8 percent of encephalitis. There were no cases of infection due to HSV-1, HSV-2 or VZV. Enterovirus infections reached 82,9 percent in the warm months (November-January) and 28,6 percent in the colder months (May-July). Conclusions. Enteroviruses are the principal etiologic agents in acute aseptic meningitis and encephalitis in pediatric patients in Lima, Peru. Enteroviruses have a seasonal epidemiological pattern with a clear increase in the number of cases during the summer months. It is useful to have this rapid diagnostic method available as an aid in the management of acute central nervous system infections.

Prevalencia de enterovirus en recién nacidos y lactantes que consultaron a un centro de atención de primer nivel, Armenia, Colombia, 2009 / Prevalence of enterovirus infection in infants in Armenia, Colombia, 2009

Introducción. Los enterovirus están distribuidos por todo el mundo; sin embargo, existe escasa información sobre su circulación en Colombia. Objetivo. Estimar la prevalencia de circulación de enterovirus en niños menores de un año que asistieron a un centro de atención de primer nivel en Armenia, Colombia, en el 2009, e identificar los principales serotipos de enterovirus circulantes. Materiales y métodos. Se tomaron 320 muestras de heces de niños menores de un año de edad. La presencia de enterovirus se determinó mediante transcripción inversa y la reacción en cadena de la polimerasa anidada (RT-N-PCR), empleando iniciadores genéricos de enterovirus. Las muestras que resultaron positivas en la RT-N-PCR, se inocularon en cultivos celulares apropiados para enterovirus. Los aislamientos obtenidos se identificaron por neutralización con la mezcla de sueros de Lim-Benyesh-Melnick. Resultados. Se detectaron enterovirus en 43 de las 320 (13,3 %) muestras de heces mediante RTN-PCR (IC95%: 9,7 a 17,1). Se obtuvo aislamiento viral en 26 de las 43 (60,4 %) muestras de heces positivas por RT-N-PCR. De los 26 aislamientos obtenidos, en 15 se identificó Coxsackie virus B (ocho CVB1, dos CVB2 y cinco CVB5) y 11 echovirus (seis E6 y cinco E30). Conclusiones. La circulación de enterovirus en la población infantil estudiada fue de 13,3 % y los serotipos de enterovirus aislados corresponden con los serotipos de mayor prevalencia global. Los resultados obtenidos indican la factibilidad de emplear la RT-N-PCR como herramienta para vigilar la circulación de enterovirus en muestras de heces.

Introduction. Despite world wide circulation of enteroviruses, little information has accumulated on the circulation of enteroviruses in Colombia. Objective. The prevalence of enterovirus circulation was examined in children under 1 year to identify the most common enterovirus serotypes. Materials and methods. Fecal samples were collected from 320 children under 1 year of age who attended a first-level health center in the city of Armenia, Colombia, in 2009. Enterovirus detection was performed by reverse transcription reaction and nested polymerase chain reaction (RT-N-PCR) using generic enterovirus primers. Samples testing positive in the RT-N-PCR were inoculated into cell cultures susceptible to enterovirus. All isolates were typed by seroneutralization with Lim-Benyesh-Melnick antiserum pools. Results. Overall, enteroviral RNA was detected in 43 of 320 (13.3%; 95% CI: 9.7 to 17.1) fecal samples by RT-N-PCR. Viral isolation was possible in 26 of 43 (60.4%) of the positive samples. Of these, 15 were Coxsackievirus B (eight CVB1, two CVB2, five CVB5) and 11 Echovirus (six E6 and five E30). Conclusions. The enteroviral circulation in a population on newly bornes up to 1 year old was 13.3%;the most frequent enterovirus was the same as those serotypes most commonly isolated in other parts of the world. The use of RT-N-PCR was demonstrably feasible as a tool to monitor the presence of enterovirus in stool samples.

Evaluation of enterovirus 71 immune status in São Paulo state, Brazil / Avaliação da situação imunitária contra enterovírus 71 no estado de São Paulo, Brasil

Antibodies to Enterovirus 71 (EV71) were evaluated in São Paulo State during 1999-2005. The titer of neutralizing antibodies against EV71 was determined by microneutralization assay, and a titer of > 1:8 was defined as indicative of protected immunity. Neutralizing antibodies to EV71 were observed in 12.4 percent (55/442) of sera samples, a low protective rate, suggesting that EV71 infection is uncommon in this region, but that there is a relatively high susceptibility to EV71 related diseases, which is worrying considering the recent Asian outbreaks. Also, a significant location-specific difference in seropositivity was observed. Neutralizing antibodies to EV71 were observed in 8.7 percent (21/241) of São Paulo metropolitan area sera samples, and 16.9 percent (34/201) of the sera samples from other municipalities. A high number of Brazilian residents live in country and coastal areas without adequate access to piped water or sanitation. This situation may contribute to the EV71 dissemination in these zones. The analysis of environmental samples could possibly make a valuable contribution to studies on the epidemiology of EV71.

Anticorpos para Enterovírus 71 (EV71) foram avaliados no Estado de São Paulo durante 1999-2005. O título de anticorpos neutralizantes contra EV71 foi determinado pelo ensaio microneutralização, e um título de > 1:8 foi definido como indicador de imunidade protetora. Anticorpos neutralizantes para EV71 foram observados em 12,4 por cento (55/442) das amostras de soro, uma baixa taxa de proteção, sugerindo que a infecção pelo EV71 é incomum nesta região e que existe alta susceptibilidade a doenças relacionadas ao EV71, o que é preocupante considerando os recentes surtos asiáticos. Ainda, foi observada diferença significativa na soropositividade em relação à localização, onde 8,7 por cento (21/241) e 16,9 por cento (34/201) das amostras provenientes da região metropolitana de São Paulo, e demais municípios, respectivamente, apresentaram anticorpos neutralizantes para EV71. Um grande número de brasileiros vive em áreas rurais e à beira-mar, sem acesso adequado à água encanada ou saneamento. Essa situação pode contribuir para a disseminação de EV71 nessas regiões. A análise de amostras ambientais poderia gerar contribuição valiosa para estudos sobre a epidemiologia da EV71.

Transmission of Seasonal Outbreak of Childhood Enteroviral Aseptic Meningitis and Hand-foot-mouth Disease

This study was conducted to evaluate the modes of transmission of aseptic meningitis (AM) and hand-foot-mouth disease (HFMD) using a case-control and a case-crossover design. We recruited 205 childhood AM and 116 HFMD cases and 170 non-enteroviral disease controls from three general hospitals in Gyeongju, Pohang, and Seoul between May and August in both 2002 and 2003. For the case-crossover design, we established the hazard and non-hazard periods as week one and week four before admission, respectively. In the case-control design, drinking water that had not been boiled, not using a water purifier, changes in water quality, and contact with AM patients were significantly associated with the risk of AM (odds ratio [OR]=2.8, 2.9, 4.6, and 10.9, respectively), while drinking water that had not been boiled, having a non-water closet toilet, changes in water quality, and contact with HFMD patients were associated with risk of HFMD (OR=3.3, 2.8, 6.9, and 5.0, respectively). In the case-crossover design, many life-style variables such as contact with AM or HFMD patients, visiting a hospital, changes in water quality, presence of a skin wound, eating out, and going shopping were significantly associated with the risk of AM (OR=18.0, 7.0, 8.0, 2.2, 22.3, and 3.0, respectively) and HFMD (OR=9.0, 37.0, 11.0, 12.0, 37.0, and 5.0, respectively). Our findings suggest that person-to-person contact and contaminated water could be the principal modes of transmission of AM and HFMD.

Management of enteroviral conjunctivitis outbreaks in the Singapore military in 2005.

Between 8 August and 9 October 2005, tropical Singapore experienced a national epidemic of acute viral conjunctivitis. We report the epidemiological and virological findings of outbreaks of viral conjunctivitis in military facilities during the same time period, and the outbreak control measures taken. Outbreaks of viral conjunctivitis were identified by medical officers in military medical facilities. Epidemiological and virological investigations were carried out, and a standard set of control measures was instituted for each outbreak upon detection. Eight outbreaks of viral conjunctivitis occurred in the time period, corresponding to the national outbreak. Delayed detection and institution of preventive measures during the outbreaks were associated with delayed effectiveness of the control measures. Every delay in outbreak detection by one day resulted in a delay in terminating the outbreak by 0.82 days (p = 0.01). Coxsackievirus A24 was identified from some of the conjunctival swab samples taken.

Infecciones por enterovirus humanos / Human enterovirus infections

Los enterovirus son una gran cantidad de agentes que pueden producir diferentes patologías. En los años 2005 y 2006 se presentó un brote de meningitis viral por echovirus en la IX región de Chile, lo que motivó la investigación y posterior publicación del tema. Es importante la prevención de infecciones con medidas higiénicas adecuadas en la comunidad y los médicos deben conocer estos agentes para evitar tratamientos antibióticos y hospitalizaciones innecesarias que aumentan el riesgo de infecciones resistentes o intrahospitalarias.

Epidemiología de los enterovirus asociados a enfermedades neurológicas / Epidemiology of enterovirus associated with neurologic diseases

El presente estudio describe los resultados de la investigación de los enterovirus humanos (HEV) mediante cultivo celular y reacción en cadena de la polimerasa y su tipificación molecular en 2167 casos de parálisis fláccida aguda, meningitis aséptica y encefalitis aguda, obtenidos entre 1991 y 1998 en la Argentina. La frecuencia de detección de HEV en parálisis fláccida aguda fue 19.5% (130/666) y de poliovirus Sabin 5.4% (36/666). La tasa de detección de HEV en los casos de meningitis fue 28.8% (231/801) y en encefalitis 3.0% (21/700). El grupo etario más afectado por las meningitis fue entre 1 y 9 años (75.3%) y en los casos de parálisis fláccida aguda, de 1 a 4 años (58%). En muestras de brotes de meningitis se identificó echovirus (E) 4, E9, E30 y E17, y en casos esporádicos virus coxsackie A (CAV) 2, B (CBV) 2 y CBV5, E7, E11, E19, E24 y E29, y enterovirus (EV) 71. Finalmente, en casos de encefalitis se detectó E4, E7 y E24. En casos de parálisis fláccida aguda se identificaron 28 serotipos distintos de enterovirus no polio. En la Argentina y en otros países latinoamericanos existe escasa información acerca de la circulación de los HEV y su relación con diversas enfermedades neurológicas. Este estudio proporciona información que puede servir como base para posteriores investigaciones.

This report describes the results of human enterovirus (HEV) detection and characterization using cell culture, polymerase chain reaction and molecular typing in 2167 samples obtained from acute flaccid paralysis, aseptic meningitis and acute encephalitis patients, from 1991 to 1998 in Argentina. HEV were isolated in 130 out of 666 cases (19.5%) and 36 out of 666 (5.4%). HEV RNA was detected in 28.8% (231/801) and 3.0% (21/700) of the patients with meningitis and encephalitis, respectively. Children with ages ranging from 1 to 9 years accounted for 75.3% of the meningitis cases and from 1 to 4 years for 58% of acute flaccid paralysis patients. Echovirus 4 (E4), E9, E30 and E17 were identified from meningitis outbreaks. Coxsackievirus A2 (CAV2), CBV2, CBV5, E7, E11, E19, E24, E29 and enterovirus 71 were recovered only from sporadic cases. Three different serotypes were identified in encephalitis patients: E4, E7 and E24. A total of 28 different serotypes of non-polio enteroviruses were detected from acute flaccid paralysis cases. The information here presented contributes to improving our knowledge about enteroviruses epidemiology in Argentina and their relationship with different neurological diseases. This study provides valuable data that could be useful to further research.

Human enterovirus infection in stray dogs: some aspects of interest to public health

Foram estudados 212 caes errantes, capturados em areas perifericas no municipio de Sao Paulo, com o objetivo de investigar o possivel papel desses animais como reservatorios de enterovirus humanos. Os animais capturados foram divididos em 19 grupos compostos por 10 a 20 animais cada um. Foram efetuadas tentativas de isolamento em amostras de fezes em 126/212 caes, obtendo-se resultados positivos em 12 deles, assim distribuidos: poliovirus tipo 1 (dois caes), poliovirus tipo 3 (um cao), echovirus tipo 7 (oito caes) e echovirus tipo 15 (um cao). Dos 12 animais infectados, quatro apresentaram anticorpos neutralizantes homotipicos com titulos>-16. Todos os 212 caes foram submetidos a pesquisa de anticorpos neutralizantes contra enterovirus humanos...

An epidemic of viral acute haemorrhagic conjunctivitis in Delhi in 1994.

An epidemic of acute haemorrhagic conjunctivitis affecting persons of all ages and both sexes occurred in Delhi and surrounding areas during the monsoon season of 1994. The symptoms lasted on an average for 4-5 days. In some of the patients corneal involvement was observed. Conjunctival swabs from the affected patients were processed for viral antigen detection, virus isolation and bacterial culture and sensitivity. Viral antigen was detected in 62% (31/50) of the smears tested by indirect immunofluorescence assay. In 22 (44%) of the specimens Coxackie A 24 (Cox A 24) virus antigen and in 9 (18%) of the specimens Entero Virus 70 (EV 70) antigen were detected. In confluent monolayers of Hep 2 cells cytopathic virus was isolated in 10 (30.30%) of the 33 specimens processed. The isolated viruses were identified as either Cox A 24 (7 isolates) or EV 70 (3 isolates) using indirect immunofluorescence assay. Super added bacterial infection was observed in 33% (89/270) of the cases, Staphylococcus albus being the predominant bacteria isolated.

Enteroviroses emergentes de importância clínica / The clinical importance of enterovirus infections

Trata como doença infecciosa emergente aquelas recentemente identificadas na populaçäo humana ou já existentes, mas que aumentaram sua incidência.

Enteric viral infections in pre-school children in Karachi, Pakistan.

A prospective study was conducted in Karachi, Pakistan on the virology of enteropathogens excreted by children with acute gastroenteritis and the results were compared with a control group of healthy children. Rotavirus and Adenovirus detection was done using ELISA techniques, while enterovirus isolation was done by virus culture. In 1990, 12.3% children with acute watery diarrhoea excreted rotavirus, as compared to 24.4% children in 1991. None of the healthy children excreted adenovirus 40 and 41. Preliminary results of 1992 revealed that rotavirus was seen in 13% of children with acute watery diarrhoea and adenovirus in 10% of children. Enteroviruses were isolated in the same frequency in all three groups i.e. children with acute watery diarrhoea, children with poliomyelitis and healthy children. Non-polio enteroviruses were excreted in 50-52% in all the 3 groups. The rate of enterovirus excretion is much higher than seen in other developed countries and is the same in children with diarrhoea and healthy children.

Enterovírus-70 na regiäo metropolitana de Säo Paulo, Brasil, de l984 a1987: aspectos da infecçäo em períodos epidêmicos e endêmico / Enterovirus 70 in the metropolitan region of Säo Paulo, Brazil, from 1984 to 1987: infection aspects in endemic and epidemic periods

Säo apresentados os resultados dos estudos sobre o comportamento do Enterovirus-70 (EV-70) na regiäo metropolitana de Säo Paulo desde sua provável introduçäo no veräo de 1984, determinando extensa de conjuntivite hemorrágica aguda (C.H.A.), até o final de 1987 abrangendo preríodo em que este agravo foi pouco notado. Na fase epidêmica ocorrida no primeiro trimestre de 1984 foram estudados 291 indivíduos divididos em três grupos denominados A, B e C, o primeiro formado por pessoas atingidas pela C.H.A. e os outros dois por indivíduos näo atingidos por este agravo mas que, respectivamente, referiam contato domiciliar com casos de C.H.A. e os que näo referiam o citado contato. A demonstraçäo de anticorpos se fez pela técnica de imunofluorescência (IFI) para detectar IgM específico para EV-70 e pela prova de neutralizaçäo em cultura de células BHK-21. Verificou-se que 56,7%,33,3%e 20,6% dos indivíduos pertencentes, respectivamente, aos grupos A,B e C apresentavam anticorpos específicos da classe IgM. No grupo A a faixa etária mais atingida foi a de 10 a 29 anos. No período que vai do fim da primeira e única epidemia até o final de 1987, identificaram-se três casos esporádicos de C.H.A. e 10 pacientes com afecçäo neurológica aguda associada à infecçäo recente pelo EV-70. Nove, destes 10 casos, apresentaram paralisia de nervos cranianos, todos evoluindo sem sequelas clinicamente discerníveis. As formas assintomáticas e os casos esporádicos de C.H.A. e de afecçoes neurológicas mantiveram a circulaçäo do EV-70 no período epidêmico