2007―2008年肠道病毒71型北京地区分离株的VP4基因序列分析

为了解2007 ― 2008 年北京地区流行的肠道病毒71 型( EV71) 是否存在基因序列变异及其与病毒毒力的关系, 我们选择2007 年分离的3 株EV71( 其中1 株分离自重症手足口病患儿的咽拭子标本, 其余2 株分离自普通手足口病患儿咽拭子标本) 和2008 年分离的5 株EV71( 其中3 株分离自重症手足口病患儿的咽拭子或鼻拭子标本, 2 株分离自普通手足口病患儿的疱疹液标本) , 提取基因组RNA, 经反转录-聚合酶链反应( RT-PCR) 扩增得到VP4 基因片段, 并进行核苷酸序列测定, 使用生物信息软件与GenBank 中的EV71 VP4 基因进行序列及病毒型别分析。结果表明, 所测得的8 株EV71 VP4 基因全长均为207 bp, 编码69 个氨基酸, 理论相对分子质量( Mr) 为7 ×10³。8 株EV71 病毒VP4 基因的核苷酸同源性在94% ～100% , 与GenBank 中其他EV71 病毒株VP4 的核苷酸同源性为82% ～100% , 与阜阳、深圳和台湾等地区流行的EV71 VP4 的核苷酸同源性比其他地区高。除了与印度报道的VP4 编码的氨基酸在第7 和54 位不同外( 印度株: 7 位蛋氨酸, 54位苏氨酸; 其余株7 位苏氨酸,54 位丙氨酸) , 这8 株EV71 VP4 编码的氨基酸序列之间以及与其他EV71 VP4编码的氨基酸同源性均为100%。8 株EV71 病毒VP4 与文献报道的3 株重症感染病毒株VP4 ( BrCr、MS 和NCKU9822) 核苷酸有较大差别, 而8 株病毒株中从重症感染( BJ97、BJ110B、BJ110Y 和BJ4243) 与轻症感染( BJ25、BJ47、BJ65 和BJ67) 分离到的毒株之间VP4 基因序列未见明显改变, 只有几个核苷酸存在差别。VP4 核苷酸序列的进化树分析表明, 这8 株EV71 均属于C4 亚型, 显示2007 ― 2008 年北京地区流行的EV71的VP4 基因相当保守, 分离自伴有神经系统感染的重症手足口病和普通手足口病患儿的EV71 的VP4 基因之间在核苷酸水平未出现同样的变异。结果提示, 近2 年来北京地区所流行的EV71 属C4 亚型。     

肠道病毒71型北京分离株VP4基因序列及蛋白抗原性分析

为探讨肠道病毒71型(EV71)VP4基因序列与手足口病(HFMD)不同临床类型之间的关系,分析重组蛋白EV71 VP4的抗原性,并初步探讨其与柯萨奇病毒A16(CA16)重组蛋白VP4是否存在交叉反应性,对2007~2009年从北京患HFMD儿童标本分离到的10株EV71的VP4基因进行克隆测序,运用生物学软件对测序结果进行比较分析,并选择其中1株与1株同期分离的CA16的VP4分别进行原核表达;用表达产物对189份正常体检的成人及来首都儿科研究所就医的非HFMD患儿血清中的IgG进行Western Blot检测,并分析14份确诊为EV71感染和12份CA16感染患者急性期血清中的IgM抗体。分析表明这10株EV71 VP4基因核苷酸同源性为94.20%~100.00%,所推导的氨基酸序列则完全相同,从重症与轻症患儿分离的毒株之间VP4的核苷酸序列未见一致性的差异,基于EV71 VP4基因核苷酸序列的进化树分析表明2007~2009年北京地区所流行的毒株均属于C4亚型;本研究中EV71和CA16的VP4核苷酸序列的同源性为69.60%,所推导的氨基酸序列的同源性为78.60%,在运用Western Blot检测189份血清中的VP4特异性IgG时,EV71 VP4的血清阳性率为38.10%,说明其具有良好的抗原性,CA16 VP4的血清阳性率为58.20%,两者差别具有显著统计学意义(2χ=15.30,P<0.01),提示EV71 VP4与CA16 VP4没有交叉反应性;在用表达的VP4检测已确诊为相应病毒的特异性IgM时,两者皆为阴性,提示感染后机体对VP1和VP4产生不同的反应。     

西安地区EV71-VP1基因分析

目的:通过在原核表达系统初步构建EV71-VP1,对西安地区肠道病毒71型(EV71)的外壳蛋白VP1基因进行分析.方法:采集西安地区手足口病患儿的疱液、咽部分泌物进行病毒分离和RT-PCR检测;通过逆转录聚合酶链式反应(RT-PCR)扩增肠道病毒71型(EV71)外壳蛋白VP1基因,构建重组表达质粒PQE30/VP1,转化到大肠杆菌BL21中,对VP1基因进行遗传学分析.结果:对肠道病毒71型(EV71)西安地方株VP1基因测序.并将其与阜阳株(序列号为EU913471)相比较,表明我国西安地区EV71分离株与阜阳株有较大差别,核苷酸差异约为4%.结论:西安地方株VPl基因与阜阳株相比,其核苷酸差异较为明显.这将为西安地区EV71的分子流行病学研究以及EV71所致疾病的预防和控制,打下良好的基础.     

2009年云南省2株肠道病毒71型分离株全基因组序列遗传特性分析

对2009年云南省肠道病毒71型分离株KMM09和KM186-09进行全基因组序列测序,并与我国及其它国家流行的EV71基因型进行比较和进化分析。KMM09和KM186-09基因组长为7 409bp,编码2 193个氨基酸,VP1系统进化分析显示2009年云南分离株属于C4基因型的C4a亚型。在结构区,与其它基因型相比较,C基因型之间的核苷酸和氨基酸的同源性高于其它基因型;而在非结构区,C4与B基因型和CA16原型株G10同源性高于其它C基因亚型。通过RDP3重组软件和blast比对分析,发现EV71C4基因型与B3基因型,与CA16原型株G10的基因组在非结构区存在重组。EV71全基因组序列的比较和分析,对了解引起我国手足口病暴发或流行C4基因亚型EV71毒株的遗传特性具有重要意义。     

2008～2010年河南省人肠道病毒71型基因特征和重组分析

对河南省2008～2010年河南省人肠道病毒71型进行基因特征及重组特点研究。对河南省2008～2010年分离的5株肠道病毒EV71型构建VP1序列系统进化树并分析其全基因组序列的重组特点。VP1序列系统进化分析显示2008～2010年河南株均属于C4基因型的C4a亚群,Bootscan分析和5’NCR、P1、P2、P3区的进化树证实C4基因型在2A～2B处存在EV71的B基因型和C基因型的型内重组及在3B～3C处存在EV71的B基因型和CA16/G-10间的型间重组。2008～2010年河南EV71分离株为C4基因型的C4a亚群,与2004年以来的中国大陆优势株流行趋势完全一致,EV71C4基因型存在基因型内和型间双重组现象。     

2009年广州人肠道病毒EV71型分离株重组分析

对人肠道病毒EV71型2009年广州分离株Guangzhou09构建序列系统进化树并分析其重组特点。P1、P2和P3区种系发生进化树提示该分离株发生重组,相似性曲线以及bootscan进一步分析显示该分离株于非结构编码蛋白2B片段区(核苷酸位置4 027bp)处存在EV71亚型C4Shanghai-FJ713137与CVA409-HQ728260型间重组。该分离株与中国大陆目前优势株流行趋势一致,是广州首例发生型间重组且由C4亚型及CVA4型发生重组。     

基因序列分析

为了解2007 ― 2008 年北京地区流行的肠道病毒71 型( EV71) 是否存在基因序列变异及其与病毒毒力的关系, 我们选择2007 年分离的3 株EV71( 其中1 株分离自重症手足口病患儿的咽拭子标本, 其余2 株分离自普通手足口病患儿咽拭子标本) 和2008 年分离的5 株EV71( 其中3 株分离自重症手足口病患儿的咽拭子或鼻拭子标本, 2 株分离自普通手足口病患儿的疱疹液标本) , 提取基因组RNA, 经反转录-聚合酶链反应( RT-PCR) 扩增得到VP4 基因片段, 并进行核苷酸序列测定, 使用生物信息软件与GenBank 中的EV71 VP4 基因进行序列及病毒型别分析。结果表明, 所测得的8 株EV71 VP4 基因全长均为207 bp, 编码69 个氨基酸, 理论相对分子质量( Mr) 为7 ×10³。8 株EV71 病毒VP4 基因的核苷酸同源性在94% ～100% , 与GenBank 中其他EV71 病毒株VP4 的核苷酸同源性为82% ～100% , 与阜阳、深圳和台湾等地区流行的EV71 VP4 的核苷酸同源性比其他地区高。除了与印度报道的VP4 编码的氨基酸在第7 和54 位不同外( 印度株: 7 位蛋氨酸, 54位苏氨酸; 其余株7 位苏氨酸,54 位丙氨酸) , 这8 株EV71 VP4 编码的氨基酸序列之间以及与其他EV71 VP4编码的氨基酸同源性均为100%。8 株EV71 病毒VP4 与文献报道的3 株重症感染病毒株VP4 ( BrCr、MS 和NCKU9822) 核苷酸有较大差别, 而8 株病毒株中从重症感染( BJ97、BJ110B、BJ110Y 和BJ4243) 与轻症感染( BJ25、BJ47、BJ65 和BJ67) 分离到的毒株之间VP4 基因序列未见明显改变, 只有几个核苷酸存在差别。VP4 核苷酸序列的进化树分析表明, 这8 株EV71 均属于C4 亚型, 显示2007 ― 2008 年北京地区流行的EV71的VP4 基因相当保守, 分离自伴有神经系统感染的重症手足口病和普通手足口病患儿的EV71 的VP4 基因之间在核苷酸水平未出现同样的变异。结果提示, 近2 年来北京地区所流行的EV71 属C4 亚型。     

新乡地区2011年肠道病毒71型VP1基因特征分析及手足口病流行特点

为了解新乡地区2011年肠道病毒71型(EV71)VP1基因特征及手足口病流行特点,采用荧光RT-PCR对临床诊断的粪便标本进行总肠道病毒(EV)、柯萨奇病毒A16(CA16)和EV71检测;选取10例EV71阳性标本进行VPl序列扩增并测序,所得序列进行同源性分析和构建系统发生树;对2011年新乡市手足口病疫情监测数据进行分析。结果显示,重症标本的EV71阳性率(73%)显著高于CA16阳性率(19%)(P<0.01);10株新乡EV71分离株的核苷酸及氨基酸差异分别为2.8%和0.9%,属于C4亚型的C4a簇;9株VP1区第170位氨基酸为A,1株为V;与近缘的C4a型代表株相比,新乡优势株的氨基酸变异一般发生在VP1第292位氨基酸(T→A);2011年新乡市共上报手足口临床诊断病例1118例,92%的发病年龄在3岁以下,发病高峰分别出现在4和12月份,提示一定要加强手足口病预防控制,寒冷天气尤其不能忽视。     

肠道病毒71型的RT-PCR诊断及基因特征

2002～2003年从上海市和重庆市手足口病患儿的疱液标本中分离到10株病毒,其中上海9株,重庆1株.利用两对分别针对EV71和Cox.A16病毒VP1区的特异性引物,用RT-PCR方法对病毒进行初步鉴别.根据PCR所用引物及PCR扩增出的产物片段大小不同,可初步判定出EV71和Cox.A16病毒的血清型别.RT-PCR结果提示,上海分离到的9株病毒中,有2株为EV71,其余7株病毒为Cox.A16;重庆分离到的1株病毒为EV71.10株病毒的RT-PCR产物经序列测定和分析证实,PCR定型结果正确,说明PCR法具有很高的特异性,可作为EV71初步鉴定的首选方法.对所分离的3株EV71病毒进行VP1区编码基因全序列的测定和遗传学分析,通过同源性比较和构建系统发生树发现,此3株EV71病毒和中国大陆已发表的7株EV71病毒(SHZH03、SHZH98、SH-F1、SH-F2、SH-H25、SH-H26和CHN-87)全部属于C基因型,与该型代表株比较,同源性为89.3%～94.6%;与A、B基因型代表株比较,同源性为81.3%～84.0%,差异较大.在C基因型中,此3株EV71病毒和中国大陆先前分离的6株病毒(SHZH03、SHZH98、SH-F1、SH-F2、SH-H25、SH-H26)的同源性较高,在94.5%～100%范围内.在系统发生树上,这9株病毒形成一个较独立的分支.与CHN-87株的同源性在92.1%～93.6%之间.与已知的C1、C2、C3亚型代表株比较,同源性在89.3%～92.9%,差异≥7%,因此认为可将这9株病毒划分为C4亚型.上海、重庆和深圳的EV71病毒有较高的同源性,提示该病毒EV71-CA亚型在中国大陆1998～2003年间有较广泛的传播.建立中国流行的EV71病毒毒株库和基因库,对诊断、预防和控制EV71在中国的爆发有重要意义,对加强EV71的实验室诊断、病毒学监测和病毒基因型和亚型的标准命名和分子流行病学研究有重要帮助.     

Characterization of full-length enterovirus 71 strains from severe and mild disease patients in northeastern China

Human enterovirus 71 (EV71)-associated hand, foot, and mouth disease (HFMD) has been a leading cause of childhood infection in China since 2008. Epidemic and molecular characteristics of HFMD have been examined in many areas of China, including the central and southern regions. However, clinical and genetic characterization of EV71 in the northeastern region of China is scarce. In this study, a series of analyses were performed on seven full-length EV71 sequences from HFMD patients who had either severe or mild disease. We have determined that these seven circulating EV71 viruses from Changchun, China are actually complex recombinant viruses involving multiple type A human enterovirus (HEV). Classified as EV71 subtype C4 (EV71 C4), these Changchun EV71 viruses contain genetic recombination events between the CA4, CA5, EV71B4 and EV71C1 strains. Most of the structural protein region (P1) of these viruses resembled that of the prototype EV71 C1 strains. The non-structural protein domains (P2 and P3) showed a high degree of similarity with CA4, CA5 and EV71 B4 in different regions. The 5'UTR had unclassified recombination,while partial 3D region of these viruses showed a high degree of similarity to CA16. Phylogenetic analysis of full-length or partial sequences of isolates from severe or mild disease patients in Changchun always formed a single cluster in various phylogenetic analyses of different genomic regions, suggesting that all seven strains originated from one single common ancestor. There was no correlation between viral genomic sequence and virulence. Thus, we found that circulating recombinant forms of EV71 are prevalent among HFMD patients in Northeastern China. The existence of a unique cluster of EV71 related viruses in Northeast China has important implications for vaccine development that would address the increasing prevalence of HFMD.     

深圳地区2001～2004年肠道病毒71型部分VP1区基因分析

肠道病毒71型（Enterovirus type71,EV71）自1974年Sehmidt等人首次报道从美国加利福尼亚暴发的表现为中枢神经系统症状的患者标本中分离到后,世界上许多国家相继报道了EV71在不同地区的流行。近年来EV71在亚洲地区的流行呈上升趋势。目前已知EV71的感染可以导致手足口病、无菌性脑膜炎、脑炎和脊髓灰质炎样的麻痹性疾病等多种与神经系统相关的疾病。EV71已经取代脊髓灰质炎病毒成为肠道病毒中最受瞩目的成员。根据病毒衣壳蛋白VP1核苷酸序列的差异,可将EV71分为A、B、C3个基因型。     

Co-Circulation and Genomic Recombination of Coxsackievirus A16 and Enterovirus 71 during a Large Outbreak of Hand,Foot, and Mouth Disease in Central China

A total of 1844 patients with hand, foot, and mouth disease (HFMD), most of them were children of age 1–3-year-old, in Central China were hospitalized from 2011 to 2012. Among them, 422 were infected with coxsackievirus A16 (CVA16), 334 were infected with enterovirus 71 (EV71), 38 were co-infected with EV71 and CVA16, and 35 were infected with other enteroviruses. Molecular epidemiology analysis revealed that EV71 and CVA16 were detected year-round, but EV71 circulated mainly in July and CVA16 circulated predominantly in November, and incidence of HFMD was reduced in January and February and increased in March. Clinical data showed that hyperglycemia and neurologic complications were significantly higher in EV71-infected patients, while upper respiratory tract infection and C-reactive protein were significantly higher in CVA16-associated patients. 124 EV71 and 80 CVA16 strains were isolated, among them 56 and 68 EV71 strains were C4a and C4b, while 25 and 55 CVA16 strains were B1a and B1b, respectively. Similarity plots and bootscan analyses based on entire genomic sequences revealed that the three C4a sub-genotype EV71 strains were recombinant with C4b sub-genotype EV71 in 2B–2C region, and the three CVA16 strains were recombinant with EV71 in 2A–2B region. Thus, CVA16 and EV71 were the major causative agents in a large HFMD outbreak in Central China. HFMD incidence was high for children among household contact and was detected year-round, but outbreak was seasonal dependent. CVA16 B1b and EV71 C4b reemerged and caused a large epidemic in China after a quiet period of many years. Moreover, EV71 and CVA16 were co-circulated during the outbreak, which may have contributed to the genomic recombination between the pathogens. It should gain more attention as there may be an upward trend in co-circulation of the two pathogens globally and the new role recombination plays in the emergence of new enterovirus variants.     

Cleavage of the adaptor protein TRIF by enterovirus 71 3C inhibits antiviral responses mediated by Toll-like receptor 3

Enterovirus 71 (EV71) causes hand-foot-and-mouth disease and neurological complications in young children. Although the underlying mechanisms remain obscure, impaired or aberrant immunity is thought to play a role. In infected cells, EV71 suppresses type I interferon responses mediated by retinoid acid-inducible gene I (RIG-I). This involves the EV71 3C protein, which disrupts the formation of a functional RIG-I complex. In the present study, we report that EV71 inhibits the induction of innate immunity by Toll-like receptor 3 (TLR3) via a distinct mechanism. In HeLa cells stimulated with poly(I · C), EV71 inactivates interferon regulatory factor 3 and drastically suppresses interferon-stimulated gene expression. Notably, EV71 specifically downregulates a TRIF, TIR domain-containing adaptor inducing beta interferon (IFN-β). When expressed alone in mammalian cells, EV71 3C is capable of exhibiting these activities. EV71 3C associates with and induces TRIF cleavage in the presence of Z-VAD-FMK, a caspase inhibitor. TRIF cleavage depends on its amino acid pair Q312-S313, which resembles a proteolytic site of picornavirus 3C proteases. Further, site-specific 3C mutants with a defective protease activity bind TRIF but fail to mediate TRIF cleavage. Consequently, these 3C mutants are unable to inhibit NF-κB and IFN-β promoter activation. TRIF cleavage mediated by EV71 may be a mechanism to impair type I IFN production in response to Toll-like receptor 3 (TLR3) activation.     

An attenuated strain of enterovirus 71 belonging to genotype a showed a broad spectrum of antigenicity with attenuated neurovirulence in cynomolgus monkeys

Enterovirus 71 (EV71) is a causative agent of hand, foot, and mouth disease and is also sometimes associated with serious neurological disorders. In this study, we characterized the antigenicity and tissue specificity of an attenuated strain of EV71 [EV71(S1-3')], which belongs to genotype A, in a monkey infection model. Three cynomolgus monkeys were inoculated with EV71(S1-3'), followed by lethal challenge with the parental virulent strain EV71(BrCr-TR) via an intravenous route on day 45 postinoculation of EV71(S1-3'). Monkeys inoculated with EV71(S1-3') showed a mild neurological symptom (tremor) but survived lethal challenge by virulent EV71(BrCr-TR) without exacerbation of the symptom. The immunized monkey sera showed a broad spectrum of neutralizing activity against different genotypes of EV71, including genotypes A, B1, B4, C2, and C4. For the strains examined, the sera showed the highest neutralization activity against the homotype (genotype A) and the lowest neutralization activity against genotype C2. The order of decreasing neutralization activity of sera was as follows: A > B1 > C4 > B4 > C2. To examine the tissue specificity of EV71(S1-3'), two monkeys were intravenously inoculated with EV71(S1-3'), followed by examination of virus distribution in the central nervous system (CNS) and extraneural tissues. In the CNS, EV71(S1-3') was isolated only from the spinal cord. These results indicate that EV71(S1-3') acts as an effective antigen, although this attenuated strain was still neurotropic when inoculated via the intravenous route.     

The persistent circulation of enterovirus 71 in People's Republic of China: causing emerging nationwide epidemics since 2008

Emerging epidemics of hand-foot-and-mouth disease (HFMD) associated with enterovirus 71 (EV71) has become a serious concern in mainland China. It caused 126 and 353 fatalities in 2008 and 2009, respectively. The epidemiologic and pathogenic data of the outbreak collected from national laboratory network and notifiable disease surveillance system. To understand the virological evolution of this emerging outbreak, 326 VP1 gene sequences of EV71 detected in China from 1987 to 2009 were collected for genetic analyses. Evidence from both traditional and molecular epidemiology confirmed that the recent HFMD outbreak was an emerging one caused by EV71 of subgenotype C4. This emerging HFMD outbreak is associated with EV71 of subgenotype C4, circulating persistently in mainland China since 1998, but not attributed to the importation of new genotype. Originating from 1992, subgenotype C4 has been the predominant genotype since 1998 in mainland China, with an evolutionary rate of 4.6∼4.8×10⁻³ nucleotide substitutions/site/year. The phylogenetic analysis revealed that the majority of the virus during this epidemic was the most recent descendant of subgenotype C4 (clade C4a). It suggests that the evolution might be one of the potential reasons for this native virus to cause the emerging outbreak in China. However, strong negative selective pressure on VP1 protein of EV71 suggested that immune escape might not be the evolving strategy of EV71, predicting a light future for vaccine development. Nonetheless, long-term antigenic and genetic surveillance is still necessary for further understanding.     

Enterovirus 71 disrupts interferon signaling by reducing the level of interferon receptor 1

The recent outbreak of enterovirus 71 (EV71) infected millions of children and caused over 1,000 deaths. To date, neither an effective vaccine nor antiviral treatment is available for EV71 infection. Interferons (IFNs) have been successfully applied to treat patients with hepatitis B and C viral infections for decades but have failed to treat EV71 infections. Here, we provide the evidence that EV71 antagonizes type I IFN signaling by reducing the level of interferon receptor 1 (IFNAR1). We show that the host cells could sense EV71 infection and stimulate IFN-β production. However, the induction of downstream IFN-stimulated genes is inhibited by EV71. Also, only a slight interferon response and antiviral effects could be detected in cells treated with recombinant type I IFNs after EV71 infection. Further studies reveal that EV71 blocks the IFN-mediated phosphorylation of STAT1, STAT2, Jak1, and Tyk2 by reducing IFNAR1. Finally, we identified the 2A protease encoded by EV71 as an antagonist of IFNs and show that the protease activity is required for reducing IFNAR1 levels. Taken together, our study for the first time uncovers a mechanism used by EV71 to antagonize type I IFN signaling and provides new targets for future antiviral strategies.     

Hand foot and mouth disease due to enterovirus 71 in Malaysia

Hand foot and mouth disease is a febrile sickness complex characterized by cutaneous eruption (exanthem) on the palms and soles with simultaneous occurrence of muco-cutanous vesiculo-ulcerative lesions (enanthem) affecting the mouth.The illness is caused by a number of enteroviruses with coxsackievirus A16 and enterovirus 71 as the main causative agents.Human enterovirus 71 (EV71) belongs to the species Human enterovirus A under the genus Enterovirus within the family Picornaviridae.EV71 has been associated with an array of clinical diseases including hand foot and mouth disease (HFMD),aseptic meningitis,encephalitis and poliomyelitis-like acute flaccid paralysis.A large outbreak of HFMD due to highly neurovirulent EV71 emerged in Malaysia in 1997,and caused 41deaths amongst young children.In late 2000,a recurrence of an outbreak of HFMD occurred in Malaysia with S fatalities in peninsular Malaysia.Outbreak of HFMD due to EV71 recurred in 2003 with an unknown number of cases and mortalities.A similar outbreak of HFMD with 2 recorded deaths in young children occurred in peninsular Malaysia in late 2005 and this was followed by a larger outbreak in Sarawak (Malaysian Borneo) with 6 reported fatalities in the early part of 2006.The current on-going outbreak of HFMD started in peninsular Malaysia in epidemiological week 12 of 2010.As with other HFMD outbreaks in Malaysia,both EV71 and CA16 were the main aetiological viruses isolated.In similarity with the HFMD outbreak in 2005,the isolation of CA16 preceded the appearance of EV71.Based on the VP 1 gene nucleotide sequences,4 sub-genogroups of EV71 (C1,C2,B3 and B4) co-circulated and caused the outbreak of hand,foot and mouth disease in peninsular Malaysia in 1997.Two sub-genogroups (C1 and B4) were noted to cause the outbreak in 2000 in both peninsular Malaysia and Sarawak.EV71 of sub-genogroup B5 with smaller contribution from sub-genogroup C1 caused the outbreak in 2003.In the 2005 outbreak,besides the EV71 strains of sub-genogroup C1,EV71 strains belonging to sub-genogroup B5 were isolated but formed a cluster which was distinct from the EV71 strains from the sub-genogroup B5 isolated in 2003.The four EV71 strains isolated from clinical specimens of patients with hand,foot and mouth disease in the Sarawak outbreak in early 2006 also belonged to sub-genogroup B5.Phylogenetic analysis of the VP1 gene suggests that the EV71 strains causing the outbreak in Sarawak could have originated from peninsular Malaysia.Epidemiological and molecular data since 1997 show the recurrence of HFMD due to EV71 in Malaysia every 2 to 4 years.In each of the past outbreaks,more than one sub-genogroup of the virus co-circulate.     

Seroepidemiology and Molecular Epidemiology of Enterovirus 71 in Russia

Enterovirus 71 (EV71) is an emerging human pathogen causing massive epidemics of hand, foot and mouth disease with severe neurological complications in Asia. EV71 also circulates in Europe, however it does not cause large outbreaks. The reason for distinct epidemiological patterns of EV71 infection in Europe and Asia and the risk of EV71 epidemic in Europe and Russia remain unknown. Seroepidemiology of EV71 and molecular epidemiology of occasional EV71 isolates were studied to explore circulation of EV71 in Russia. In six regions of Russian Federation, seroprevalence of EV71 in sera collected in 2008 ranged from 5% to 20% in children aged 1–2 years and from 19% to 83% in children aged 3–5 years. The seroprevalence among elder children was significantly higher (41–83% vs. 19–27%) in Asian regions of Russia. EV71 strains identified in Russia in 2001–2011 belonged to subtypes C1 and C2, while genotype C4 that was causing epidemics in Asia since 1998 emerged in 2009 and became dominant in 2013.