濮阳市2008—2012年手足口病流行病学特征分析

目的了解濮阳市手足口病流行病学特征,为制定防控策略提供科学依据。方法通过国家疾病监测信息管理系统收集的全市2008—2012年6月6日手足口病疫情资料进行描述和分析,并对部分病例和重症病例标本进行肠道病毒病原学检测。结果全市共报手足口病16 492例,发病高峰是每年的3-5月(第12～20周),呈典型的单峰型曲线;发病年龄以0～4岁居多;男性多于女性;散居儿童多于托幼机构儿童,爆发病例多发生在托幼机构,手足口病病原有EV71、CoxA16和其他肠道病毒,以EV71和CoxA16为主。结论手足口病发病有明显的季节性、年龄和性别差异,小年龄组儿童是手足口病预防控制重点人群,流行年度和流行季节的优势毒株为EV71,重症患者中EV71占到86.35%;非流行年和季节手足病例主要由CoxA16和其他肠道病毒引起。手足口病防控重点应体现在对病例分类管理上,同时应继续加强重症病例疫情监测和爆发控制。     

Replication kinetics of coxsackievirus A16 in human rhabdomyosarcoma cells

Coxsackievirus A16 (CVA16), together with enterovirus type 71 (EV71), is responsible for most cases of hand, foot and mouth disease (HFMD) worldwide. Recent findings suggest that the recombination between CVA16 and EV71, and the co-circulation of these two viruses may have contributed to the increase of HFMD cases in China over the past few years. It is therefore important to further understand the virology, epidemiology, virus-host interactions and host pathogenesis of CVA16. In this study, we describe the viral kinetics of CVA16 in human rhabdomyosarcoma (RD) cells by analyzing the cytopathic effect (CPE), viral RNA replication, viral protein expression, viral RNA package and viral particle secretion in RD cells. We show that CVA16 appears to first attach, uncoat and enter into the host cell after adsorption for 1 h. Later on, CVA16 undergoes rapid replication from 3 to 6 h at MOI 1 and until 9 h at MOI 0.1. At MOI 0.1, CVA16 initiates a secondary infection as the virions were secreted before 9 h p.i. CPE was observed after 12 h p.i., and viral antigen was first detected at 6 h p.i. at MOI 1 and at 9 h p.i. at MOI 0.1. Thus, our study provides important information for further investigation of CVA16 in order to better understand and ultimately control infections with this virus.     

2010年上海部分地区440例手足口病病例的病原谱及分子流行病学分析

本文旨在对上海部分地区2010年440例临床手足口病病例进行病原谱及分子流行病学特征分析,为上海地区手足口病防治工作提供依据.采集4所哨点医院440例手足口病病例的咽拭子、粪便和脑脊液标本,进行肠道病毒核酸检测、反转录-聚合酶链反应扩增、DNA测序和序列分子系统发生树分析.结果显示,引起手足口病的肠道病毒主要为肠道病毒...     

湘潭地区2013-2014年手足口病病原监测结果分析

目的:分析2013-2014年湖南省湘潭市手足口病(HFMD)病原体型别及分布特征,为进一步完善HFMD的预防和治疗提供依据。方法:采用RT-PCR方法,对571例HFMD患儿进行肠道病毒通用型核酸(EV-RNA)、EV71及柯萨奇病毒A16(CA16)检测。结果:2013年除EV71及CA16外其他EV核酸阳性率75.30%,明显高于EV71的17.65%和CA16的7.05%(P0.05),2014年EV71型核酸阳性率为50.68%,明显高于CA16的19.93%和其他EV的29.39%(P0.05)。重症HFMD患儿EV71感染率明显高于轻症。结论:2013年湘潭地区HFMD患儿以除EV71及CA16外的其他EV病毒感染为主,2014年湘潭地区HFMD患儿以EV71感染为主。     

2009年上海市手足口病流行病学和病原学特征

本研究对上海市手足口病(Hand-foot-and-mouth disease,HFMD)的流行病学和病原学特征进行了分析。从国家疾病监测信息报告管理系统获取上海市2009年HFMD的流行病学数据;采用荧光定量RT-PCR方法对来自上海15个区县的799例HFMD进行肠道病毒(Enterovirus,EV)核酸检测;对部分肠道病毒71型(Enterovirus71,EV71)的VP1区和部分其它EV的VP4区序列进行测定和分析。采用Office excel软件进行简单数据统计分析,用BioEdit和MEGA软件进行病毒基因特征分析,通过BLAST服务器的在线比对进行EV型别鉴定。分析显示:上海市18个区县均有病例报告,地区分布无显著特点;小于6岁的婴幼儿期为疾病高发年龄段;4～7月为发病高峰期;EV71和柯萨奇病毒A16(Coxsackie virus A16,CA16)为主要病原,不同地区、不同月份的病原构成各不相同,CA16为轻症病例的主要病原,EV71则为重症病例的主要病原;基于VP1区序列分析,上海EV71毒株与C4a亚型毒株具有最近的亲缘性和最高的同源性;2株其它肠道病毒经鉴定属于CA2和CA10型。结果表明:EV71和CA16为2009年上海HFMD流行的主要病原,EV71属于C4a亚型;除EV71和CA16外,还存在小部分其它EV(如:CA2和CA10)引起的HFMD。     

The Establishment of Infectious Clone and Single Round Infectious Particles for Coxsackievirus A10

Coxsackievirus A10(CVA10) is one of the major etiological agents of hand, foot, and mouth disease. There are no vaccine and antiviral drugs for controlling CVA10 infection. Reverse genetic tools for CVA10 will benefit its mechanistic study and development of vaccines and antivirals. Here, two infectious clones for the prototype and a Myc-tagged CVA10 were constructed. Viable CVA10 viruses were harvested by transfecting the viral m RNA into human rhabdomyosarcoma(RD)cells. Rescued CVA10 was further confirmed by next generation sequencing and characterized experimentally. We also constructed the vectors for CVA10 subgenomic replicon with luciferase reporter and viral capsid with EGFP reporter,respectively. Co-transfection of the viral replicon RNA and capsid expresser in human embryonic kidney 293 T(HEK293 T)cells led to the production of single round infectious particles(SRIPs). Based on CVA10 replicon RNA, SRIPs with either the enterovirus A71(EVA71) capsid or the CVA10 capsid were generated. Infection by EVA71 SRIPs required SCARB2,while CVA10 SRIPs did not. Finally, we showed great improvement of the replicon activity and SRIPs production by insertion of a cis-active hammerhead ribozyme(HHRib) before the 50-untranslated region(UTR). In summary, reverse genetic tools for prototype strain of CVA10, including both the infectious clone and the SRIPs system, were successfully established. These tools will facilitate the basic and translational study of CVA10.     

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.     

2007年北京地区儿童手足口病病原的初步筛查

2007年4～6月儿童手足口病流行期间,对北京地区51例皮损症状典型、伴/不伴发热、无重症合并症的手足口病患儿采样,建立RT-PCR方法,以5'非编码区(5'UTR)肠道病毒通用引物、CA16和EV71 VP1区特异性引物直接对82份临床标本进行了初步筛查,肠道病毒阳性率达70.6%。检测病例中CA16阳性25例(25/51)、EV71阳性4例(4/51)、非CA16和EV71的肠道病毒阳性病例7例(7/51),三者比例约为6:1:2。2007年北京地区儿童轻症手足口病主要病原包括CA16和EV71,同时还存在一定比例其它肠道病毒。部分EV71毒株经测序验证及系统进化分析显示为C4基因亚型。     

Development and characterization of a clinical strain of Coxsackievirus A16 and an eGFP infectious clone

Coxsackievirus A16(CA16) is one of the major causes of hand, foot, and mouth disease(HFMD) worldwide, which is a common illness that affects children. The frequent occurrence of HFMD outbreaks has become a serious public health problem in Asia. Therefore, it is important to understand the pathogenesis and replication of CA16. In this study, a stable infectious c DNA clone of an epidemic strain of Coxsackievirus A16(CA16) was assembled, and subsequently a reporter virus(e GFP-CA16) was constructed by inserting the e GFP gene between the 5'-UTR and the N-terminus of VP4, with the addition of a 2A protease cleavage site(ITTLG) at its C-terminus. This was transfected into Vero cells to generate infectious recombinant viruses. The growth characteristics and plaque morphology, in vitro, in mammalian cells were found to be indistinguishable between the parental and recombinant viruses. Although the e GFP-CA16 showed smaller plaque size as compared to recombinant CA16, both were found to exhibit similar growth trends and EC50 of NITD008. In summary, this stable infectious c DNA clone should provide a valuable experimental system to study CA16 infection and host response. The e GFP-CA16 is expected to provide a powerful tool to monitor e GFP expression in infected cells and to evaluate the antiviral activity of potential antiviral agents in the treatment of CA16 infections.     

2011—2016年上海地区手足口病病原谱及柯萨奇病毒A组6型不同基因型感染细胞的差异研究

本文旨在分析2011—2016年上海地区手足口病病原谱的构成和主要病原体流行规律,为手足口病的疫情防控和重症预警提供参考。采集2011—2016年哨点医院临床诊断为手足口病的患儿标本,首先进行肠道病毒通用型核酸和分型检测,其次对2012—2016年核酸检测为柯萨奇病毒A组6型(coxsackievirus A6,CA6)阳性样本进行基因型重组检测,分离重组型和非重组型CA6株,比较两者生物学特性。结果显示,2011—2012年秋季上海地区手足口病主要致病原为肠道病毒71型(enterovirus type 71,EV71)和CA16;2012年秋季起CA6成为主要病原体;2013—2014年重组型CA6(recombinant CA6,R CA6)占一定比例;2015—2016年非重组型CA6(non-recombinant CA6,NR CA6)成为优势流行株。R CA6和NR CA6代表株在RD细胞中增殖良好,在KB、MRC-5和HEp-2细胞中未见明显增殖。比较R CA6与NR CA6代表株接种于RD细胞后细胞活性下降的动态变化,未见显著差异。本研究证实,CA6为近年来上海地区手足口病的主要病原体,R CA6和NR CA6的构成比逐年变化,提示持续监测手足口病主要病原体并了解其生物学特性,对上海地区手足口病的防控预警及疫苗研发具有重要意义。     

Towards broadly protective polyvalent vaccines against hand,foot and mouth disease

Hand, foot, and mouth disease (HFMD) caused by multiple enterovirus infections is a serious health threat to children in the Asia–Pacific region. This article reviews progresses in the development of vaccines for HFMD and discusses the need for polyvalent HFMD vaccines for conferring broad-spectrum protection.     

Genomic surveillance of coxsackievirus A10 reveals genetic features and recent appearance of genogroup D in Shanghai,China, 2016-2020

Coxsackievirus A10 (CVA10) is one of the major causative agents of hand, foot and mouth disease (HFMD). To investigate the epidemiological characteristics as well as genetic features of CVA10 currently circulating in Shanghai, China, we collected a total of 9,952 sporadic HFMD cases from January 2016 to December 2020. In the past five years, CVA10 was the fourth prevalent causatives associated with HFMD in Shanghai and the overall positive rate was 2.78%. The annual distribution experienced significant fluctuations over the past five years. In addition to entire VP1 sequencing, complete genome sequencing and recombination analysis of CVA10 isolates in Shanghai were further performed. A total of 64 near complete genomes and 11 entire VP1 sequences in this study combined with reference sequences publicly available were integrated into phylogenetic analysis. The CVA10 sequences in this study mainly belonged to genogroup C and presented 91%-100% nucleotide identity with other Chinese isolates based on VP1 region. For the first time, our study reported the appearance of CVA10 genogroup D in Chinese mainland, which had led to large-scale outbreaks in Europe previously. The recombination analysis showed the recombination break point located between 5,100 nt and 6,700 nt, which suggesting intertypic recombination with CVA16 genogroup D. To conclusion, CVA10 genogroup C was the predominant genogroup in Shanghai during 2016-2020. CVA10 recombinant genogroup D was firstly reported in circulating in Chinese mainland. Continuous surveillance is needed to better understand the evolution relationships and transmission pathways of CVA10 to help to guide disease control and prevention.     

肠道病毒71型和柯萨奇病毒A16型多重反转录聚合酶链反应的建立及初步应用

本文旨在建立一种快速、高效的方法检测肠道病毒71型（EV71）和柯萨奇病毒A16型(CA16)的方法,以用于儿童手足口病的病原学监测。通过设计肠道病毒通用引物和CA16与EV71的型特异性引物,建立不同引物浓度配比及两阶段退火温度以提高检测敏感性和特异性的多重反转录聚合酶链反应（RT-PCR）方法,并对首都儿科研究所附属儿童医院2010年3~10月收集的371例手足口病患儿共381份临床标本同时进行病毒分离和核酸检测。结果显示,本研究建立的多重RT-PCR方法对CA16和EV71的最低模板检测浓度分别为5.32 pg/ml和0.64 pg/ml,反应特异度为100%。应用该方法检测381份手足口病临床标本的总阳性率为78.4%,其中CA16与EV71的检测阳性率分别为32.6%和35.8%,二者检测阳性比为1:1.1。以病毒分离为标准,多重RT-PCR对CA16及EV71检测的准确率分别为95.2%和98.6%。因此,本研究新建立的多重RT-PCR方法准确、简便,适用于较大量样本的手足口病病原学监测。2010年引起北京地区儿童手足口病的主要病原为CA16和EV71。     

柯萨奇病毒A组16型研究进展

柯萨奇病毒A组16型(CA16)是引起手足口病(HFMD)的主要病原体,与肠道病毒71型(EV71)交替或共同流行;特别是近年在西太平洋地区呈现流行强度高、重症和死亡人数多的特点,已成为该地区的重大公共卫生问题。研发安全有效的疫苗是控制HFMD流行的有效手段。由于EV71所致疾病在重症和死亡病例中所占比例高,对其疫苗研发得到了广泛关注,全病毒灭活疫苗已进入III期临床,有望即将应用于婴幼儿HFMD的防控。EV71疫苗的顺利研发随之也增加了对CA16疫苗研发的迫切性。近年来日本、新加坡以及中国台湾地区逐渐开始关注CA16相关的研究,我国也有多家企业开展CA16疫苗的研发。本文就CA16的病原学,流行病学,实验室诊断,治疗和预防等方面进行了综述。     

MA104 Cell line presents characteristics suitable for enterovirus A71 isolation and proliferation

Enterovirus A71 (EV‐A71), one of the most important causative agents of hand, foot and mouth disease (HFMD) in children, can lead to severe clinical outcomes, even death. However, the infection spectrum of EV‐A71 in different cell lines remains unknown. Therefore, in this study, the biological characteristics of EV‐A71 Subgroup C4 in different cell lines were investigated. To this end, the infectivity of EV‐A71Jinan1002 isolated from children with severe HFMD was assessed in 18 different host cell lines. It was found that the MA104 cell line displayed biological characteristics suitable for EV‐A71 Subgroup C4 strain isolation and proliferation; indeed, it was found that a broad spectrum of cell lines can be infected by EV‐A71Jinan1002. Among the screened cells, four cell lines (HEK293, RD, MA104 and Marc145) produced high 50% tissue culture infective dose (TCID₅₀) values calculated in viral proliferations (ranged from 10^7.6 to 10^7.8); the TCID₅₀ being negatively associated with the time to appearance of CPE. Proliferation curves demonstrated that EV‐A71Jinan1002 amplifies more efficiently in MA104, Hep‐2 and RD cells. Remarkably, the virus isolation rate was much higher in MA104 cells than in RD cells. Thus this study, to our knowledge, is for the first to explore the infection spectrum of EV‐A71 subgroup C4 in such a large number of different cell lines. Our data provide useful reference data for facilitating further study of EV‐A71.     

柯萨奇病毒A组16型河南省分离株基因组序列分析

为了解河南省手足口病患者标本中分离柯萨奇A组的16型(CoxAl6)病毒基因组特征,对2010年采集的手足口病患者临床标本406份进行RT-PCR扩增和病毒分离鉴定;通过10对引物分段扩增和拼接CoxAl6分离株基因组序列,利用生物信息学软件对序列分析,构建序列遗传发育树。测序获得河南省CoxAl6分离株HN1162/HN/CHN/2010基因组全长序列7 411bp,5′非编码区(5′UTR)、P1、P2、P3、3′非编码区(3′UTR)区域核苷酸序列与GenBank公布的其它分离株相似性分别为87.0%～97.9%、77.0%～95.4%、80.3%～96.9%、77.9%～96.2%、80.5%～100%;VP1区核苷酸相似性为91.4%～96.4%,氨基酸相似性为99.3%～99.7%;遗传发育树分析表明与我国深圳、广州、福建分离株处于同一分支。河南省手足口病患者标本CoxAl6病毒分离株属于C2基因亚型/B-2基因亚型,对加强该病毒变异检测,预防控制手足口病疫情具有重要意义。     

Coxsackievirus A16 infection triggers apoptosis in RD cells by inducing ER stress

Coxsackievirus A16 (CA16) infection, which is responsible for hand, foot and mouth disease (HFMD), has become a common health problem in Asia due to the prevalence of the virus. Thus, it is important to understand the pathogenesis of CA16 infection. Viruses that induce endoplasmic reticulum (ER) stress are confronted with the unfolded protein response (UPR), which may lead to apoptotic cell death and influence viral replication. In this study, we found that CA16 infection could induce apoptosis and ER stress in RD cells. Interestingly, apoptosis via the activation of caspase-3, -8 and -9 in the extrinsic or intrinsic apoptotic pathways in RD cells was inhibited by 4-phenyl butyric acid (4PBA), a chemical chaperone that reduces ER stress. These results suggest that CA16 infection leads to ER stress, which in turn results in prolonged ER stress-induced apoptosis. This study provides a new basis for understanding CA16 infection and host responses.     

TAR DNA-Binding Protein 43 is Cleaved by the Protease 3C of Enterovirus A71

Enterovirus A71(EV-A71) is one of the etiological pathogens leading to hand, foot, and mouth disease(HFMD), which can cause severe neurological complications. The neuropathogenesis of EV-A71 infection is not well understood. The mislocalization and aggregation of TAR DNA-binding protein 43(TDP-43) is the pathological hallmark of amyotrophic lateral sclerosis(ALS). However, whether TDP-43 was impacted by EV-A71 infection is unknown. This study demonstrated that TDP-43 was cleaved during EV-A71 infection. The cleavage of TDP-43 requires EV-A71 replication rather than the activated caspases due to viral infection. TDP-43 is cleaved by viral protease 3 C between the residues 331 Q and332 S, while mutated TDP-43(Q331 A) was not cleaved. In addition, mutated 3 C which lacks the protease activity failed to induce TDP-43 cleavage. We also found that TDP-43 was translocated from the nucleus to the cytoplasm, and the mislocalization of TDP-43 was induced by viral protease 2 A rather than 3 C. Taken together, we demonstrated that TDP-43 was cleaved by viral protease and translocated to the cytoplasm during EV-A71 infection, implicating the possible involvement of TDP-43 in the pathogenesis of EV-A71 infection.