Cases of Acute Flaccid Paralysis Associated with Coxsackievirus A2: Findings of a 20-Year Surveillance in the Russian Federation.

Olga E Ivanova,Nadezhda R Rozaeva,Elena Y Shustova,Olga Y Baykova,Natalia I Romanenkova,Natela I Dzhaparidze,Liubov I Kozlovskaya,Nadezhda A Novikova,Yulia A Vakulenko,Yulia M Mikhailova,Armen K Shakaryan,Nadezhda S Morozova,Vladimir V Zverev,Tatyana P Eremeeva,Lyudmila N Golitsyna,Alexander N Lukashev

doi:10.3390/microorganisms10010112

Abstract

Surveillance for acute flaccid paralysis syndrome (AFP) in children under 15 is the backbone of the Global Polio Eradication Initiative. Laboratory examination of stool samples from AFP cases allows the detection of, along with polioviruses, a variety of non-polio enteroviruses (NPEV). The etiological significance of these viruses in the occurrence of AFP cases has been definitively established only for enteroviruses A71 and D68. Enterovirus Coxsackie A2 (CVA2) is most often associated with vesicular pharyngitis and hand, foot and mouth disease. Among 7280 AFP cases registered in Russia over 20 years (2001–2020), CVA2 was isolated only from five cases. However, these included three children aged 3 to 4 years, without overt immune deficiency, immunized with 4–5 doses of poliovirus vaccine in accordance with the National Vaccination Schedule. The disease resulted in persistent residual paralysis. Clinical and laboratory data corresponded to poliomyelitis developing during poliovirus infection. These findings are compatible with CVA2 being the cause of AFP. Molecular analysis of CVA2 from these patients and a number of AFP cases in other countries did not reveal association with a specific phylogenetic group, suggesting that virus genetics is unlikely to explain the pathogenic profile. The overall results highlight the value of AFP surveillance not just for polio control but for studies of uncommon AFP agents.

Highlights

Coxsackievirus A2 (CVA2) belongs to the genus Enterovirus of the Picornaviridae family and is a representative of the species Enterovirus A [1]
acute flaccid paralysis syndrome (AFP) cases with CVA2 isolation were detected in five regions of the central part of the Russian Federation in 2008, 2015 and 2019 in two girls and three boys
The methodology of AFP surveillance and subsequent laboratory investigation allows the detection of non-polio enteroviruses (NPEV) in materials from AFP cases

Summary

Introduction

Coxsackievirus A2 (CVA2) belongs to the genus Enterovirus of the Picornaviridae family and is a representative of the species Enterovirus A [1]. CVA2 is widespread throughout the world, causing outbreaks [2,3,4] or sporadic cases of disease [5] It is most commonly associated with vesicular pharyngitis, hand, foot and mouth disease (HFMD) [4,6] and pleurodynia [7]. CVA2 has been reported to cause infectious diseases of the nervous system, such as meningitis, encephalitis, and myelitis [7]. The latter can manifest as acute flaccid paralysis syndrome (AFP), accompanied by persistent movement disorders [7], and is clinically (without laboratory tests) indistinguishable from paralytic poliomyelitis caused by poliovirus [11]

Methods

Results

Conclusion