Epidemic myalgia and myositis associated with human parechovirus type 3 infections occur not only in adults but also in children: findings in Yamagata, Japan, 2014

Abstract

We previously reported an association between human parechovirus type 3 (HPeV3) and epidemic myalgia with myositis in adults during summers in which an HPeV3 outbreak occurred in children. However, this disease association has not yet been reported elsewhere. We have since continued our surveillance to accumulate data on this disease association and to confirm whether myalgia occurs in children as well as adults. Between June and August 2014, we collected 380 specimens from children with infectious diseases. We also collected clinical specimens from two adult and three paediatric patients suspected of myalgia. We then performed virus isolation and reverse-transcription-PCR using the collected specimens. We detected HPeV3 in 26 children with infectious diseases, which we regarded as indicating an outbreak. We also confirmed HPeV3 infection in all patients suspected of myalgia. In particular the symptoms in two boys, complaining of myalgia and fever, closely matched the criteria for adult myalgia. Based on our findings from 2008, 2011 and 2014, we again urge that clinical consideration be given to the relationship between myalgia and HPeV3 infections during HPeV3 outbreaks in children. Furthermore, our observations from 2014 suggest that epidemic myalgia and myositis occur not only in adults but also in children.

Evolutionary and network analysis of virus sequences from infants infected with an Australian recombinant strain of human parechovirus type 3

“…not further recombined, Yamagata 2011 lineage virus 1 . Interestingly, although only indirectly related to our analyses presented here and to our knowledge not reported in the literature, the Yamagata 2011 lineage viruses reported 38–40 and deposited in GenBank contain what appear to be two different clusters most likely derived by recombination at approximately nucleotide 5000 (equivalent to nucleotide 4300 in the deposited Yamagata 2011 lineage viruses as they only included the coding regions). These two clusters are represented by GenBank Accession number AB759207 in one of the two clusters and AB759204 and AB759205 in another.…”

“…However, it appears that more recent strains have spread worldwide only within the last 20–30 years 28, 37 , and during this time, may have evolved into being more virulent. One such example may be the Yamagata 2011 lineage of HPeV3 shown to cause severe disease in young children and myalgia in adults 38–40 . We have previously shown that the first reported outbreaks of HPeV3 in infants in Australia in 2013/14 and 2015, respectively, were caused by a novel recombinant HPeV3 with the capsid encoding region closely related to the Yamagata 2011 lineage, while the nonstructural encoding region derived from an as yet unknown/unpublished HPeV(s) 1 .…”

Seroepidemiology of human parechovirus types 1, 3, and 6 in Yamagata, Japan, in 2014

“…According to our previous studies, HPeV3 also causes epidemic myalgia and myositis in both adults and children during these summer outbreaks. This phenomenon was also observed in Osaka, Japan, during an outbreak in 2014 and was recently described in a textbook for the first time . The detection of HPeV6 has been quite limited in comparison with that of HPeV1 and HPeV3, with HPeV6 viruses detected from infants and children with Reye syndrome, gastroenteritis, rash, flaccid paralysis, and upper respiratory infection, according to the original report .…”

An outbreak of severe infections among Australian infants caused by a novel recombinant strain of human parechovirus type 3

“…As this was the first outbreak of HPeV3 observed at University Hospital Geelong and because the Yamagata lineage of HPeV3 is known to cause severe clinical disease505152, we decided to sequence and further characterise the Geelong 2015 outbreak virus in detail. Our initial strategy of using NGS Ampliseq based on a constructed composite full length reference genome containing the coding region from the Yamagata 2011 lineage gave very good coverage for the structural/capsid coding region, but only sporadic coverage downstream of nucleotide 3114 indicating that the Geelong 2015 outbreak virus was likely a recombinant.…”

“…However, more recent strains appear to have spread worldwide within the last 20–30 years2433, and possibly evolved into being more virulent. One such example may be the Yamagata 2008/2014 and the Yamagata 2011 lineages of HPeV3 shown to cause severe disease in young children and myalgia in adults505152.…”