Epidemiology and Clinical manifestations of Enterovirus in Pediatric Inpatient in Incheon

Byoung Wook Cho; Seong Eun Kwon; Mun Ju Kwon; Myong Je Hur; Kyung Seon Kim; Young Jin Hong; Soon Ki Kim; Young Se Kwon; Dong Hyun Kim

doi:10.14776/piv.2016.23.1.46

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Cho, Kwon, Kwon, Hur, Kim, Hong, Kim, Kwon, and Kim: Epidemiology and Clinical manifestations of Enterovirus in Pediatric Inpatient in Incheon

Original Article

Pediatric Infection & Vaccine 2016; 23(1): 46-53.

Published online: 30 April 2016

DOI: https://doi.org/10.14776/piv.2016.23.1.46

Epidemiology and Clinical manifestations of Enterovirus in Pediatric Inpatient in Incheon

Byoung Wook Cho¹, Seong Eun Kwon¹, Mun Ju Kwon², Myong Je Hur², Kyung Seon Kim², Young Jin Hong¹, Soon Ki Kim¹, Young Se Kwon¹, Dong Hyun Kim¹

¹Department of Pediatrics, Inha University School of Medicine, Incheon, Korea.

²Incheon Research Institute of Public Health and Environment, Korea.

Corresponding author (md21@inha.edu)

Received 24 September 2015 Revised 30 October 2015 Accepted 30 October 2015

Abstract

Purpose

Enterovirus (EV) infection in children can manifest various diseases from asymptomatic infection to nonspecific febrile illness, hand-foot-mouth disease, and aseptic meningitis. This study was aimed to investigate epidemiology and clinical significance of various genotypes of EV infections in pediatric inpatient.

Methods

We collected the stool samples from the admitted pediatric patients in Inha University Hospital from March 2014 to March 2015. EV detection and genotype identification were performed by real-time RT-PCR and semi-nested RT-PCR. Phylogenetic trees were constructed by neighbor joining method.

Results

A total of 400 samples were collected during study period and 112 patients (28%) were diagnosed with EV infections. The mean age of EV positive patients was 2.66 years (0.1-14) and sex ratio was 1.73:1. Genetic sequences of EVs were identified; coxsackievirus B5 (17, 15.2%), coxsackievirus A16 (13, 11.6%), enterovirus 71 (10, 8.9%), and coxsackievirus A2 (9, 8.0%). Nonspecific febrile illness (96, 86%) was the most common clinical manifestation and the duration of fever was 0-11 days (mean 3.1 days). Rash (44, 39%) and meningitis (43, 38%) were followed. Patients who were attending daycare center or had siblings accounted for 82.1%. Phylogenetic relationship tree revealed 6 distinct genogroups among 56 types of EVs.

Conclusions

This study is the report of epidemiology, serotype distribution and clinical manifestations of children with EV infection in Incheon. This data will be helpful for further study about the epidemiology of EV infection in Korea.

Keywords: Enterovirus, Epidemiology, Children, Genotype

Figures and Tables

Fig. 1

Monthly distribution of enterovirus-positive patients in Incheon, 2014–2015.

Fig. 2

Phylogenetic Relationship in Patients with Enterovirus Infections in Incheon, 2014–2015.

Fig. 3

Geographical distribution in patients with enterovirus infections in Incheon, 2014–2015. Green, CVB5/CC10 strains; Brown, CVB5/2000/CSF/KOR; Blue, CVB5/Faulkner; Red, Enterovirus 71; Violet, Coxsackievirus A16, genotype A; Orange, Coxsackievirus A16, genotype B1a; Pink, Coxsackievirus A2.

Table 1

The Number and Distribution of Serotypes of Enteroviruses in Incheon, 2014–2015

^*Individual serotype distinction was not done.

Table 2

Comparison among Patient Groups with Enterovirus Infection according to Common Serotypes in Incheon, 2014–2015

Table 3

Characteristics of Fever Pattern in Patients with Enterovirus Infection in Incheon, 2014–2015

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