Re-emergence of a coxsackievirus A24 variant causing acute hemorrhagic conjunctivitis in Brazil from 2017 to 2018
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A large outbreak (over 200,000 cases) of acute hemorrhagic conjunctivitis (AHC) took place in Brazil during the summer of 2017/2018, seven years after a nationwide epidemic, which occurred in 2011. To identify the etiological agent, 80 conjunctival swabs from patients with a clinical presentation suggestive of AHC were analyzed at the national enterovirus laboratory. Real-time RT-PCR for human enteroviruses was performed, and enterovirus RNA was detected in 91.25% (73/80) of the specimens. Twenty-nine swab fluids were used to inoculate cell cultures (RD and Hep2C), and 72.4% (21/29) yielded a cytopathic effect. Genotype IV coxsackievirus A24v (CV-A24v) was identified as the causative agent of the outbreak. Phylogenetic analysis based on the VP1 gene revealed that Brazilian isolates were genetically related to strains that caused an outbreak in French Guiana in 2017. Our results show the re-emergence of CV-A24v causing AHC outbreaks in Brazil between the end of 2017 and the beginning of 2018.
We would like to acknowledge the collaboration of Silas Oliveira, Antônia dos Santos Alves, Euda Galiza Primo and Edna da Silveira as well as the Sanger co-facility at Instituto Oswaldo Cruz - Fiocruz.
This work was funded by a grant from the SVS/CGLAB, Brazilian Ministry of Health.
Compliance with ethical standards
Conflict of interest
The authors declare that there are no conflicts of interest.
The enterovirus laboratory at Instituto Oswaldo Cruz - FIOCRUZ is an official Brazilian Ministry of Health Reference Laboratory. During the course of the clinical cases, patients voluntarily visited local public health system clinics, where the clinical samples were collected. This activity was considered a public-health response to the conjunctivitis outbreaks and thus did not require review by the review board. All data were analyzed anonymously.
- 1.Wright PW, Strauss GH, Langford MP (1992) Acute hemorrhagic conjunctivitis. Am Fam Physician 45:173–178Google Scholar
- 4.Harada K, Fujimoto T, Asato Y, Uchio E (2015) Virological and epidemiological analysis of coxsackievirus A24 variant epidemic of acute hemorrhagic conjunctivitis in Okinawa, Japan, in 2011. Clin Ophthalmol 9:1085–1092Google Scholar
- 16.Medina NH, Haro-Muñoz E, Pellini AC, Machado BC, Russo DH, Timenetsky MC, Carmona RCC (2016) Acute hemorrhagic conjunctivitis epidemic in São Paulo State, Brazil, 2011. Rev Panam Salud Publica 39(2):137–141Google Scholar
- 17.WHO (2015) Enterovirus Surveillance Guidelines—guidelines for enterovirus surveillance in support of the polio eradication initiative, World Health Organization Regional Office for Europe, 2015Google Scholar
- 18.Kearse M, Moir R, Wilson A, Stones-Havas S, Cheung M, Sturrock S, Buxton S, Cooper A, Markowitz S, Duran C, Thierer T, Ashton B, Meintjes P, Drummond A (2012) Geneious basic: an integrated and extendable desktop software platform for the organization and analysis of sequence data. Bioinformatics 28(12):1647–1649CrossRefGoogle Scholar
- 25.Baggen J, Hurdiss D, Zocher G, Mistry N, Roberts R, Slager J, Guo H, van Vliet A, Wahedi M, Benschop K, Duizer E, de Haan C, de Vries E, Casasnovas J, de Groot R, Arnberg N, Stehle T, Ranson N, Thibaut H, van Kuppeveld F (2018) Role of enhanced receptor engagement in the evolution of a pandemic acute hemorrhagic conjunctivitis virus. PNAS 115(2):397–402CrossRefGoogle Scholar