title: High prevalence of human enterovirus a infections in natural circulation of human enteroviruses.
abstract: Human enterovirus (HEV) infections can be asymptomatic or cause only mild illness; recent evidence may implicate HEV infection in type 1 diabetes mellitus and myocarditis. Here, we report the molecular characterization of HEV obtained in serial monthly collections from healthy Norwegian infants. A total of 1,255 fecal samples were collected from 113 healthy infants beginning at age 3 months and continuing to 28 months. The samples were analyzed for HEV nucleic acid by real-time PCR. Fifty-eight children (51.3%) had HEV infections. One hundred forty-five positive samples were typed directly by nucleotide sequencing of the VP1 region. HEV-A was detected most frequently, with an overall prevalence of 6.8%. HEV-B was present in 4.8% of the samples and HEV-C in only 0.2% of the samples. No poliovirus or HEV-D group viruses were detected. Twenty-two different serotypes were detected in the study period: the most common were EV71 (14.5%), CAV6 (10.5%), CAV4 (8.9%), E18 (8.9%), and CBV3 (7.3%). These findings suggest that the prevalence of HEV infections in general, and HEV-A infections in particular, has been underestimated in epidemiological studies based on virus culture.
authors.affiliation: Norwegian Institute of Public Health, Oslo, Norway. elisabet.witso@fhi.no
authors.forename: Elisabet
authors.initials: E
authors.lastname: Witsø
authors.forename: Gustavo
authors.initials: G
authors.lastname: Palacios
authors.forename: Ondrej
authors.initials: O
authors.lastname: Cinek
authors.forename: Lars C
authors.initials: LC
authors.lastname: Stene
authors.forename: Bjørn
authors.initials: B
authors.lastname: Grinde
authors.forename: Diana
authors.initials: D
authors.lastname: Janowitz
authors.forename: W Ian
authors.initials: WI
authors.lastname: Lipkin
authors.forename: Kjersti S
authors.initials: KS
authors.lastname: Rønningen
mesh_terms: D001483:Base Sequence; D002675:Child, Preschool; D029821:Enterovirus A, Human / Q000145:classification* / Q000235:genetics; D029822:Enterovirus B, Human / Q000145:classification; D004769:Enterovirus Infections / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D008969:Molecular Sequence Data; D010802:Phylogeny; D015995:Prevalence; D011446:Prospective Studies; D019562:Viral Load