PURPOSE: Enterovirus (EV) infection in children can manifest various diseases from asymptomatic infection to nonspecific febrile illness, hand-foot-mouth disease, and aseptic meningitis. This study was aimed to investigate epidemiology and clinical significance of various genotypes of EV infections in pediatric inpatient. METHODS: We collected the stool samples from the admitted pediatric patients in Inha University Hospital from March 2014 to March 2015. EV detection and genotype identification were performed by real-time RT-PCR and semi-nested RT-PCR. Phylogenetic trees were constructed by neighbor joining method. RESULTS: A total of 400 samples were collected during study period and 112 patients (28%) were diagnosed with EV infections. The mean age of EV positive patients was 2.66 years (0.1-14) and sex ratio was 1.73:1. Genetic sequences of EVs were identified; coxsackievirus B5 (17, 15.2%), coxsackievirus A16 (13, 11.6%), enterovirus 71 (10, 8.9%), and coxsackievirus A2 (9, 8.0%). Nonspecific febrile illness (96, 86%) was the most common clinical manifestation and the duration of fever was 0-11 days (mean 3.1 days). Rash (44, 39%) and meningitis (43, 38%) were followed. Patients who were attending daycare center or had siblings accounted for 82.1%. Phylogenetic relationship tree revealed 6 distinct genogroups among 56 types of EVs. CONCLUSIONS: This study is the report of epidemiology, serotype distribution and clinical manifestations of children with EV infection in Incheon. This data will be helpful for further study about the epidemiology of EV infection in Korea.
Asymptomatic Infections ; Child ; Enterovirus* ; Epidemiology* ; Exanthema ; Fever ; Genotype ; Humans ; Incheon* ; Inpatients* ; Korea ; Meningitis ; Meningitis, Aseptic ; Sex Ratio ; Siblings ; Trees

PURPOSE: To evaluate the epidemiologic characteristics of aseptic meningitis in Daejeon, Korea from 1987 to 2003. METHODS: A total of 2201 medical records of children with aseptic meningitis admitted to the Catholic University of Korea, Daejeon St. Mary's Hospital, was retrospectively analyzed. RESULTS: The mean annual number of cases was 129, with a higher rate of occurrence in the summer season(May to August, 74.1%). Outbreaks of aseptic meningitis were noted in the years 1990, 1993, 1996, 1997, 2001, and 2002. The age distribution was relatively even, with higher incidences in the 4-7 years group and in the under one year old group. The male-to-female ratio was 2 : 1. Comparing the epidemics of 1997 and 2002, there were no marked differences in age distribution, except in the less than 1 year old age group(11.8% vs. 4.4%), nor in the monthly incidence. Neurologic complications were found in 0.7% of the patients. CONCLUSION: Outbreaks of aseptic meningitis occurred every one to three years in Daejeon, reflecting typical nationwide epidemics that occurred from 1987 to 2003. The incidence of disease in the less than 1 year age group during each epidemic may reflect the herd immunity of the maternal generation.
Age Distribution ; Child ; Disease Outbreaks ; Epidemiologic Studies* ; Epidemiology ; Humans ; Immunity, Herd ; Incidence ; Korea ; Medical Records ; Meningitis, Aseptic* ; Retrospective Studies

BACKGROUND: To investigate the epidemiology of aseptic meningitis in Korea, we have isolated and characterized enteroviruses isolated from patients with acute meningitis from 1993 to 1998. METHODS: Stool and/or cerebrospinal fluid (CSF) samples from patients with aseptic meningitis were inoculated onto enterovirus-susceptible cell lines. The virus propagation was examined by the presence of cytopathic effects and each viral isolate was further characterized using a neutralization test. RESULTS: Out of 1,127 specimens, 197 enteroviral isolates were obtained mostly from stool samples (82.8 %) of children aged zero to ten years. At least 15 serotypes of enteroviruses, including echoviruses (EV) 3, 6, 7, 9, 25 and 30, coxsackieviruses (CV) B1~B6, and vaccine-derived polioviruses (PV) had circulated during the previous 6 years. The major serotypes that caused outbreaks of aseptic meningitis, were EV30 in 1997 and EV6 in 1998. Although the incidence of virus isolation peaked during summer, we had isolated enteroviruses all the year round in 1998. CONCLUSION: Since 1993, we had confirmed 197 cases of enteroviral meningitis. Outbreaks of aseptic meningitis were mainly caused by EVs, with peaks during the summer months. Our data emphasize that the nationwide surveillance of aseptic meningitis should be expanded and maintained throughout the year.
Cell Line ; Cerebrospinal Fluid ; Child ; Disease Outbreaks ; Enterovirus B, Human ; Enterovirus* ; Epidemiologic Studies* ; Epidemiology ; Humans ; Incidence ; Korea* ; Meningitis ; Meningitis, Aseptic* ; Neutralization Tests ; Poliovirus

BACKGROUND: To investigate the epidemiology of aseptic meningitis in Korea, we have isolated and characterized enteroviruses isolated from patients with acute meningitis from 1993 to 1998. METHODS: Stool and/or cerebrospinal fluid (CSF) samples from patients with aseptic meningitis were inoculated onto enterovirus-susceptible cell lines. The virus propagation was examined by the presence of cytopathic effects and each viral isolate was further characterized using a neutralization test. RESULTS: Out of 1,127 specimens, 197 enteroviral isolates were obtained mostly from stool samples (82.8 %) of children aged zero to ten years. At least 15 serotypes of enteroviruses, including echoviruses (EV) 3, 6, 7, 9, 25 and 30, coxsackieviruses (CV) B1~B6, and vaccine-derived polioviruses (PV) had circulated during the previous 6 years. The major serotypes that caused outbreaks of aseptic meningitis, were EV30 in 1997 and EV6 in 1998. Although the incidence of virus isolation peaked during summer, we had isolated enteroviruses all the year round in 1998. CONCLUSION: Since 1993, we had confirmed 197 cases of enteroviral meningitis. Outbreaks of aseptic meningitis were mainly caused by EVs, with peaks during the summer months. Our data emphasize that the nationwide surveillance of aseptic meningitis should be expanded and maintained throughout the year.
Cell Line ; Cerebrospinal Fluid ; Child ; Disease Outbreaks ; Enterovirus B, Human ; Enterovirus* ; Epidemiologic Studies* ; Epidemiology ; Humans ; Incidence ; Korea* ; Meningitis ; Meningitis, Aseptic* ; Neutralization Tests ; Poliovirus

OBJECTIVETo determine the partial sequence of virus strains causing an aseptic meningitis outbreak in northern part of Jiangsu province in 2003 and to compare them with the same serotype strains isolated in other countries to better understand its genetic characteristics and hereditary trend of development.

METHODSVirus RNA was amplified using two sets of specific enteroviral 3' half of VP1 primers 012/011 and 040/011. Polymerase chain reaction (PCR) products were purified and sequenced. BLAST program was then used to perform on nucleotide and amino acid pairwise-alignment with all available sequences in NCBI database. Phylogenetic trees were drawed to compare with other enteroviral sequences using PHYLIP software.

RESULTSUnder BLAST program, three sequences we submitted to GenBank were identically inferred as echovirus type 30, which had been identified by neutralization test in previous study. Phylogenetic analysis demonstrated that strains isolated from this outbreak were aggregated into a cluster, and the closest relationships with them were those isolated in 1999 and 2000. This phenomenon indicated that Echo30 from this outbreak was different from other strains in different epidemic area.

CONCLUSION3' half of VP1 sequence could be used to quickly identify the serotype of isolated enterovirus. Strains isolated from this outbreak had the similar hereditary developing trend comparing with Echo30 strains isolated from other countries.

Base Sequence ; China ; epidemiology ; DNA, Viral ; genetics ; Disease Outbreaks ; Enterovirus B, Human ; genetics ; isolation & purification ; Female ; Humans ; Male ; Meningitis, Aseptic ; epidemiology ; virology ; Molecular Sequence Data ; Sequence Analysis, DNA

OBJECTIVETo study the variation and evolution rules and analyze the genetic characterization of echovirus 30 during an outbreak of aseptic meningitis.

METHODSFor all the echovirus 30 isolates during the outbreaks in Zhangqiu city in 2003, complete VP1 genes were determined. Phylogenetic tree reconstruction and pairwise sequence were determined to compare the homological relationship and evolution rules between Zhangqiu strains and the other reported echovirus 30 in GenBank.

RESULTSPairwise sequence comparisoms in VP1 region indicated that there were 98.9%-99.5% identity of nucleotide acid among Zhangqiu strains, and having the highest homology with Taian strains (98.5%-99.0%) isolated in Shandong province. At the same time, when comparing with Zhejiang and Jiangsu strains, the nucleotide homology showed 98.2%-98.9%, relatively low identity with Taiwan strains (87.4%-87.6%) and French strains (89.1%-89.7%) but only 82.4%-82.8% identity when comparing with echovirus 30 prototype strain Bastianni. Data from phylogenetic tree analyses indicated that all the echovirus 30 correlated with aseptic meningitis in China recently came from the same evolution linkage and formed a monophyletic cluster.

CONCLUSIONIn 2003, there was an circulation of echovirus 30 in Shandong province which causing an endemic of aseptic meningitis in local areas. Data from phylogenetic tree analyses indicated that the antigenic characteristics of echovirus 30 in mainland China might be different from strains early isolated in other continents and formed a new genotype.

China ; epidemiology ; DNA, Viral ; analysis ; Disease Outbreaks ; Enterovirus B, Human ; classification ; genetics ; Enterovirus Infections ; epidemiology ; Genotype ; Humans ; Meningitis, Aseptic ; Phylogeny ; Sequence Analysis, DNA

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.
Adolescent ; Child ; Child, Preschool ; Comorbidity ; Disease Outbreaks/*statistics & numerical data ; Enterovirus Infections/*epidemiology/*transmission ; Female ; Hand, Foot and Mouth Disease/*epidemiology/*transmission ; Humans ; Incidence ; Male ; Meningitis, Aseptic/*epidemiology ; Risk Assessment ; Risk Factors ; *Seasons

In order to confirm the cause of the outbreak of aseptic meningitis in Zhejiang Province in 2002-2004, trace the pathogen and analyze the molecular characteristics, 271 cerebrospinal fluid (CSF) and faeces specimens were collected from suspected patients. The virus strains from the specimens were isolated with RD and Hep-2 cell lines. The VP1 and VP4/VP2 genes of the isolated viruses were sequenced, and their phylogenetic and homology trees were also constructed. Of the total 271 samples, 78 Echovirus type 30 (E30) strains were isolated. All of the complete VP1 genes in 31 sequenced virus isolates of E30 were composed of 876 nt without any insertion or deletion, encoding 292 amino acids (aa). The identity of nucleotide and amino acid in VP1 gene were 84.7%-86.3% and 92.1%-94.2% between the 31 Zhejiang strains and the prototype strain Bastianni of E30, and 87.1%-99.4% and 96.2%-100% among the 31 Zhejiang strains, respectively. The Zhejiang strains of E30 in the phylogenetic tree of the VP1 gene were attributed into two branches of the G and H genotype, respectively. In G genotype, the Shangdong and Jiangsu E30 strains in 2003 among domestic strains and Ukraine E30 strain in 1999 among overseas strains had maximum similarity with the Zhejiang strains, while H genotype had maximum similarity with the Korea E30 strains in 2008. The phylogenetic tree of the VP4/VP2 genes was similar to that of VP1 gene. The results indicated that the outbreak of aseptic meningitis in Zhejiang Provinec in 2002-2004 was caused by the G and H genotypes of E30 strains existing simultaneously. The H genotype was a new variant strain, which was first isolated in Zhejiang Province in 2002.
Amino Acid Sequence ; Capsid Proteins ; genetics ; Cell Line ; Cerebrospinal Fluid ; virology ; China ; epidemiology ; Disease Outbreaks ; Enterovirus B, Human ; classification ; genetics ; isolation & purification ; Evolution, Molecular ; Feces ; virology ; Genotype ; Humans ; Meningitis, Aseptic ; epidemiology ; virology ; Molecular Sequence Data ; Phylogeny ; Sequence Alignment

BACKGROUNDTo find the pathogenic agents of aseptic meningitis prevalent in Xuzhou of Jiangsu province in 2001.

METHODSThe enterovirus (EV) was cultured from CSF of the patients and identified with anti-serum by neutralization test. Neutralization titer of antibody in paired sera from meningitis children was determined. EV RNA was detected by RT-PCR.

RESULTSFour strains of Coxsackievirus B5, 2 strains of Coxsackievirus B3 and 1 strain of Echovirus 7 were isolated from 22 CSF specimens. The isolation rate of virus was 31.8% (7/22), 21 CSF were tested by RT-PCR, the positive rate of EV RNA was 52.4% (11/21); 57.9% (11/19) of patients paired-sera had over 4 folds antibody rise or became seroconverted.

CONCLUSIONEnterovirus was the pathogenic agent of aseptic meningitis prevalent in Xuzhou of Jiangsu province, the main serotype of the virus was Coxsackievirus B5.

Antibodies, Viral ; immunology ; Child ; Child, Preschool ; China ; epidemiology ; Coxsackievirus Infections ; cerebrospinal fluid ; epidemiology ; virology ; Echovirus Infections ; cerebrospinal fluid ; epidemiology ; virology ; Enterovirus ; genetics ; immunology ; isolation & purification ; Humans ; Infant ; Meningitis, Aseptic ; cerebrospinal fluid ; epidemiology ; virology ; Microscopy, Electron ; Neutralization Tests ; Prevalence ; RNA, Viral ; genetics ; Reverse Transcriptase Polymerase Chain Reaction ; Virion ; isolation & purification ; ultrastructure

PURPOSE: It is not surprising that serologically based epidemiologic studies have documented the high incidence of mycoplasma respiratory infection throughout the world. We studied the epidemiologic and clinical aspects of mycoplasma pneumonia in children if there is any differences in the peak age-related incidence, seasonal predominance and clinical manifestations in compare with other studies reported in Korea. METHODS: We reviewed 1004 cases of Mycoplasma pneumoniae pneumonia diagnosed by clinical manifestations and positive serologyc tests, retrospectively, who were admitted to the department of pediatrics in four university hospitals in Seoul and Inchon during the last 5 years from 1993 to 1997. RESULTS: 1) The age distribution of mycoplasma pneumonia showed highest incidence in children 4-6 years old. There was no difference in sex distribution at any age group. 2) Although there was little difference in annual distribution, it was highest in 1997. 3) Cough was the most prevalent prodromal symptom. 4) Vomiting, Nausea, Abdominal pain and headache were noted as the extrapulmonary manifestations. 5) Pulmonary infiltration was noted mostly in lower lobe lobes on chest X-ray. They showed interstial involvement in 34.5%, lobar involvement in 30.0%, and pleural effusion in 7.8% of the total. 6). As the complications, aggravate or trigger the asthma attack were noted in 4.0%, development of sinusitis in 3.5% and otitis media in 1.4% of the total. There were four cases of aseptic meningitis and one case of lung abscess. CONCLUSIONS: In our survey, there was little or no epidemiologic differences in the incidence of Mycoplasma pneumoniae pneumonia. We can find the increasing tendency of lobar pattern of involvement on chest X-ray in mycoplasma pneumonia in children.
Abdominal Pain ; Age Distribution ; Asthma ; Child ; Cough ; Epidemiologic Studies ; Epidemiology ; Headache ; Hospitals, University ; Humans ; Incheon ; Incidence ; Korea ; Lung Abscess ; Meningitis, Aseptic ; Mycoplasma pneumoniae* ; Mycoplasma* ; Nausea ; Otitis Media ; Pediatrics ; Pleural Effusion ; Pneumonia* ; Pneumonia, Mycoplasma* ; Prodromal Symptoms ; Retrospective Studies ; Seasons ; Seoul ; Sex Distribution ; Sinusitis ; Thorax ; Vomiting