1887

Abstract

EV-D68 is an emerging enterovirus infection associated with severe acute respiratory illness (SARI), acute flaccid myelitis (AFM) and acute flaccid paralysis (AFP). While EV-D68 outbreaks and sporadic cases are reported globally, a single case has been reported from India. The present study aims to investigate the molecular epidemiology and clinical characteristics of EV-D68-associated SARI cases from South India. We screened influenza-negative archived throat swab specimens from Influenza-Like Illness (ILI) and SARI cases (n=959; 2016 to 2018 period) for enteroviruses by pan-enterovirus real-time RT-PCR. Thirteen samples positive for enteroviruses were typed by PCR and sequencing based on VPI, VP2 and/or 5′NCR regions. One EV-D68 RNA sample was subjected to next-generation sequencing for whole genome characterisation. Among 13 enterovirus cases, four were ECHO-11, three EV-D68, two CV-A16 and one each EV-71, CV-B1, CV-B2 and CV-A9. All three cases of EV-D68 infection were reported in children below 2 years of age from Kerala state of South India during June and July 2017. The patients developed pneumonia without any neurological complications. Sequencing based on VPI and 5′NCR regions showed that EV-D68 strains belong to the novel subclade B3. The EV-D68 complete genome identified with two unique amino acid substitutions in VP1 (T-246-I) and 3D (K-344-R) regions. This study reiterates the EV-D68 novel subclade B3 circulation in India and indicates the urgent need for structured EV-D68 surveillance in the country to describe the epidemiology.

Funding
This study was supported by the:
  • Indian Council of Medical Research (Award 5/8/7/15/2010-ECD-I)
    • Principle Award Recipient: GovindakarnavarArunkumar
Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.001356
2021-05-17
2024-03-28
Loading full text...

Full text loading...

References

  1. Enterovirus D EntErovirus d (internet; 2018 https://www.picornaviridae.com/sg3/enterovirus/ev-d/ev-d.htm
  2. Schieble JH, Fox VL, Lennette EH. A probable new human picornavirus associated with respiratory diseases. Am J Epidemiol 1967; 85:297–310 [View Article][PubMed]
    [Google Scholar]
  3. Holm-Hansen CC, Midgley SE, Fischer TK. Global emergence of enterovirus D68: a systematic review. Lancet Infect Dis 2016; 16:e64–e75 [View Article][PubMed]
    [Google Scholar]
  4. Cassidy H, Poelman R, Knoester M, Van Leer-Buter CC, Niesters HGM. Enterovirus D68 – the new polio?. Front Microbiol 2018; 9: [View Article]
    [Google Scholar]
  5. Greninger AL, Naccache SN, Messacar K, Clayton A, Yu G et al. A novel outbreak enterovirus D68 strain associated with acute flaccid myelitis cases in the USA (2012-14): a retrospective cohort study. Lancet Infect Dis 2015; 15:671–682 [View Article][PubMed]
    [Google Scholar]
  6. Messacar K, Abzug MJ, Dominguez SR. 2014 outbreak of enterovirus D68 in North America. J Med Virol 2016; 88:739–745 [View Article][PubMed]
    [Google Scholar]
  7. Lu Q-B, Wo Y, Wang H-Y, Wei M-T, Zhang L et al. Detection of enterovirus 68 as one of the commonest types of enterovirus found in patients with acute respiratory tract infection in China. J Med Microbiol 2014; 63:408–414 [View Article][PubMed]
    [Google Scholar]
  8. Xiao Q, Ren L, Zheng S, Wang L, Xie X et al. Prevalence and molecular characterizations of enterovirus D68 among children with acute respiratory infection in China between 2012 and 2014. Sci Rep 2015; 5:16639 [View Article][PubMed]
    [Google Scholar]
  9. Fall A, Ndiaye N, Jallow MM, Barry MA, Touré CSB et al. Enterovirus D68 subclade B3 circulation in Senegal, 2016: detection from influenza-like illness and acute flaccid paralysis surveillance. Sci Rep 2019; 9:13881 [View Article][PubMed]
    [Google Scholar]
  10. CCY Y, Lo JYC SS, Lung DC, Luk S, Chan K-H. First report of a fatal case associated with EV-D68 infection in Hong Kong and emergence of an Interclade recombinant in China revealed by genome analysis. Int J Mol Sci 2017; 18:
    [Google Scholar]
  11. Shen L, Gong C, Xiang Z, Zhang T, Li M et al. Upsurge of enterovirus D68 and circulation of the new subclade D3 and subclade B3 in Beijing, China, 2016. Sci Rep 2019; 9:1–9 [View Article]
    [Google Scholar]
  12. Wang G, Zhuge J, Huang W, Nolan SM, Gilrane VL et al. Enterovirus D68 subclade B3 strain circulating and causing an outbreak in the United States in 2016. Sci Rep 2017; 7: [View Article]
    [Google Scholar]
  13. Dyrdak R, Grabbe M, Hammas B, Ekwall J, Hansson KE et al. Outbreak of enterovirus D68 of the new B3 lineage in Stockholm, Sweden, August to September 2016. Euro Surveill 2016; 21: [View Article][PubMed]
    [Google Scholar]
  14. Knoester M, Schölvinck EH, Poelman R, Smit S, Vermont CL et al. Upsurge of enterovirus D68, the Netherlands, 2016. Emerg Infect Dis 2017; 23:140–143 [View Article][PubMed]
    [Google Scholar]
  15. Fall A, Jallow MM, Kebe O, Kiori DE, Sy S et al. Low circulation of subclade A1 Enterovirus D68 strains in senegal during 2014 North America Outbreak - Volume 25, Number 7—July 2019 - Emerging infectious diseases journal - CDC.
  16. Bhardwaj SD, Potdar VA, Yadav PD, Chaudhary ML, Chadha MS et al. A case report of the enterovirus-D68 associated severe acute respiratory illness in a pediatric case from India. J Infect Public Health 2019
    [Google Scholar]
  17. Nix WA, Oberste MS, Pallansch MA, Sensitive PMA. Sensitive, seminested PCR amplification of VP1 sequences for direct identification of all enterovirus serotypes from original clinical specimens. J Clin Microbiol 2006; 44:2698–2704 [View Article][PubMed]
    [Google Scholar]
  18. Nasri D, Bouslama L, Omar S, Saoudin H, Bourlet T et al. Typing of human enterovirus by partial sequencing of VP2. J Clin Microbiol 2007; 45:2370–2379 [View Article][PubMed]
    [Google Scholar]
  19. Richter J, Koptides D, Tryfonos C, Christodoulou C. Molecular typing of enteroviruses associated with viral meningitis in Cyprus, 2000-2002. J Med Microbiol 2006; 55:1035–1041 [View Article][PubMed]
    [Google Scholar]
  20. Clusters of Acute Respiratory Illness Associated with Human Enterovirus 68 Asia, Europe, and United States, 2008--2010 [Internet].
  21. Maan HS, Dhole TN, Chowdhary R. Identification and characterization of nonpolio enterovirus associated with nonpolio-acute flaccid paralysis in polio endemic state of Uttar Pradesh, Northern India. PLoS One 2019; 14:e0208902 [View Article][PubMed]
    [Google Scholar]
  22. Kujawski SA. Enterovirus D68–Associated acute respiratory illness — new vaccine surveillance network, United States, July–October, 2017 and 2018. MMWR Morb Mortal Wkly Rep 2019; 68:
    [Google Scholar]
  23. Knoester M, Helfferich J, Poelman R, Van Leer-Buter C, Brouwer OF et al. Twenty-Nine cases of Enterovirus-D68–associated acute flaccid myelitis in Europe 2016. Pediatr Infect Dis J 2019; 38:16–21 [View Article]
    [Google Scholar]
  24. Lau SKP, Yip CCY, Zhao PS-H, Chow W-N, To KKW et al. Enterovirus D68 infections associated with severe respiratory illness in elderly patients and emergence of a novel clade in Hong Kong. Sci Rep 2016; 6:25147 [View Article][PubMed]
    [Google Scholar]
  25. Gong Y-N, Yang S-L, Shih S-R, Huang Y-C, Chang P-Y et al. Molecular evolution and the global reemergence of enterovirus D68 by genome-wide analysis. Medicine 2016; 95:e4416 [View Article][PubMed]
    [Google Scholar]
  26. Sun J, Hu X-Y, Yu X-F. Current understanding of human enterovirus D68. Viruses 2019; 11:490 [View Article][PubMed]
    [Google Scholar]
  27. Zhang Y, Cao J, Zhang S, Lee AJ, Sun G et al. Genetic changes found in a distinct clade of enterovirus D68 associated with paralysis during the 2014 outbreak. Virus Evolution 2016; 2:vew015 [View Article]
    [Google Scholar]
  28. Lukashev AN, Shumilina EY, Belalov IS, Ivanova OE, Eremeeva TP et al. Recombination strategies and evolutionary dynamics of the human enterovirus a global gene pool. J Gen Virol 2014; 95:868–873 [View Article][PubMed]
    [Google Scholar]
  29. Tan Y, Hassan F, Schuster JE, Simenauer A, Selvarangan R et al. Molecular evolution and Intraclade recombination of enterovirus D68 during the 2014 outbreak in the United States. J Virol 2016; 90:1997–2007 [View Article][PubMed]
    [Google Scholar]
  30. Oberste MS, Maher K, Schnurr D, Flemister MR, Lovchik JC et al. Enterovirus 68 is associated with respiratory illness and shares biological features with both the enteroviruses and the rhinoviruses. J Gen Virol 2004; 85:2577–2584 [View Article][PubMed]
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/jmm.0.001356
Loading
/content/journal/jmm/10.1099/jmm.0.001356
Loading

Data & Media loading...

Supplements

Supplementary material 1

PDF
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error