Analysis of an echovirus 18 outbreak in Thuringia, Germany: insights into the molecular epidemiology and evolution of several enterovirus species B members

Abstract

In October and November 2010, six children and one woman were presented with symptoms of aseptic meningitis in Jena, Thuringia, Germany. Enterovirus RNA was detected in the cerebrospinal fluid of all patients by RT-PCR, and preliminary molecular typing revealed echovirus 18 (E-18) as causative agent. Virus isolates were obtained from stool samples of three patients and several contact persons. Again, most isolates were typed as E-18. In addition, coxsackievirus B5 (CV-B5) and echovirus 25 (E-25) were found to co-circulate. As only few complete E-18 sequences are available in GenBank, the entire genomes of these isolates were determined using direct RNA-sequencing technology. We did not find evidence for recombination between E-18, E-25 or CV-B5 during the outbreak. Viral protein 1 gene sequences and the cognate 3D polymerase gene sequences of each isolate and GenBank sequences were analysed in order to define type-specific recombination groups (recogroups).

Serotypes of human enteroviruses causing pediatric viral encephalitis and meningitis in Hebei province, China, from 2013 to 2015

“…E18, which was detected at low prevalence in mainland China in previous studies, became the predominant EV serotype causing VE and VM in Hebei province in 2015 . The E18 serotype of EV‐B has caused many outbreaks of aseptic meningitis in the USA, Japan, Germany, and other regions . Prior to our study, E18 had been detected sporadically and was rarely reported in mainland China .…”

Molecular characterization of two novel echovirus 18 recombinants associated with hand-foot-mouth disease

“…However, it is unclear whether the recombination of SVDV occurred in humans or pigs 29 . In addition, the non-structural protein and un-translated regions, which have diverse functions in the viral replication are characterized by species-specific 11 . Recombination events usually occur in non-structural regions of EV-B 23, 30–32 , which is consistent with our report.…”

An outbreak of echovirus 18 encephalitis/meningitis in children in Hebei Province, China, 2015

“…Non-polio human enteroviruses (EVs), especially the species Enterovirus B (EV-B), are major causative agents of these diseases. Echovirus 18 (E18), a serotype of EV-B, has mostly been reported as an important pathogen that has caused many outbreaks of aseptic meningitis in the United States, 1 , 2 Japan, 3 Korea, 4 Germany, 5 and other countries or regions. 6 So far, there has been no report of an E18-associated encephalitis/meningitis outbreak in mainland China, but little E18 epidemiological data is available.…”