Elsevier

Journal of Clinical Virology

Volume 58, Issue 1, September 2013, Pages 188-193
Journal of Clinical Virology

Epidemic myalgia associated with human parechovirus type 3 infection among adults occurs during an outbreak among children: Findings from Yamagata, Japan, in 2011

https://doi.org/10.1016/j.jcv.2013.05.019Get rights and content

Abstract

Background

Based on our findings in Yamagata, Japan, in 2008, we reported that human parechovirus type 3 (HPeV3) could be associated with epidemic myalgia among adults, although HPeV3 is generally associated with infectious diseases in children.

Objectives

To clarify the relationship between community outbreaks among children and myalgia through the continued surveillance of HPeV3 infections.

Study design

In the summer season (June–August) of 2011, we collected 586 specimens from children with infectious diseases, and throat swabs, and stool and serum specimens from 5 patients with myalgia. We detected HPeV3 using virus isolation and reverse-transcription PCR, and carried out phylogenetic analysis. We also performed screening for HPeV3 using 309 stocked frozen specimens collected in 2008 for a comparison between 2008 and 2011 strains.

Results

We detected HPeV3 in 59 children and isolated HPeV3 from all myalgia patients. Phylogenetic analysis indicated that the HPeV3 strains circulating in 2008 and 2011 could be clearly distinguished, apart from two strains. Further, we detected HPeV3 strains with identical nucleotide sequences from children and adults in 2008 and 2011, respectively. Two children belonging to one myalgia patient had upper respiratory infections prior to the onset of their father's illness, and the HPeV3 isolates from these three patients had identical nucleotide sequences.

Conclusions

These findings suggest that HPeV3, circulating among children in the community, infects their household, including parents, a portion of whom may subsequently show symptoms of myalgia. Our observations in 2008 and 2011 strongly suggest that clinical consideration should be given to HPeV3 in children as well as in adults during summer seasons in which an HPeV3 outbreak occurs among the children in the community.

Section snippets

Background

Human parechovirus (HPeV) is a positive-sense, single-stranded RNA virus belonging to the genus Parechovirus of the family Picornaviridae.1, 2 HPeV type 1 (HPeV1) and HPeV2 were initially classified as echovirus types 22 and 23 of genus Enterovirus, but were recently reclassified.1, 2 HPeV3 was first isolated from a stool specimen of a 1-year-old Japanese child with transient paralysis in 1999.3 There are 8 types of HPeV (HPeV1-8) and one newly reported strain that remains untyped for which the

Objectives

To clarify the relationship between community outbreaks of HPeV3 among children and epidemic myalgia among adults through continued surveillance of both diseases.

Surveillance of viral infectious diseases among children

We have been taking part in the national surveillance of viral infectious diseases in Japan based on the Infectious Diseases Control Law. Between June and August, 2011, 559 nasopharyngeal swabs and 27 stool specimens (n = 586) were collected from patients at pediatric clinics. Among these patients, 418 (71.3%) were from patients <5 years old, 110 (18.8%) were from patients between 6 and 9 years old, 41 (7.0%) were from patients between 10 and 14 years old, 7 (1.2%) were from patients >14 years

Detection of HPeV3 in the surveillance of viral infectious diseases among children

Our surveillance system based on virus isolation using a microplate method can isolate a wide range of viruses such as influenza viruses, parainfluenza viruses, and a variety of enteroviruses.17 However, herein we limit our results to those for HPeV3. During the study period, we isolated HPeV3 strains from 29 specimens using the LLC-MK2 cell line and detected the HPeV3 genome in 59 specimens using the RT-PCR method. We succeeded in detecting the HPeV3 genome in all specimens from which the

Discussion

We proposed that epidemic myalgia among adults might be associated with HPeV3 infections based on our experience in Yamagata in 2008.16 However, it was difficult to imagine that HPeV3 viruses are transmitted directly from one adult myalgia patient to another. Rather, we postulated that HPeV3 infections were spread through a community outbreak among children, and thereafter tried to accumulate data to support this hypothesis.

The monthly distribution of HPeV3 strains isolated from public health

Funding

This work was partly supported by a grant-in-aid from the Japan Society for the Promotion of Science and for Research on Emerging and Re-emerging Infectious Diseases of the Ministry of Health, Labour and Welfare, Japan (H22-Shinko-Ippan-011 and H25-Shinko-Ippan-015) and a grant from the Association for Research on Lactic Acid Bacteria.

Competing interests

None declared.

Ethical approval

This study is a public health activity under the Infectious Diseases Control Law and approval from an ethics committee was considered not to be required.

Acknowledgments

We thank the medical staff and people of Yamagata Prefecture for their collaboration in specimen collection for the surveillance of viral infectious diseases.

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