PURPOSE: We identified the causative viruses from patients with aseptic meningitis, acute hemorrhagic conjunctivitis and other enterovirus-related diseases to understand the epidemiological patterns and prevailing strains of enterovirus infections each year. MATERIALS AND METHODS: During 1999-2003, we examined 3,260 specimens from 2,939 patients with aseptic meningitis or other clinical manifestations for the presence of enteroviruses by using both cell culture/ neutralisation test and reverse transcription-polymerse chain reaction-sequencing. To investigate the etiological agents which caused an epidemic of acute haemorrhagic conjunctivitis, conjunctival swab samples from acute haemorrhagic conjunctivitis patients showing cytopathic effects in HEp2 cells were tested by enteroviral specific PCR. RESULTS: We identified 603 isolates of enteroviruses (20.5%) among 2,939 cases and 22 serotypes of human enteroviruses were isolated during this 5 year period. Echovirus 13 and coxsackievirus A24 in 2002 and coxsackievirus A9 in 2003 were the first enterovirus to be indentified in Korea since we began the enterovirus surveillance in 1993. While an epidemic of echovirus 13 infection in Korea began in Gwangju and Jeolla province in 2002 and spread to Seoul, Gyunggi, Busan, Ulsan and other regions, echovirus 6 isolates in 2002 were mainly detected in Busan specimens and some Gwangju samples. From the nucleotide sequencing of enteroviral PCR products of conjunctival swab specimens, we found 85% nucleotide homology to coxsackievirus A24 (D90457). CONCLUSIONS: We isolated 603 enteroviral isolates among 2939 cases during 1999-2003. Echovirus 13 and coxsackievirus A24 were the first enterovirus to be identified in Korea and caused nationwide epidemics in 2002.
Busan ; Conjunctivitis ; Conjunctivitis, Acute Hemorrhagic ; Echovirus 6, Human ; Enterovirus B, Human ; Enterovirus Infections ; Enterovirus* ; Gwangju ; Humans ; Korea* ; Meningitis, Aseptic ; Polymerase Chain Reaction ; Seoul ; Ulsan

PURPOSE: We identified the causative viruses from patients with aseptic meningitis, acute hemorrhagic conjunctivitis and other enterovirus-related diseases to understand the epidemiological patterns and prevailing strains of enterovirus infections each year. MATERIALS AND METHODS: During 1999-2003, we examined 3,260 specimens from 2,939 patients with aseptic meningitis or other clinical manifestations for the presence of enteroviruses by using both cell culture/ neutralisation test and reverse transcription-polymerse chain reaction-sequencing. To investigate the etiological agents which caused an epidemic of acute haemorrhagic conjunctivitis, conjunctival swab samples from acute haemorrhagic conjunctivitis patients showing cytopathic effects in HEp2 cells were tested by enteroviral specific PCR. RESULTS: We identified 603 isolates of enteroviruses (20.5%) among 2,939 cases and 22 serotypes of human enteroviruses were isolated during this 5 year period. Echovirus 13 and coxsackievirus A24 in 2002 and coxsackievirus A9 in 2003 were the first enterovirus to be indentified in Korea since we began the enterovirus surveillance in 1993. While an epidemic of echovirus 13 infection in Korea began in Gwangju and Jeolla province in 2002 and spread to Seoul, Gyunggi, Busan, Ulsan and other regions, echovirus 6 isolates in 2002 were mainly detected in Busan specimens and some Gwangju samples. From the nucleotide sequencing of enteroviral PCR products of conjunctival swab specimens, we found 85% nucleotide homology to coxsackievirus A24 (D90457). CONCLUSIONS: We isolated 603 enteroviral isolates among 2939 cases during 1999-2003. Echovirus 13 and coxsackievirus A24 were the first enterovirus to be identified in Korea and caused nationwide epidemics in 2002.
Busan ; Conjunctivitis ; Conjunctivitis, Acute Hemorrhagic ; Echovirus 6, Human ; Enterovirus B, Human ; Enterovirus Infections ; Enterovirus* ; Gwangju ; Humans ; Korea* ; Meningitis, Aseptic ; Polymerase Chain Reaction ; Seoul ; Ulsan

This study was performed to monitor the causative agent of patient with respiratory disease in Pusan, 1998-1999. The results obtained were as follows. Among 1,320 cases of specimens from throat swab, influenzavirus infections were detected 232(89.6%), adenovirus infections were in 14(5.4%), coxsackievirus infections were in 11(4.2%), and echovirus infections were in 2(0.8%). The 222 strains out of 232 strains of influenzavirus showed A-type and the rest of them represented B-type. The distribution for sex- and age-groups is as follows. The male distribution was similar to the female distribution: male distribution, 47.1% and female distribution, 52.9%. Most of the patients was less than 10 years old. The monthly influenza distribution was consistent from Dec. 1998 to Apr. 1999. The 113 strains from the A-type isolates was A/Sydney/05/97(H3N2)-like, the 109 strains A/Beijing/262/95(H1N1)-like, and all of the 10 B-type isolates B/Harbin/07/94-like. Electron micrograph of negative-stained showed about 95 nm and about 71 nm with influenzavirus and adenovirus, respectively. Coxsackievirus and echovirus showed non-enveloped, isometric particle of about 30 nm diameter.
Adenoviridae ; Adenoviridae Infections ; Busan* ; Child ; Coxsackievirus Infections ; Echovirus Infections ; Enterovirus B, Human ; Female ; Humans ; Influenza, Human ; Male ; Pharynx

PURPOSE: This study was performed to investigate the epidemiology of enterovirus (EV) infections in children at a secondary hospital during recent 5 years. METHODS: We collected the cerebrospinal fluid, stool and throat swab samples from the pediatric patients with suspected EV infections in KEPCO Medical Center, Seoul, Korea from July 2006 to September 2010. EV detection and genotype identification were performed by RT-PCR at Korea Centers for Disease Control and Prevention. RESULTS: A total of 386 samples were collected from 277 patients during study period. Ninety-eight patients (35.4%) were diagnosed with EV infections. The RT-PCR positive rate was the highest in throat swab samples (48.3%). The median age of patient was 4.7 years (range, 0.1-12.5 years). Aseptic meningitis (50, 51.0%) was the most common clinical manifestation; herpangina (22, 22.4%) and hand-foot-mouth disease (18, 18.4%). One hundred EVs were isolated from 98 patients and 20 genotypes of EV were identified; Echovirus 30 (28 cases, 28%), Enterovirus 71 (12 cases, 12%), Echovirus 25 (10 cases, 10%), Echovirus 9 (9 cases, 9%) and Coxsackievirus A6 (8 cases, 8%). Aseptic meningitis caused by Echovirus 30 was the most common manifestation in 2008. There was no complicated case caused by Enterovirus 71. CONCLUSION: This study showed the epidemiology of confirmed EV infection in children from 2006 to 2010. There is a need for continuous surveillance of EV infections and its clinical manifestations.
Centers for Disease Control and Prevention (U.S.) ; Child ; Echovirus 9 ; Enterovirus ; Enterovirus B, Human ; Enterovirus Infections ; Genotype ; Herpangina ; Humans ; Korea ; Meningitis, Aseptic ; Pharynx

To identify and trace the pathogen of acute hemorrhagic conjunctivitis (AHC) epidemic in Zhejiang Province in 2010. Viral nucleic acid of Enterovirus (EV) and Coxsackievirus A24 variant (CA24v) were directly detected by real-time RT-PCR from the conjunctival swab collected from suspected patients. The virus was isolated from the swab samples using Hep-2 cell. The viral RNAs were extracted from the isolated viruses and followed by RT-PCR to amplify VP1 gene and 3C protease region(3C). The amplified fragments were sequenced and phylogenetic trees were also constructed. Eight out of 13 swab samples from suspected patients were both positive for EV and CA24v RNA (61.5%), 6 CA24v strains were isolated (46.2%). The complete VP1 genes of CA24v in 4 sequenced virus strains were 915 nt in length and the complete 3C genes were 549 nt in length. All VP1 and 3C genes were confirmed without any insertion or deletion. The identity of nucleotide and amino acid in 3C between the 2010 isolated strains and the prototype strain EH24/70 were 85.2%-85.8% and 96.2%-96.7%, and that between the 2010 Zhejiang strains and the Zhejiang,Yunnan and Guangdong CA24v strains isolated between 2007-2008 were 93.4%-93.8% and 96.7%-97.3%, respectively. The phylogenetic tree of 3C indicated that the isolated CA24v viruses of Zhejiang in 2010 located in the CA24v IV genotype cluster 4 (GIV-C4) and all the VP1 genes located in the human Enterovirus C (EV-C) CA24v. These findings indicated that AHC epidemic in Zhejiang Province in 2010 was caused by CA24v GIV-C4 viruses and they most likely evolved from CA24v viruses circulating locally in external environment from 2002.
Amino Acid Sequence ; China ; epidemiology ; Conjunctivitis, Acute Hemorrhagic ; epidemiology ; virology ; Coxsackievirus Infections ; epidemiology ; virology ; Disease Outbreaks ; Enterovirus ; classification ; genetics ; isolation & purification ; Enterovirus Infections ; epidemiology ; virology ; Genes, Viral ; genetics ; Humans ; Molecular Sequence Data ; Phylogeny ; RNA, Viral ; genetics ; Sequence Alignment ; Sequence Homology

Autopsy ; Coxsackievirus Infections ; Enterovirus ; isolation & purification ; Enterovirus B, Human ; isolation & purification ; Enterovirus Infections ; Hand, Foot and Mouth Disease ; pathology ; virology ; Humans ; Infant ; Male

To identify the cause of an outbreak of acute hemorrhagic conjunctivitis (AHC) in Jiangxi (China) in 2010, 20 eye conjunctival swabs were first collected from AHC patients. Then, viruses were isola- ted and tested for human enterovirus 70, coxsackievirus A24 variant (CV-A24v) and adenovirus using the polymerase chain reaction. All CV-A24v isolates underwent sequencing of 3C and VP1 coding regions. Then, a phylogenetic tree was constructed for Jiangxi CV-A24v and worldwide CV-A24v based on,3C and VP1 regions, respectively. Ten out of 20 specimens were positive for CV-A24v, implying that the outbreak was caused by CV-A24v. The phylogenetic tree based on the 3C region showed that Jiangxi CV- A24v belonged to cluster 5 in genotype IV (GIV-C5) with strains isolated throughout the world after 2010, and were divided further into A and B lineages. Phylogenetic analyses of the VP1 region showed that all of the worldwide CV-A24v strains isolated after 2000 could be divided into five groups (1-5). Jiangxi CV-A24v was classified into group 5 and also divided further into A and B lineages upon analyses of the 3C region. These data suggested that CV-A24v causing AHC outbreaks in China in 2010 belonged to GIV-C3 and GIV-C5. At least two transmission lineages were circulated in Jiangxi in 2010. The classification of CV-A24v isolated after 2010 worldwide using the phylogenetic tree based on the VP1 region was almost consistent with that based on the 3C region and also had significant chronological clustering.
China ; epidemiology ; Conjunctivitis, Acute Hemorrhagic ; epidemiology ; virology ; Coxsackievirus Infections ; epidemiology ; virology ; Disease Outbreaks ; Enterovirus C, Human ; classification ; genetics ; isolation & purification ; Genotype ; Humans ; Molecular Sequence Data ; Phylogeny ; Viral Proteins ; genetics

OBJECTIVETo compare the differences of epidemiological and clinical characteristics in children with hand-foot-mouth disease (HFMD) caused by Coxsackievirus A16 (CA16) and Enterovirus 71 (EV71).

METHODSThe samples of vesicle fluid and throat swabs of 108 children with HFMD were collected and detected for enterovirus by RT-PCR. The clinical data of children with EV71 and CA16 infection were retrospectively reviewed and compared.

RESULTSThe total positive rate of enterovirus was 97.2% (105/108). Of the 105 cases, 56 cases were positive for EV71 (51.9%), 39 cases were positive for CA16 (36.1%), 2 cases were positive for other enterovirus (1.9%), and 8 cases were co-infected by EV71 and CA16 (7.4%). There were no significant differences in age and sex between EV71 and CV16 infected cases. The univariate analysis showed that the incidences of herpes of mouth, erythra of knees, and nose running in children infected by CA16 were higher than in those infected by EV71. The multivariate logistic regression analysis showed that the HFMD children who had erythra of knees had higher probability of CA16 infection.

CONCLUSIONSEV71 should be considered as the pathogen in children with HFMD who have no herpes of mouth, erythra of knees, and nose running.

Child ; Child, Preschool ; Coxsackievirus Infections ; epidemiology ; Enterovirus A, Human ; Female ; Hand, Foot and Mouth Disease ; epidemiology ; Humans ; Infant ; Logistic Models ; Male

Enterovirus infections occur throughout the year, but in temperate climates infections are strikingly more prevalent in the summer and autumn. About 50~80% of nonpolio enteroviral infections are completely asymptomatic. The fecal-oral route is thought to be the predominant mode of enterovirus transmission, because viral shedding from the gastrointestinal tract is more prolonged than is shedding from the upper respiratory tract. Even symptomatic infections usually produce undifferentiated febrile illnesses lasting a few days, and often accompanied by symptoms of upper respiratory tract. It has been known that the most common cause of aseptic meningitis is enteroviruses, and this type of meningitis demonstrates benign clinical course and the absence of signs of parenchymal brain involvement. We could see many children with meningitis in the summer of 2008. Among 1,922 children with aseptic meningitis from 1 week to 29 weeks of 2008, 882 (49.9%) was 3~6 years old, and 883 (50.1%) was 7~14 years old. Echovirus 30 (60%) and Echovirus 6 (30%) caused large outbreaks throughout South Korea from May to August 2008, which was analyzed by the Division of Enteric and Hepatitis Viruses, National Institute of Health in Seoul, Korea.
Brain ; Child ; Climate ; Communicable Diseases ; Disease Outbreaks ; Echovirus 6, Human ; Enterovirus ; Enterovirus B, Human ; Enterovirus Infections ; Gastrointestinal Tract ; Hepatitis Viruses ; Humans ; Korea ; Meningitis ; Meningitis, Aseptic ; Republic of Korea ; Respiratory System ; Virus Shedding

PURPOSE:We undertook this study to improve our understanding of the epidemiologic and clinical features of non-polioenterovirus (NPEV) infections, especially enterovirus 71 (EV71) infections, in Korean children. METHODS:Between April and June 2000, NPEVs were detected by RT-PCR and cultures of specimens obtained from patients with aseptic meningitis, acute respiratory disease, and acute gastroenteritis which were associated with enteroviral exanthem and vesicular pharyngeal enanthem, such as herpangina, and hand, foot, and mouth disease (HFMD). EV71 was identified by sequencing the VP1 gene. The clinical and epidemiologic data were analyzed retrospectively after all 87 NPEV-positive patients were divided into 4 groups, according to the clinical manifestations. Sixteen patients who mainly had symptoms of acute gastroenteritis were in group A, 21 patients with symptoms and signs of lower respiratory tract infections were in group B, 42 patients with a HFMD rash only were in group C with or without fever, and 8 patients with aseptic meningitis or paralysis were in group D. For the 11 EV71-positive patients, 1 was in group A, 2 were group B, 7 were in group C, and 1 was in group D. RESULTS:There were 87 NPEV infections, including 11 EV71 infections. The mean age of the patients was 2 years and 11 months, ranging from 1 day to 15 years. There were no fatal cases among a total of 87 NPEV infections and no significant differences in clinical severity between the EV71 and other NPEV infections. CONCLUSION:NPEV infections in children were common during the 3 months in the spring of 2000. Unlike in southeast Asia, where fatal EV71 infection outbreaks have occurred since 1997, the clinical features of EV71 infection in Korean children are mild.
Asia, Southeastern ; Child ; Disease Outbreaks ; Enterovirus ; Exanthema ; Fever ; Foot ; Gastroenteritis ; Hand ; Herpangina ; Humans ; Korea ; Meningitis, Aseptic ; Mouth Diseases ; Paralysis ; Respiratory Tract Infections ; Retrospective Studies