Enteroviral Infection Outbreak in the Republic of Belarus: Principal Characteristics and Phylogenetic Analysis of Etiological Agents

Abstract

For the last decade enterovirus outbreaks were registered in all of six districts of Belarus. Two of them, reported in 1997 (in Gomel) and in 2003 (in Minsk), were the most extensive and involved 461 and 1,351 patients respectively. Virus ECHO 30 was identified as the dominant etiologic agent of the outbreak in 1997 whereas co-circulation of ECHO 30, ECHO 6 and Coxsackievirus B5 took place in 2003. Analysis of clinical manifestations during the Minsk outbreak revealed unusually high rate of severe clinical forms of infection including aseptic meningitis, encephalitis and myocardial disorders. Epidemiologic observation was ordinary for enterovirus epidemics in temperate climates: the peak of the outbreak was recorded during summer-autumn period of 2003, and 0-14 years old children predominated. Data from the case-control study indicated that illness was associated with drinking water from community water system. Also the laboratory examination demonstrated contamination of different water samples with the epidemic virus serotypes and sequence analysis showed high level of genetic similarity between waterborne and clinical isolates. For these reasons the outbreak should be classified as a waterborne one. Phylogenetic reconstruction showed that all Belarusian ECHO 30 isolates belong to the major genotype of ECHO 30 which has been circulating for last 15 years in Europe and North America. Viral agents of 2003 were very similar and substantially differed from isolates of 1997. Comparison of nucleotide sequences of isolates from myocarditis patients revealed their considerable genetic similarity with ECHO 30 isolates from patients with aseptic meningitis and from water. The results of the study draw attention to the importance of virological control of tap and bottled water as a relevant measure aimed at reduction of epidemiological risks.

A large Finnish echovirus 30 outbreak was preceded by silent circulation of the same genotype

“…In tandem several other reports described similar findings, indicating a global predominance of a single epidemic genotype [3][4][5]. These reports were followed by global descriptions of E-30 outbreaks [6][7][8][9][10][11][12][13][14][15]. Long-term surveillance of E-30 reporting by the Centers for Disease Control and Prevention has revealed the periodicity of E-30 outbreaks within a community [10].…”

The efficacy of simulated solar disinfection (SODIS) against coxsackievirus, poliovirus and hepatitis A virus

“…Following the recent decline in cases of poliomyelitis, infections caused by other enterovirus serotypes represent an emerging and increasing threat to human health (Khetsuriani et al 2006;Yang et al 2on). In particular, enterovirus 71 serotype has recently been linked with an epidemic resulting in 490,000 cases in the Asia-Pacific region with 126 deaths ) and coxsackievirus B5 was associated with 1,351 cases in Belarus through the consimiption of contaminated drinking water (Amvrosieva et al 2006). …”

Use of Propidium Monoazide in Reverse Transcriptase PCR To Distinguish between Infectious and Noninfectious Enteric Viruses in Water Samples

“…Noroviruses are the second most common cause of viral gastroenteritis next to rotaviruses worldwide (38). In recent years, a number of these enteric viruses have been the etiological agents of several waterborne outbreaks (1,2,10,14,21,29,32).…”