Molecular epidemiology of enterovirus 71 in peninsular Malaysia, 1997?2000

Herrero, Lara J.; Lee, C. S. M.; Hurrelbrink, Robert J.; Chua, Beng Hooi; Chua, K. B.; McMinn, Peter C.

doi:10.1007/s00705-003-0100-2

Cited by 100 publications

(93 citation statements)

References 31 publications

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“…Indeed, almost all of the EV 71 infections detected in 2009 were nearly identical, in terms of their genetic identities, to those reported in China during the preceding 2 years (32). It has been reported that EV 71 subgenotype C4a causes fewer neurological complications than other subgenotypes, including C1 and B5 (1,8,11,12). An aggressive treatment strategy for EV 71 infection could be another reason.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Etiological Characteristics of Enterovirus 71-Related Diseases during a Recent 2-Year Period in Korea

et al. 2010

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Human enterovirus 71 (EV 71) has caused large-scale outbreaks of hand-foot-and-mouth disease (HFMD), particularly in the Asian-Pacific region. In this study, we report a major outbreak of EV 71 infection in Korea and describe the clinical differences between EV 71 and non-EV 71 enterovirus infections. We prospectively enrolled patients with suspected viral infections during a recent 2-year period through a nationwide surveillance system. We identified 719 patients with suspected HFMD or herpangina using real-time PCR and genotyping based on VP1 sequence analysis. The major pathogen causing HFMD changed substantially from 2008 to 2009, with EV 71 becoming the most common cause of HFMD in Korea in 2009. We successfully identified the enteroviral genotypes for 218 of the 719 patients. Patients with EV 71 infections tended to be younger than those with non-EV 71 enteroviral infections and presented with HFMD and meningoencephalitis. In addition, the occurrence of fever, headache, and neck stiffness was significantly higher in patients with EV 71 infections. Multivariable analysis showed that for patients presenting with HFMD, fever, or a sore throat, each covariate was independently associated with EV 71 infection; the adjusted odds ratios (with 95% confidence intervals in parentheses) for these variables were 31.86 (10.04 to 101.09), 4.76 (1.71 to 13.25), and 0.18 (0.04 to 0.77), respectively. Our results indicate that EV 71 was a major cause of HFMD in Korea during the study period. In addition, we found that clinical symptoms may be helpful in the early identification of patients with EV 71 infections.Human enterovirus 71 (EV 71) is an important emerging pathogen of hand-foot-and-mouth disease (HFMD) (1, 6, 30). In particular, several major outbreaks of EV 71 have been documented in the Asia-Pacific region since 1997 (3,4,7,9,25). EV 71 infection causes HFMD, a common exanthema of young children that is characterized by a fever, rashes on the palms and the bottoms of the feet, and ulcers in the oral cavity. In general, patients with HFMD experience a mild course of disease; however, some patients develop severe neurological complications, especially as a result of EV 71 (18).Given that EV 71 infection could cause severe neurological complications, its early detection in patients with HFMD is an important part of intensive care efforts and efforts to prevent mortality. Unfortunately, current methods for the detection of EV 71 do not enable early detection (23). Here we report an outbreak of EV 71 infection in Korea. As part of this nationwide surveillance study, we examined the clinical differences between EV 71 and non-EV 71 enteroviral infections, and we investigated whether these differences are clinically applicable to the early detection of EV 71 in patients with complications of HFMD. MATERIALS AND METHODS Patients.A nationwide surveillance system for infection with enterovirus (EV) in Korea was initiated in 2005. Sixty-two clinics (8 primary clinics, 14 secondary hospitals, and 40 tertiary hospitals located...

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Section: Discussionmentioning

confidence: 99%

Clinical and Etiological Characteristics of Enterovirus 71-Related Diseases during a Recent 2-Year Period in Korea

et al. 2010

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“…Recombination would be facilitated by the presence of several subgenogroups circulating during the same period in one country or region, such as the cocirculation of the four subgenogroups B3, B4, C1 and C2 in Malaysia between 1997(Herrero et al, 2003 ( Fig. 1).…”

Section: Discussionmentioning

confidence: 99%

Molecular characterization of enterovirus 71 and coxsackievirus A16 using the 5′ untranslated region and VP1 region

Zhou

Kong

Wang

et al. 2011

Journal of Medical Microbiology

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Enterovirus 71 (EV71) and coxsackievirus A16 (CVA16) are members of the species Human enterovirus A, and are both major and independent aetiological agents of hand-foot-and-mouth disease. The human enterovirus (HEV) 59 untranslated region (UTR) is fundamentally important for efficient virus replication and for virulence, whilst the VP1 region correlates well with antigenic typing by neutralization, and can be used for virus identification and evolutionary studies. A comparison was undertaken of the 59UTR and VP1 nucleotide sequences of five EV71 clinical isolates and 10 CVA16 clinical isolates from one laboratory with the 59UTR and VP1 sequences of 104 EV71 strains and 45 CVA16 strains available in GenBank. The genetic relationships were analysed using standard phylogenetic methods. The EV71 phylogenetic analysis showed that the VP1 sequences were clustered into three genogroups, A, B and C, with genogroups B and C further divided into five subgenogroups, B1-B5 and C1-C5, respectively. All EV71 strains were clustered similarly in the 59UTR and VP1 trees, except for one Taiwanese strain, which demonstrated different clustering in the two trees, suggesting a recombination event in the phylogeny. The CVA16 phylogenetic analysis showed that the VP1 sequences were clustered into two genogroups, A and B, with genogroup B further divided into B1 (B1a and B1b), B2 and a possible B3; and that a similar pattern and grouping of all strains were displayed in the 59UTR tree. This study demonstrated that comparing the two regions provides evidence of epidemiological linkage of HEV-A strains, and that mutation in the two regions plays a vital role in the evolution of these viruses. The combination of molecular typing and phylogenetic sequence analysis will be beneficial in both individual patient diagnosis and public health measures. INTRODUCTIONEnterovirus 71 (EV71) and coxsackievirus A16 (CVA16), members of the species Human enterovirus A in the genus Enterovirus, family Picornaviridae, are both major and independent aetiological agents of large outbreaks of handfoot-and-mouth disease (HFMD). In contrast to CVA16, EV71-associated HFMD is more frequently associated with serious neurological complications and fatalities (McMinn et al., 2001b). Initial EV71 isolates were identified in the USA and Australia in the early 1970s, and in HFMD outbreaks in Sweden and Japan (Wong et al., 2010). Since 1997, the Asia-Pacific region has had several large EV71 epidemics, including in the Chinese mainland, Taiwan, Singapore, Malaysia and Japan. Several outbreaks have also been recorded in Australia (Gilbert et al., 1988;Sanders et al., 2006;McMinn et al., 2001b). Co-circulation of EV71 and CVA16 has contributed to serious HFMD outbreaks in China in (Zhang et al., 2009), Taiwan in 1998(Lin et al., 2003), and Malaysia in 1997(Podin et al., 2006.The enterovirus genome is a positive ssRNA molecule of approximately 7500 nt, comprising a single ORF flanked 59Abbreviations: CVA16, coxsackievirus A16; EV71, enterovirus 71; HEV, human enterovirus; ...

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“…They had more than 95% nucleotide identity to the representative Malaysian C2 strain 03750-MAA-97. C2 had been reported in Malaysia, Taiwan, Australia, and Japan between 1997 and 1999 (2,5,7,17). In 2000, all isolates analyzed were typed as B4 except for one strain, 1116-Yamagata-00, which was typed as C2.…”

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confidence: 99%

“…Because fatal cases have been reported in Asian countries, such as Malaysia (1997), Taiwan (1998), Singapore (2000), and Japan (2000), careful monitoring of the incidence of HFMD and a plan for dealing with severe outbreaks of HFMD are considered to be of great importance (3,5,16,18,20). To realize this, understanding the epidemiology and pathogenesis of EV71 is primary.…”

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confidence: 99%

Frequent Importation of Enterovirus 71 from Surrounding Countries into the Local Community of Yamagata, Japan, between 1998 and 2003

et al. 2005

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Molecular epidemiology of enterovirus 71 in peninsular Malaysia, 1997?2000

Cited by 100 publications

References 31 publications

Clinical and Etiological Characteristics of Enterovirus 71-Related Diseases during a Recent 2-Year Period in Korea

Clinical and Etiological Characteristics of Enterovirus 71-Related Diseases during a Recent 2-Year Period in Korea

Molecular characterization of enterovirus 71 and coxsackievirus A16 using the 5′ untranslated region and VP1 region

Frequent Importation of Enterovirus 71 from Surrounding Countries into the Local Community of Yamagata, Japan, between 1998 and 2003

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