Epidemic myalgia associated with human parechovirus type 3 infection among adults occurs during an outbreak among children: Findings from Yamagata, Japan, in 2011
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.
References (20)
- et al.
Human parechoviruses: biology, epidemiology and clinical significance
J Clin Virol
(2009) - et al.
Human parechovirus infections, Lyon, France, 2008–10: evidence for severe cases
J Clin Virol
(2012) - et al.
Human parechovirus—biology and clinical significance
Rev Med Virol
(2000) - et al.
Isolation and identification of a novel human parechovirus
J Gen Virol
(2004) - Picornavirus homepage. <http://www.picornaviridae.com/parechovirus/hpev/hpev_seqs.htm> [cited...
- et al.
Complete genome sequence of a novel human parechovirus
J Virol
(2012) - et al.
Human parechovirus 3 and neonatal infections
Emerg Infect Dis
(2005) - et al.
Human parechovirus infections in Dutch children and the association between serotype and disease severity
Clin Infect Dis
(2006) - et al.
Prevalence of human parechovirus in the Netherlands in 2000 to 2007
J Clin Microbiol
(2008) - et al.
Specific association of human parechovirus type 3 with sepsis-like syndrome and fever in young infants, as identified by direct typing of cerebrospinal fluid samples
J Infect Dis
(2009)
Cited by (35)
HPeV-3 predominated among Parechovirus A positive infants during an outbreak in 2013–2014 in Queensland, Australia
2018, Journal of Clinical VirologyCitation Excerpt :Most samples were received during early summer 2013 (December; n = 22), which yielded 55% of HPeV positive samples (n = 12; Fig. 1A). Phylogenetic analysis identified all HPeV positives to be HPeV-3 variants, sharing 99% nucleotide identity with each other (Fig. 2) and with strains from Yamagata, Japan [31], Denmark [32], Italy [33], Scotland [9], Taiwan [34], England [35] and recently described as a novel recombinant virus reported in Victoria, Australia [28,36]. Whether Queensland viruses were variants of this recombinant virus couldn’t be confirmed using VP3/VP1 subgenomic sequences; this region cannot characterise HPeVs below the level of genotype.
Human parechovirus type 3 infection: An emerging infection in neonates and young infants
2017, Journal of Infection and ChemotherapyCitation Excerpt :Enterovirus (EV) infection is one of the most successful targets, and use of a PCR assay reduced unnecessary diagnostic and therapeutic interventions [4]. In addition to EV infection, human parechovirus (HPeV) infection, especially HPeV type 3 (HPeV3), is now recognized as an important disease among infants younger than 3 months [5], because of its severity [6–8] and epidemiological characteristics [9–11]. Since the first report of HPeV3 detection, in 2004 [12], clinical findings have accumulated and HPeV infection now attracts considerable attention among pediatricians [13].
First report of human parechovirus type 3 infection in a pregnant woman
2017, International Journal of Infectious DiseasesCitation Excerpt :Human parechovirus type 3 (HPeV3) can be a cause of sepsis, encephalitis, and hepatitis in neonates (Harvala et al., 2010; de Crom et al., 2016). HPeV3 has been reported to be associated with myalgia and muscle weakness in adults (Mizuta et al., 2013; Mizuta et al., 2012), but available data are limited. The case of a woman at 36 weeks of pregnancy, in whom fasciitis related to HPeV3 infection developed and delivery was achieved without complications, is reported herein.
Clinical utility of serum samples for human parechovirus type 3 infection in neonates and young infants: The 2014 epidemic in Japan
2016, Journal of InfectionCitation Excerpt :Clinical signs of HPeV3 infection in young infants include abdominal distention and umbilical protrusion,12,13 and palmar–plantar erythema.14 HPeV3 epidemics have been reported prospectively and retrospectively in many countries and regions, including Europe,4–7,15–19 the United States,20 Australia,21 Middle East,22 and Asian countries.8,14,23–25 In Japan, epidemics of HPeV3 infection have occurred every 2–3 years since 2006.24
Molecular Evolution and Epidemiology of Parechovirus-A3 in Japan, 1997-2019
2023, Journal of Infectious Diseases