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Published on: April 27, 2011
The Identification and Genetic Characterization of Parechovirus Infection Among Pediatric Patients With Wide Clinical
Xiao-Ai Zhang1, Rui-Qiu Zhao2, Jin-Jin Chen1
1State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China.
Insights
Human parechoviruses (HPeV) cause various childhood infections. This study tracked HPeV epidemiology and genotypes in China, finding diverse strains and seasonal patterns, but clinical significance requires further investigation.
Area of Science:
- Pediatric Infectious Diseases
- Virology
- Epidemiology
Background:
- Human parechoviruses (HPeV) are significant pediatric pathogens.
- Limited surveillance data hinders understanding of HPeV epidemiology and clinical impact.
Purpose of the Study:
- To conduct hospital-based surveillance of HPeV in pediatric patients with respiratory infections, diarrhea, and hand, foot, and mouth disease (HFMD).
- To identify HPeV genotypes, analyze their distribution, and investigate interactions with other pathogens and clinical outcomes.
Main Methods:
- Hospital-based surveillance of 10,212 pediatric patients (2009-2015) in Chongqing, China.
- HPeV detection via PCR, sequencing for genotyping, and statistical analysis of co-infections and clinical associations.
Main Results:
- HPeV was detected in 6.92% of patients, with higher rates in diarrhea cases (14.94%).
- Ten HPeV genotypes were identified, with HPeV1, HPeV4, and HPeV3 being most common. Significant interactions were observed between HPeV and other viruses (e.g., Enterovirus).
- HPeV1 viral load correlated with severe diarrhea and HPeV single infection in HFMD cases.
Conclusions:
- HPeV infection presents a broad clinical spectrum in children with diverse genotypes.
- Further molecular surveillance is needed to confirm the clinical significance of HPeV infections.
Abstract:
Human parechoviruses (HPeVs) are important causes of infection in children. However, without a comprehensive and persistent surveillance, the epidemiology and clinical features of HPeV infection remain ambiguous. We performed a hospital-based surveillance study among three groups of pediatric patients with acute respiratory infection (Group 1), acute diarrhea (Group 2), and hand, foot and mouth disease (Group 3) in Chongqing, China, from 2009 to 2015. Among 10,212 tested patients, 707 (6.92%) were positive for HPeV, with the positive rates differing significantly among three groups (Group 1, 3.43%; Group 2, 14.94%; Group 3, 3.55%; P < 0.001). The co-infection with other pathogens was detected in 75.2% (531/707) of HPeV-positive patients. Significant negative interaction between HPeV and Parainfluenza virus (PIV) (P = 0.046, OR = 0.59, 95% CI = 0.34-0.98) and positive interactions between HPeV and Enterovirus (EV) (P = 0.015, OR = 2.28, 95% CI = 1.23-4.73) were identified. Among 707 HPeV-positive patients, 592 (83.73%) were successfully sequenced, and 10 genotypes were identified, with HPeV1 (n = 396), HPeV4 (n = 86), and HPeV3 (n = 46) as the most frequently seen. The proportion of genotypes differed among three groups (P < 0.001), with HPeV1 and HPeV4 overrepresented in Group 2 and HPeV6 overrepresented in Group 3. The spatial patterns of HPeV genotypes disclosed more close clustering of the currently sequenced strains than those from other countries/regions, although they were indeed mixed. Three main genotypes (HPeV1, HPeV3, and HPeV4) had shown distinct seasonal peaks, highlighting a bi-annual cycle of all HpeV and two genotypes (HPeV 1 and HPeV 4) with peaks in odd-numbered years and with peaks in even-numbered years HPeV3. Significantly higher HPeV1 viral loads were associated with severe diarrhea in Group 2 (P = 0.044), while associated with HPeV single infection than HPeV-EV coinfection among HFMD patients (P = 0.001). It's concluded that HPeV infection was correlated with wide clinical spectrum in pediatric patients with a high variety of genotypes determined. Still no clinical significance can be confirmed, which warranted more molecular surveillance in the future.
