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ORIGINAL RESEARCH
Etiological structure of enterovirus infection in children in the Moscow region
1 Center for Strategic Planning and Management of Medical and Biological Health Risks of the Federal Medical Biological Agency, Moscow, Russia
2 Speransky Children's City Clinical Hospital No. 9, Moscow, Russia
Correspondence should be addressed: Ekaterina E. Davydova
Pogodinskaya, 10, Moscow, 119121, Russia, еur.abmfpsc@avodyvad
Author contribution: Polyakova VA, Luparev AR, Matsvay AD, Gnusareva NI, Gordukova MA, Galeeva EV, Tolokonceva AA — conducting the research; Davydova EE, Polyakova VA, Luparev AR — literature analysis; Davydova EE, Luparev AR — data interpretation; Gordukova MA, Galeeva EV — collection of biological samples; Polyakova VA — article authoring; Davydova EE — manuscript editing; Polyakova VA — preparation of illustrations; Shipulin GA — supervision and procurement of funding.
Compliance with ethical standards: the study was approved by the Ethics Committee of the Children's City Clinical Hospital No. 9 named after G.N. Speransky (Minutes No. 44 of April 19, 2022), conducted in accordance with the principles of the Declaration of Helsinki. All participants submitted signed informed consent forms prior to participation in the study.
The diversity and succession of epidemiologically significant enteroviruses (EV) lead to constant changes in the clinical presentation and morbidity levels. The aim of the study is to investigate cases of EV infection in hospitalized children during the resurgence of the epidemic process following the COVID-19 pandemic. We collected clinical samples from 156 patients with EV infection across a range of ages. Virus genotyping was performed using the Sanger sequencing of the 5’UTR-VP2 and VP1 genome fragments. Sixteen types of enteroviruses were identified, with one additional case identified only to the species level (EV-C). The dominant EV type 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. Most commonly, CV-A6 caused skin lesions (exanthema or HFMD) and respiratory manifestations. 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 EV infection cases were associated with ECHO 6 — four out of 11 patients were diagnosed with meningitis, while the remaining patients exhibited neurological symptoms (meningism, intense headache, vomiting) accompanied by fever. We observed a large number of EV cases accompanied by the presence of other infectious agents in biological samples, which may result from immune suppression during EV infection 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 enable subsequent epidemiological analysis of enterovirus circulation in the Russian Federation.
Keywords: Sanger sequencing, enterovirus infection, epidemiologically significant enteroviruses, hand, foot and mouth disease (HFMD), herpangina, Coxsackie viruses, Echoviruses, co-infection