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ORIGINAL RESEARCH
Etiological structure of enterovirus infection in children in the Moscow region
The diversity of epidemiologically significant enteroviruses (EVs) and their tendency to regularly change the currently prevalent strain result in a naturally unstable clinical picture and morbidity. This study aimed to investigate cases of enterovirus infection (EVI) in hospitalized children during the recovery phase of the epidemic process following the COVID-19 pandemic. We collected clinical samples from 156 EVI patients across a range of ages. Virus genotyping was performed using the Sanger sequencing method; we analyzed the 5′UTR–VP2 and VP1 fragments of the genome. Sixteen types of enteroviruses have been identified. For one, we established the type only (EV-C). The dominant type of EV was Coxsackie CV-A6, with a share of 80.6% (95% CI: 66.7‒95.5) in 2021 and 36.1% (95% CI: 27.5‒44.6) in 2022. CV-A6 most often caused skin lesions (vesicular exanthema and enterovirus vesicular stomatitis with exanthema) and was associated with respiratory infections. In 2022, the proportion of CV-A10 cases increased considerably to 27.0% (95% CI: 19.2–34.9) compared with 6.4% (95% CI: 0–15.1) in 2021. The most common clinical manifestation of CV-A10 was herpangina. The most severe cases of EVI were associated with ECO6 ― four out of 11 patients were diagnosed with meningitis, the rest showed neurological symptoms (meningism, intense headache, vomiting) against the background of fever. We observed a large number of EVI cases accompanied by the presence of other infectious agents in biological samples, which may result from immune weakening during EVI development. The most common of these agents was human herpesvirus 6 (HHV-6). The nucleotide sequences of the characterized enteroviruses have been deposited in the NCBI database to facilitate future epidemiological analyses of enterovirus circulation in the Russian Federation.
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