肠道病毒71型分子流行病学研究进展

肠道病毒71型(Enterovirus type71,EV71),自1974年首次报道以来,在世界范围内引起多次爆发与流行[1].EV71感染主要引起患者手足口病(hand,foot and mouth disease,HFMD),在临床上与柯萨奇病毒A16(Coxsakie A16,CA16)感染所引起的手足口病难以区别,但EV71还能够引起多种与神经系统相关的疾病[2].近年来,EV71病毒的流行在亚太地区呈上升趋势[3～5],其中最令人关注的是在该地区的EV71感染引起越来越严重的中枢神经系统症状.     

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。     

EV71病毒核酸快速检测方法的比较

PCR方法检测肠道病毒71型(EV71)的分子诊断技术十分快速敏感。目前已有多篇文献报道了不同的检测EV71的PCR方法,但对不同方法检测结果的比较还少有报道。本研究将检测肠道病毒通用5’UTR基因的3种定量PCR(rRT-PCR)方法和1种普通PCR(cRT-PCR)方法和特异性检测EV71的2种rRT-PCR和1种cRT-PCR方法进行特异性和敏感性比较评估。所有试验方法都有较好的特异性,无交叉反应。核酸最低检测限值为从8.19×101～8.19×105个拷贝,rRT-PCR比cRT-PCR更敏感。所有的rRT-PCR方法检测50份临床标本时都较敏感。     

人肠道病毒71型动物模型研究进展

人肠道病毒71型是婴幼儿手足口病的致病原之一,其严重的并发症可导致神经系统疾病,甚至死亡,是近期威胁中国儿童健康的因素之一。目前尚无临床疫苗可以预防该病毒感染,而EV71的动物模型是进行致病机理、疫苗评价和药物等研究的基础。本文对EV71的两种常用动物模型：小鼠和猕猴（Macaca mulatta）模型进行了描述,并对其在研究中的应用给与概括,为研究者选择合适的动物模型提供了依据。     

Seroepidemiology of Coxsackievirus A6, Coxsackievirus A16, and Enterovirus 71 Infections among Children and Adolescents in Singapore, 2008-2010

Coxsackieviruses A6 (CV-A6) and A16 (CV-A16) and Enterovirus 71 (EV-A71) have caused periodic epidemics of hand, foot and mouth disease (HFMD) among children in Singapore. We conducted a cross-sectional study to estimate the seroprevalence of these enteroviruses among Singapore children and adolescents. The study was conducted between August 2008 and July 2010. It involved 700 Singapore residents aged 1–17 years whose residual sera were obtained following the completion of routine biochemical investigations in two public acute-care hospitals. The levels of neutralizing antibodies (NtAb) against CV-A6, CV-A16 and EV-A71 were analyzed by the microneutralization test. The age-specific geometric mean titer (GMT) of antibodies against each of the three enteroviruses and the 95% confidence intervals (CI) were calculated. The seroprevalence of CV-A6 and CV-A16 was high at 62.7% (95% CI: 59.1–66.2%) and 60.6% (95% CI: 56.9–64.1%), respectively. However, the seroprevalence of EV-A71 was significantly lower at 29.3% (95% CI: 26.0–32.8%). About 89.7% of the children and adolescents had been infected by at least one of the three enteroviruses by 13–17 years of age. About half (52.3%) were seropositive for two or all three enteroviruses, while only 16.1% had no NtAb against any of the three enteroviruses. High NtAb levels were observed in the younger age groups. CV-A6 and CV-A16 infections are very common among Singapore children and adolescents, while EV-A71 infections are less common. Infection is continually acquired from early childhood to adolescent age.     

Epidemiology of Enterovirus D68 in Ontario

In August 2014, children’s hospitals in Kansas City, Missouri and Chicago, Illinois notified the Centers for Disease Control and Prevention (CDC) about increased numbers of pediatric patients hospitalized with severe respiratory illness (SRI). In response to CDC reports, Public Health Ontario Laboratories (PHOL) launched an investigation of patients being tested for enterovirus D-68 (EV-D68) in Ontario, Canada. The purpose of this investigation was to enhance our understanding of EV-D68 epidemiology and clinical features. Data for this study included specimens submitted for EV-D68 testing at PHOL from September 1, 2014 to October 31, 2014. Comparisons were made between patients who tested positive for the virus (cases) and those testing negative (controls). EV-D68 was identified in 153/907 (16.8%) of patients tested. In the logistic regression model adjusting for age, sex, setting and time to specimen collection, individuals younger than 20 years of age were more likely to be diagnosed with EV-D68 compared to those 20 and over, with peak positivity at ages 5–9 years. Cases were not more likely to be hospitalized than controls. Cases were more likely to be identified in September than October (OR 8.07; 95% CI 5.15 to 12.64). Routine viral culture and multiplex PCR were inadequate methods to identify EV-D68 due to poor sensitivity and inability to differentiate EV-D68 from other enterovirus serotypes or rhinovirus. Testing for EV-D68 in Ontario from July to December, 2014 detected the presence of EV-D68 virus among young children during September-October, 2014, with most cases detected in September. There was no difference in hospitalization status between cases and controls. In order to better understand the epidemiology of this virus, surveillance for EV-D68 should include testing of symptomatic individuals from all treatment settings and patient age groups, with collection and analysis of comprehensive clinical and epidemiological data.     

Norepinephrine and Epinephrine Enhanced the Infectivity of Enterovirus 71

Background

Enterovirus 71 (EV71) infections may be associated with neurological complications, including brainstem encephalitis (BE). Severe EV71 BE may be complicated with autonomic nervous system (ANS) dysregulation and/or pulmonary edema (PE). ANS dysregulation is related to the overactivation of the sympathetic nervous system, which results from catecholamine release.

Objective

The aims of this study were to explore the effects of catecholamines on severe EV71 infection and to investigate the changes in the percentages of EV71-infected cells, virus titer, and cytokine production on the involvement of catecholamines.

Study Design

Plasma levels of norepinephrine (NE) and epinephrine (EP) in EV71-infected patients were measured using an enzyme-linked immunoassay. The expression of adrenergic receptors (ADRs) on RD, A549, SK-N-SH, THP-1, Jurkat and human peripheral blood mononuclear cells (hPBMCs) were detected using flow cytometry. The percentages of EV71-infected cells, virus titer, and cytokine production were investigated after treatment with NE and EP.

Results

The plasma levels of NE and EP were significantly higher in EV71-infected patients with ANS dysregulation and PE than in controls. Both α_1A- and β₂-ADRs were expressed on A549, RD, SK-N-SH, HL-60, THP-1, Jurkat cells and hPBMCs. NE treatment elevated the percentages of EV71-infected cells to 62.9% and 22.7% in THP-1 and Jurkat cells, respectively. Via treatment with EP, the percentages of EV71-infected cells were increased to 64.6% and 26.9% in THP-1 and Jurkat cells. The percentage of EV71-infected cells increased upon NE or EP treatment while the α- and β-blockers reduced the percentages of EV71-infected cells with NE or EP treatment. At least two-fold increase in virus titer was observed in EV71-infected A549, SK-N-SH and hPBMCs after treatment with NE or EP. IL-6 production was enhanced in EV71-infected hPBMCs at a concentration of 10² pg/mL NE.

Conclusion

The plasma levels of NE and EP elevated in EV71-infected patients with ANS dysregulation and PE. Both NE and EP enhanced the percentages of infected cells and virus titers in EV71 infection in vitro. NE and EP may play a role in the pathogenesis of EV71 BE complicated with ANS dysregulation and PE.     

菏泽地区2009年肠道病毒71型与其他肠道病毒所致手足口病临床差异研究

目的:探讨EV71引起小儿手足口病与其他肠道病毒所致手足口病的临床特点的差异.方法:回顾性分析2009年3月-9月菏泽地区各定点医院收治的病原学检测为阳性的320例小儿手足口病的临床资料,筛出EV71感染的手足口病患儿进行分析,其他肠道病毒所致手足口痛患儿作为对照组.结果:菏泽地区2009年抽取的病原学检测为阳性的320例患儿,肠道病毒71型引起手足口病占106例,其余为其他肠道病毒所致手足口病.(1)男女发病基本相同,发病年龄1～3岁居多,农村患儿占绝大多数.(2)EV71感染的患儿临床主要表现高热、神经系统症状、无皮疹,大多数外周血象高、血糖高,可合并心肌损害,心电图异常、部分发现胸片、脑电图及核磁异常,部分符合重症手足口病标准.(3)其他肠道病毒感染的惠儿临床症状以皮疹、低热、上感症状为主,少数患儿有精神差,基本不出现神经系统症状,少数发现外周血象高、血糖高、合并心肌损害,一般胸片不会发现异常.(4)56例出现神经系统症状的患儿收集脑脊液进行两次RT-PCR扩增,发现50例EV71阳性.结论:EV71导致的手足口病,病情凶险,易致神经损害及肺水肿,早期识别重症病例,及时救治,普及病原体的检测对提高诊治能力,加强疾病的认识,对减少致残率及死亡率很有帮助.     

The complete genome of Enterovirus 71 China strain

Five overlapping clones covering the full genome of Enterovirus 71 China strain SHZH98 were obtained and then the sequences were determined by the chain termination method. It showed that the full length of EV71 SHZH98 genome (not including Poly A tail) is 7408 bp. There are some diversities on the lengths and sequences of 5′ UTR and 3′ UTR between SHZH98 and the other EV71 strains. In P1 capsid region, which is closely associated with viral immunogenicity, EV71 strain SHZH98 shares the highest homology with Taiwan strains; but in P2 and P3 non-structural gene regions there are higher identities with Coxsakievirus A16 and EV71 strains MS, BrCr than with Taiwan strains. Phylogenetic tree constructed by structural gene region indicates that China strain SHZH98 has a closer relationship with Taiwan strains, however, in the non-coding region it has a closer relationship with Coxsakievirus A16, EV71 strains MS and BrCr. EV71 China strain was analyzed at the molecular level. The results will contribute to the basic study on enteroviruses and the EV71 prevention in China.     

3株肠道病毒71型毒株的全基因组序列分析

目的：对获得的3株肠道病毒71（EV71）型毒株进行全基因组序列测定,并对其进化特点及分型进行初步分析。方法：提取病毒RNA,反转录得到eDNA,PCR分段扩增覆盖病毒全长序列的6个重叠片段（不包括多聚腺苷酸尾）;用软件将3株EV71的备片段序列进行拼接、编辑和校正,随后进行氨基酸翻译及序列比较;用MEGA4.1软件构建系统进化树。结果：获得了3株EV71的全长序列：GDV103株基因组全长7404 nt,包括741bp的5’端非编码区（UTR）、6582bp的病毒基因组编码区（ORF）及81bp的3’UTR;安徽株（Anhui2007）基因组全长7405nt,包括742bp的5＇UTR、6582bp的ORF及81bp的3＇UTR;VR1432株基因组全长7408nt,包括743bp的5’UTR、6582bp的ORF及83bp的3’UTR长。经同源性比对和进化树分析,证实GDV103和安徽株EV71属于C基因型的C4基因亚型。而VR1432株则属于C基因型的C2基因亚型。结论：获得了3株EV71的全长基因组序列,并进一步探讨了其型别,为下一步的干扰素保护宴,哈重定了基础．     

人肠道病毒71型亚单位疫苗的研制

目的利用原核表达技术制备人肠道病毒71型（EV71）的亚单位融合疫苗,并通过小鼠模型对其保护效果进行评价。方法在大肠杆菌中融合表达EV71的亚单位肽段,随后将肽段免疫雌鼠,对其交配后产下的幼鼠进行病毒感染,通过检测其组织内的病毒拷贝数和病理变化,对疫苗的保护效果进行评价。结果通过肽段融合的方法,得到五种备选疫苗,分别为VacA,VacB,VacC,VacD和VacE,这五种疫苗均具有一定的体外保护能力,并且VacB和VacC与正常人大脑组织无明显交叉反应。动物模型评价结果显示,VacB和VacE能赋予幼鼠抗病毒感染的保护效果。结论利用EV71的小鼠感染模型评价了针对EV71的亚单位联合疫苗,VacB和VacE的保护效果较好,此外,VacB与人脑组织间无明显交叉反应,可以作为潜在的无神经毒性的临床使用疫苗。     

Enterovirus 71 adsorption on metal ion-composite chitosan beads

In this study, we developed composite chitosan beads combining various metal ions, including Ni(2+), Cu(2+), Zn(2+), and Fe(2+), for direct adsorption of enterovirus 71 (EV71). The metal-ion species had significant effects on the adsorption capacity of beads. Among these metal ion-composite chitosan beads, Ni(2+)-chitosan beads exhibited the best adsorption capacity of EV71. Using a concentration of 0.01-M Ni(2+) was found to best provide for bead formation and EV71 adsorption. The adsorption of EV71 for Ni(2+)-chitosan beads at neutral or alkaline pH was favored. Under a competitive condition with albumin proteins, Ni(2+)-chitosan beads exhibited significant capacity of EV71 adsorption in culture media. The adsorption of EV71 on the Ni(2+)-chitosan beads was attributed to the strong binding between Ni(2+) ions chelated to the surface amino acid of EV71 capsids and Ni(2+) ions chelated on the chitosan materials. Moreover, the adsorbed EV71 retained its antigenicity and infectivity after desorption. The Ni(2+)-chitosan beads exhibit a promising application to EV71 adsorption and removal.     

人肠道病毒71型基因重组的研究进展

人肠道病毒71 型(Enterovirus 71,HEV-A71),是手足口病(Hand,footandmouthdisease,HFMD)的常见病因,属于人肠道病毒属中的肠道病毒A型,隶属于微小RNA病毒科.许多研究证明HEV-A71经常发生基因重组并且使得HEV-A71在全球内多次暴发,这对疫苗的研发和疾病的防控是一种新的挑战.本文对HEV-A71不同亚型内、不同型间和多重重组等不同基因重组类型及其毒力、抗原性变化进行了综述.     

The Association between Enterovirus 71 Infections and Meteorological Parameters in Taiwan

Background

Enterovirus 71 (EV71) infections are a significant cause of neurological disorder and death in children worldwide. Seasonal variations in EV71 infections have been recognized, but the mechanisms responsible for this phenomenon remain unknown. The purpose of this study was to examine the relationship between meteorological parameters and EV71 infection.

Methods and Findings

We analyzed the number of EV71 infections and daily climate data collected in Taiwan between 1998 and 2008 and used Poisson regression analysis and case-crossover methodology to evaluate the association between weather variability and the incidence of EV71 infection. A total of 1,914 EV71-infected patients were reported between 1998 and 2008. The incidence of EV71 infections reflected significant summertime seasonality (for oscillation, p<0.001). The incidence of EV71 infections began to rise at temperatures above 13°C (r² = 0.76, p<0.001); at temperatures higher than approximately 26°C (r² = 0.94, p<0.05), the incidence began to decline, producing an inverted V-shaped relationship. The increase in the incidence with increasing relative humidity was positive and linear (r² = 0.68, p<0.05). EV71 infection was most highly correlated with temperature and relative humidity in the period that likely preceded the infection.

Conclusion

Our study provides quantitative evidence that the rate of EV71 infection increased significantly with increasing mean temperature and relative humidity in Taiwan.     

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 associa...     

Adaptation of Enterovirus 71 to Adult Interferon Deficient Mice

Non-polio enteroviruses, including enterovirus 71 (EV71), have caused severe and fatal cases of hand, foot and mouth disease (HFMD) in the Asia-Pacific region. The development of a vaccine or antiviral against these pathogens has been hampered by the lack of a reliable small animal model. In this study, a mouse adapted EV71 strain was produced by conducting serial passages through A129 (α/β interferon (IFN) receptor deficient) and AG129 (α/β, γ IFN receptor deficient) mice. A B2 sub genotype of EV71 was inoculated intraperitoneally (i.p.) into neonatal AG129 mice and brain-harvested virus was subsequently passaged through 12 and 15 day-old A129 mice. When tested in 10 week-old AG129 mice, this adapted strain produced 100% lethality with clinical signs including limb paralysis, eye irritation, loss of balance, and death. This virus caused only 17% mortality in same age A129 mice, confirming that in the absence of a functional IFN response, adult AG129 mice are susceptible to infection by adapted EV71 isolates. Subsequent studies in adult AG129 and young A129 mice with the adapted EV71 virus examined the efficacy of an inactivated EV71 candidate vaccine and determined the role of humoral immunity in protection. Passive transfer of rabbit immune sera raised against the EV71 vaccine provided protection in a dose dependent manner in 15 day-old A129 mice. Intramuscular injections (i.m.) in five week-old AG129 mice with the alum adjuvanted vaccine also provided protection against the mouse adapted homologous strain. No clinical signs of disease or mortality were observed in vaccinated animals, which received a prime-and-boost, whereas 71% of control animals were euthanized after exhibiting systemic clinical signs (P<0.05). The development of this animal model will facilitate studies on EV71 pathogenesis, antiviral testing, the evaluation of immunogenicity and efficacy of vaccine candidates, and has the potential to establish correlates of protection studies.