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.
Highlights
Human parechoviruses (HPeVs) are small, non-enveloped RNA viruses closely related to enteroviruses (EVs) in the Picornaviridae family
Compared with those with HPEV single infection, the coinfection with other respiratory viruses was related to an increased frequency of cough (95.51%), moist rales (92.13%), and dyspnea (17.98%), none of the difference attained significant level
The interaction analysis between HPeV and other respiratory viruses disclosed significant negative interaction between HPeV and parainfluenza virus (PIV), when HPeV was used as response virus, and PIV was used as the responsive explanatory virus (P = 0.046, Odds ratio (OR) = 0.59, 95% CI = 0.34–0.98) (Supplementary Table 4)
Summary
Human parechoviruses (HPeVs) are small, non-enveloped RNA viruses closely related to enteroviruses (EVs) in the Picornaviridae family. Among them Parechovirus A is the only species of Parechovirus genus which infects humans (de Crom et al, 2016b). HPeV genotypes 1, 3, and 6 are most commonly associated with human disease (de Crom et al, 2016b; Olijve et al, 2018). Of particular interest is HPeV3, which has been suggested as a leading cause of sepsis-like illness and central nervous system infection in neonates and young infants (Boivin et al, 2005; Olijve et al, 2018). Without a comprehensive and persistent surveillance, the epidemiological and genetic characteristics of HPeV infection remain ambiguous. The present study was designed to systematically investigate the prevalence, epidemiological feature, and genetic diversity of HPeV in pediatric patients in China through a long-lasting surveillance period in three groups of patients
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