Genetic Characteristics of the Coxsackievirus A24 Variant Causing Outbreaks of Acute Hemorrhagic Conjunctivitis in Jiangsu,China, 2010

During September 2010, an outbreak of acute hemorrhagic conjunctivitis reemerged in Jiangsu, three years after the nationwide epidemic in China in 2007. In total, 2409 cases were reported, 2118 of which were reported in September; 79.8% of those affected were students or teachers, with a median age of 16 years. To identify and demonstrate the genetic characteristics of the etiological agent, 52 conjunctival swabs were randomly collected from four different cities. After detection and isolation, 43 patients were positive for coxsackievirus A24 variant according to PCR and 20 according to culture isolation. Neither adenovirus nor EV70 was detected. A phylogenetic study of the complete 3Cpro and VP1 regions showed that the Jiangsu isolates clustered into a new lineage, GIV-C5, with two uniform amino-acid mutations that distinguished them from all previous strains. Another new cluster, GIV-C4, formed by Indian isolates from 2007 and Brazilian isolates from 2009, was also identified in this study. Interestingly, our isolates shared greatest homology with the GIV-C4 strains, not with the isolates that were responsible for the nationwide acute hemorrhagic conjunctivitis epidemic in China in 2007. Although all our isolates were closely related, they could be differentiated into two subclusters within GIV-C5. In conclusion, our study suggests that a new cluster of coxsackievirus A24 variant that had already evolved into diverse strains was associated with the acute hemorrhagic conjunctivitis outbreaks in Jiangsu in September 2010. These viruses might have originated from the virus isolated in India in 2007, rather than from the epidemic strains isolated in China in 2007.     

急性出血性结膜炎流行后居民中柯萨奇病毒A24变种抗体水平的变化

由柯萨奇病毒A24变种(CA24v)引起的急性出血性结膜炎(AHC)在沙市出现首次流行后半年与1年(即1989年春、秋季),从城市居民中采集了423份血清,用微量中和试验作了CA24v中和抗体与特异性IgM的检测。春季中和抗体阳性率为37.9％,特异性IgM阳性率为3.3％;秋季为48.8％与6.7％,并从感冒样病人中分离到1株CA24v,提示1989年秋季又有一次CA24v的传播过程。在年龄分布上,秋季中各年龄组抗体阳性率已无明显差异,提示经一年多的传播扩散,各年龄组的免疫水平已趋于接近,达到50％左右,并预测近期内本地将不会有CA24v引起的AHC流行。     

2010年浙江省部分地区急性出血性 结膜炎暴发疫情病原学研究

为查明引起2010年浙江省急性出血性结膜炎(AHC)暴发疫情的病因,并对病原进行分子溯源。本研究采用荧光RT-PCR方法直接从患者眼拭子样本中检测肠道病毒(EV)和柯萨奇病毒A24变异株(CA24v)核酸;用Hep-2细胞分离病毒,对阳性分离物提取病毒核酸后进行VP1全基因和3C蛋白酶区(3C)扩增和测序,同源性与进化分析。结果13份眼拭子样本中EV和CA24v核酸均阳性8份,分离到CA24v6株。选取4株病毒测序,获得VP1全长均为915个核苷酸(nt),3C区全长495nt,VP1和3C区均没有nt插入和缺失。2010年浙江4株CA24v分离株之间在3C区和VP1区核苷酸和氨基酸(aa)高度同源,2010年浙江CA24v分离株与原型株EH24/70在3C区的nt和aa同源性分别为85.2%～85.8%和96.2%～96.7%,与2002～2008年浙江、云南和广东CA24v株的同源性分别为93.4%～96.2%和96.7%～99.3%;浙江2010年CA24v株在3C区进化树的GⅣ基因亚型C4分枝上(GⅣ-C4),在VP1基因进化树的人类肠道病毒C组(EV-C)CA24v分枝上。研究表明引起2010年浙江省急性出血性结膜炎暴发流行的病原为CA24v,GⅣ基因亚型,与引起2002～2008年浙江AHC流行的CA24v株(GⅣ)具有密切的亲缘关系,推测CA24v病毒自2002年以来一直在本地低强度循环,2010年又导致了浙江AHC的暴发。     

A study of the evolution of coxsackievirus A24 variant in Ghana by viral RNA fingerprinting analysis

An epidemic of acute haemorrhagic conjunctivities (AHC) caused by coxsackievirus A24 variant (CA24v) was reported in Accra, Ghana in May 1987. We studied 7 of the viral strains collected from May to November, 1987, by RNA genome fingerprinting. Pairwise comparisons of the oligonucleotide maps showed that genetic similarity among them ranged from between 60.0 to 84.7 %.Using base sequence variations deduced from genetic similarity among the isolates, isolation time of the strains and the rate of nucleotide substitution (estimated in a previous paper, Miyamura et al., 1990), we calculated divergence times and constructed a phylogenetic tree. This tree indicated that all the 7 strains had diverged from each other from 11 to 26 months before the AHC epidemic in Accra. CA24v may have been introduced into the country or the neighbouring area, at least, more than two years earlier, i. e. in the early half of 1985.     

2007年北京市急性出血性结膜炎的病原与分子进化分析

2007年北京市发生了急性出血性结膜炎(Acute Hemorrhagic Conjunctivitis,AHC)疫情。为鉴定引起这次疫情的致病病原体,采集北京市门诊就诊的AHC患者眼结膜拭子标本共57份,使用PCR或RT-PCR法分别检测临床标本中腺病毒、人肠道病毒70型(Human Enterovirus 70,HEV70)和柯萨奇病毒A组24型变种(CoxsackievirusA24 variant,CVA24v)的基因,其中有38份检测结果为CVA24v阳性,阳性率为66.7%,而腺病毒和HEV70检测结果均为阴性,说明引起本次AHC流行的病原体是CVA24v。使用HEp-2细胞共分离到9株病毒,通过分子定型均鉴定为CVA24v,对9株CVA24v进行全长VP1区扩增和核苷酸序列测定和分析后,发现除0744/BJ/CHN/2007株之外,其它8株在全长VP1区核苷酸水平和氨基酸水平上差异都很小,同源性分别大于99.6%和100.0%,而0744/BJ/CHN/2007株与其它8株CVA24v的核苷酸和氨基酸同源性分别为96.8%~97.2%和99.7%。进化树图显示,2007年北京CVA24v分离株与...     

An outbreak of acute hemorrhagic conjunctivitis in Yugoslavia in 1973.

An outbreak of approximately 200 cases of acute hemorrhagic conjunctivitis is described in Prekmurje, a northern province in Yugoslavia. The epidemic was caused by enterovirus type 70, serologically identical with the causative agents of similar outbreaks in London and Japan. The origin of the outbreak could not be elucidated but a link was seen between this case and a small outbreak in Veenendaal in the Netherlands.     

Molecular evolution of VP3, VP1, 3Cpro and 3Dpol coding regions in coxsackievirus group A type 24 variant isolates from acute hemorrhagic conjunctivitis in 2011 in Okinawa,Japan

A large acute hemorrhagic conjunctivitis (AHC) outbreak occurred in 2011 in Okinawa Prefecture in Japan. Ten strains of coxsackievirus group A type 24 variant (CA24v) were isolated from patients with AHC and full sequence analysis of the VP3, VP1, 3C^pro and 3D^pol coding regions performed. To assess time‐scale evolution, phylogenetic analysis was performed using the Bayesian Markov chain Monte Carlo method. In addition, similarity plots were constructed and pairwise distance (p‐distance) and positive pressure analyses performed. A phylogenetic tree based on the VP1 coding region showed that the present strains belong to genotype 4 (G4). In addition, the present strains could have divided in about 2010 from the same lineages detected in other countries such as China, India and Australia. The mean rates of molecular evolution of four coding regions were estimated at about 6.15 to 7.86 × 10^?3 substitutions/site/year. Similarity plot analyses suggested that nucleotide similarities between the present strains and a prototype strain (EH24/70 strain) were 0.77–0.94. The p‐distance of the present strains was relatively short (<0.01). Only one positive selected site (L25H) was identified in the VP1 protein. These findings suggest that the present CA24v strains causing AHC are genetically related to other AHC strains with rapid evolution and emerged in around 2010.

     

A Sialic Acid Binding Site in a Human Picornavirus

The picornaviruses coxsackievirus A24 variant (CVA24v) and enterovirus 70 (EV70) cause continued outbreaks and pandemics of acute hemorrhagic conjunctivitis (AHC), a highly contagious eye disease against which neither vaccines nor antiviral drugs are currently available. Moreover, these viruses can cause symptoms in the cornea, upper respiratory tract, and neurological impairments such as acute flaccid paralysis. EV70 and CVA24v are both known to use 5-N-acetylneuraminic acid (Neu5Ac) for cell attachment, thus providing a putative link between the glycan receptor specificity and cell tropism and disease. We report the structures of an intact human picornavirus in complex with a range of glycans terminating in Neu5Ac. We determined the structure of the CVA24v to 1.40 Å resolution, screened different glycans bearing Neu5Ac for CVA24v binding, and structurally characterized interactions with candidate glycan receptors. Biochemical studies verified the relevance of the binding site and demonstrated a preference of CVA24v for α2,6-linked glycans. This preference can be rationalized by molecular dynamics simulations that show that α2,6-linked glycans can establish more contacts with the viral capsid. Our results form an excellent platform for the design of antiviral compounds to prevent AHC.     

Molecular analysis of Coxsackievirus A24 variant isolates from three outbreaks of acute hemorrhagic conjunctivitis in 1988, 1994 and 2007 in Beijing,China

Coxsackievirus A24 variant (CVA24v) is a major pathogen that causes continued outbreaks and pandemics of acute hemorrhagic conjunctivitis (AHC). In China, the first confirmed outbreak of CVA24v-related AHC occurred in Beijing in 1988, followed by another two significant outbreaks respectively in 1994 and 2007, which coincides with the three-stage dynamic distribution of AHC in the world after 1970s. To illustrate the genetic characteristics of CVA24v in different periods, a total of 23 strains were isolated from those three outbreaks and the whole genome of those isolations were sequenced and analyzed. Compared with the prototype strain, the 23 strains shared four nucleotide deletions in the 5' UTR except the 0744 strain isolated in 2007. And at the 98th site, one nucleotide insertion was found in all the strains collected from 2007. From 1994 to 2007, amino acid polarity in the VP1 region at the 25th and the 32nd site were changed. Both the 3C and VP1 phylogenetic tree indicated that isolates from 1988 and 1994 belonged to Genotype III (GIII), and 2007 strains to Genotype IV (GIV). According to the Bayesian analysis based on complete genome sequence, the most recent common ancestors for the isolates in 1988, 1994 and 2007 were respectively estimated around October 1987, February 1993 and December 2004. The evolutionary rate of the CVA24v was estimated to be 7.45×10^-3 substitutions/site/year. Our study indicated that the early epidemic of CVA24v in Chinese mainland was the GIII. Point mutations and amino acid changes in different genotypes of CVA24v may generate intensity differences of the AHC outbreak. CVA24v has been evolving constantly with a relatively rapid rate.     

Epidemiological analysis of acute respiratory disease (ARD) and characteristics of the influenza epidemic in Bohemia during the season 1986/1987

The authors analyze the findings of epidemiological and virological surveillance of ARD in Bohemia during the season 1986/1987. In all, 57.5% of the Czech population was affected by acute respiratory disease (ARD). There were 5,950,832 cases reported, 124,444 complications (2.1% of the overall morbidity rate) and 5,374 deaths due to influenza, bronchitis, pneumonia and chronic pulmonary affection. The influenza epidemic commenced during the 48-th calendary week (CW) and lasted 5 weeks till the 52-nd CW. The epidemic was due to an influenza virus strain of the subtype A(H1N1) antigenically related to the drift variant A (Singapore) 6/86. Within an extremely short period of the epidemic, 1,094,865 influenza cases were reported and 22,313 cases of complications. 10.7% of the CSR population were affected during the epidemic in whose etiology noninfluenza respiratory viruses were significantly implicated, especially adenoviruses (41.7%) and the RS virus (26.9%). There was no excessive mortality in the course of the epidemic. The authors discuss the atypical nature of this particular influenza epidemic and the etiological role of respiratory viruses.     

Genome typing of adenovirus strains isolated from conjunctivitis in Japan, Australia, and the Philippines

DNA restriction endonuclease analysis for genome typing of adenovirus (Ad) DNA was carried out on a total of 65 Ad isolates including serotypes Ad4, Ad7, Ad8, Ad11, Ad19, and Ad37 from patients with epidemic keratoconjunctivitis and acute conjunctivitis obtained in Japan from 1982 to 1986, Australia from 1973 to 1986, and the Philippines in 1984. All 4 isolates of Ad7 in Australia were Ad7b. Four of 6 Ad11 isolates obtained in Japan were typed as Ad11 prototype (Ad11p), and the remaining were identified to be new genome types, designated tentatively as Ad11c and Ad11d. An isolate of Ad11 obtained in Australia was typed as Ad11c. Nine Ad8 isolates in Australia and in the Philippines were typed as Ad8p, but 11 Ad8 isolates in Japan were Ad8b. Thirteen Ad19 isolates were identified as Ad19a. All 3 isolates of Ad37 in Japan and three isolates in Australia before 1982 were typed as Ad37p, however, 5 isolates in Australia after 1983 were identified as a new genome type, designated as Ad37d. In Japan, 10 isolates of Ad4 were identified as Ad4a.     

Etiological relation between Korean hemorrhagic fever and epidemic hemorrhagic fever in Japan.

The first case of epidemic hemorrhagic fever in Japan was seen in Osaka in 1960. The etiologic agent of this disease has not yet been isolated, but a close etiologic relation between Korean hemorrhagic fever and epidemic hemorrhagic fever in Japan has been suspected because of similarities in the clinical and pathological pictures of the two diseases. This relation has now been confirmed serologically by demonstrating specific immunofluorescent antibodies to Korean hemorrhagic fever virus in 19 of 20 sera obtained from subjects 7 to 17 years after an acute attack of epidemic hemorrhagic fever.     

Characterization of a virus associated with epidemic conjunctivitis in Thailand.

A strain of virus, named the A-E strain, was isolated from a patient suffering from acute haemorrhagic conjunctivitis during an epidemic of the disease in Bangkok in 1972. The virus had the characteristics of an enterovirus but was not neutralized by any known enterovirus antiserum. Cross neutralization tests indicated that the isolate was closely related to the J670-71 virus isolated in Japan. The virus produced conjunctivitis in rabbits and monkeys following conjunctival inoculation.     

Sialic acid is a cellular receptor for coxsackievirus A24 variant, an emerging virus with pandemic potential

Binding to target cell receptors is a critical step in the virus life cycle. Coxsackievirus A24 variant (CVA24v) has pandemic potential and is a major cause of acute hemorrhagic conjunctivitis, but its cellular receptor has hitherto been unknown. Here we show that CVA24v fails to bind to and infect CHO cells defective in sialic acid expression. Binding of CVA24v to and infection of corneal epithelial cells are efficiently inhibited by treating cells with a sialic acid-cleaving enzyme or sialic acid-binding lectins and by treatment of the virus with soluble, multivalent sialic acid. Protease treatment of cells efficiently inhibited virus binding, suggesting that the receptor is a sialylated glycoprotein. Like enterovirus type 70 and influenza A virus, CVA24v can cause pandemics. Remarkably, all three viruses use the same receptor. Since several unrelated viruses with tropism for the eye use this receptor, sialic acid-based antiviral drugs that prevent virus entry may be useful for topical treatment of such infections.     

Genomic comparison of adenovirus type 3 isolates from patients with acute conjunctivitis in Japan, Australia, and the Philippines

A total of 53 Ad3 isolates obtained from patients with acute conjunctivitis in Japan, Australia, and the Philippines during 1973 to 1986 were analyzed for their genome types with 4 restriction endonucleases, BamHI, BglII, HindIII, and SmaI. Two new genome types designated tentatively as Ad3f and Ad3g were identified by combination of BamHI and BglII in the isolates. The changes of restriction sites and sizes of restriction fragments in newly recognized Ad3f and Ad3g were located at the similar regions reported in other Ad3 genome types by O'Donnell et al (1986) on physical maps of the Ad3 prototype strain GB genome. In Japan, 46 Ad3 isolates obtained from 1983 to 1986 were either Ad3f or Ad3g. Yearly alternation of predominance of both genome types were observed in the northern part of Japan during the period. In Australia, two genome types Ad3p and Ad3f were found in 6 isolates, and the former was observed in the 3 isolates obtained before 1981 and the remaining 3 isolates were obtained after 1983. In the Philippines, the only isolate obtained in 1984 was Ad3p.     

Enteroviral aseptic meningitis in Japan, 1981-1991. A report of the National Epidemiological Surveillance of Infectious Agents in Japan.

In Japan, aseptic meningitis cases due to enterovirus infections increase every summer in various degrees with an incidence peak usually in July. During the past 11 years from 1981 through 1991, a total of 8,595 enterovirus isolations from aseptic meningitis cases were reported from 54 participating laboratories. Eight enterovirus types caused large epidemics; more than 100 isolations of each type from aseptic meningitis cases were reported for every epidemic year of the respective type. They were coxsackievirus (C) types B3 and B5, echovirus (E) types 4, 6, 7, 9, 18 and 30. Among these, the highest meningitis-associating frequency was reported for E30, representing 82.6% of the total isolations reported for the type during this period, followed by E4, 71.1%. The frequencies of E9, E7, E6 and CB5 were in a range from 54.5% to 44.4%, while that of E18 was 37.7% and that of CB3 21.0%. During the epidemics, enterovirus-associated meningitis was most frequently reported among children of 4-7 years of age. High frequencies were also shown in infants less than 1-year of age in some types. A total of 4,240 enteroviruses were isolated from cerebrospinal fluid of aseptic meningitis cases, representing 49.3% of the cases with enterovirus isolation.     

Epidemic of acute haemorrhagic conjunctivitis in Freetown, Sierra Leone, in 1970

Epidemiological features of the epidemic of acute haemorrhagic conjunctivitis in Freetown, Sierra Leone, in 1970, are described. On the basis of hospital figures and a House-to -House survey of 0.9% of the population it is estimated that 50-53% of Freetown's population suffered from the conjunctivitis in 20 weeks. Though no causative agent was isolated, it is supposed, on the basis of the striking similarity with other outbreaks, that the epidemic was caused by enterovirus type 70. Hospital figures, a house-to-house survey and a survey in a closed community provided evidence that man-to-man contact was the principal mode of spread.     

Sexually transmitted diseases among prostitutes in Fukuoka, Japan

The prevalence of sexually transmitted diseases (STDs) among prostitutes was investigated at a genitourinary hospital in Fukuoka, Japan, in 1985 and 1986. The most common STD was Chlamydia trachomatis infection, followed by gonorrhea and condyloma acuminatum. Candidiasis, trichomoniasis and genital herpes were relatively uncommon. The rate of prostitutes who had STD but had no subjective symptoms were 42.9% in 1985 and 30.9% in 1986. The rate of prostitutes having mixed STD infection was 35.8% among the summed 162 STD-contracted prostitutes.     

Antiviral potency of a siRNA targeting a conserved region of coxsackievirus A24

Coxsackievirus A24 (CVA24) is responsible for acute hemorrhagic conjunctivitis, a highly contagious eye disease for which no prevention or treatment is currently available. We thus assessed the antiviral potential of a small interfering RNA (siRNA) targeting CVA24. HeLa cells with or without four different siRNAs complementary to 2C or 3D genome region, were challenged with various CVA24s. Among several siRNAs, a siRNA targeting the highly conserved genome region called the cis-acting replication element (CVA24-CRE), was the only siRNA that decreased virus replication and subsequent cytotoxicity by both CVA24 variant and clinical isolates. Furthermore, CVA24-CRE had effective antiviral activity against CVA24 in primary human conjunctival cells. In addition, CVA24-CRE was highly resistant to the emergence of genetically altered escape mutants. Collectively, the present study provides evidence that CVA24-CRE targeting a conserved viral genome region had universal, prolonged anti-CVA24 activity. This siRNA may thus hold a potential to act clinically as a novel anti-CVA24 agent.     

2009～2011年上海市手足口病流行病学和病原学特征

为分析2009～2011年上海地区手足口病流行病学特征和病原构成,从国家疾病监测信息报告管理系统获取上海市2009～2011年手足口病流行病学资料;采用实时荧光反转录聚合酶链反应（RT-PCR）对来自上海18个区（县）的6676例手足口病病例标本进行肠道病毒核酸检测,对其中257份标本进行病毒分离;对27份人肠道病毒71型（HEV71）毒株进行VPl基因序列全长测定和分析。结果显示,2009～2011年上海市18个区（县）均有手足口病病例报道,地区分布元显著差异;≤5岁的婴幼儿为疾病高发年龄段;4～11月为发病高峰期。HEV71和柯萨奇病毒A组16型（CAl6）为主要病原,不同地区病原构成有所不同。实时荧光RT—PCR对6676例病例标本进行核酸检测,其中肠道病毒通用核酸检测阳性率为69．61％,HEV71和CAl6阳性率分别为38．83％和21．26％。对257份HEV71核酸阳性标本进行病毒分离,获得毒株57株,分离阳性率为22．18％。对其中27株进行VPl基因全长测序,均属C4a基因亚型。