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An outbreak of echovirus 33 in schools in China in 2013

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Abstract

Echovirus 33 (E33) has been infrequently detected and is less frequently associated with clinical diseases when compared with other types of enteroviruses (EVs) in China. An outbreak of E33 was identified in four schools in Hunan Province, China, in June 2013. For laboratory diagnosis, throat swabs and/or serum specimens were collected from 27 patients. E33 was isolated in cell culture and typed by molecular methods. Complete VP1 gene sequences were determined and analyzed. Specific E33 antibody was measured by virus neutralization testing. From June 3-20, 108 suspected cases were reported, and 19 were confirmed to be associated with E33 by laboratory testing, with seven virologically confirmed and 12 serologically confirmed cases. The suspected cases were in children aged 3-16 years (mean, 11 years), most of whom (94 %, 102/108) were ≥6 years old. The majority of cases (98 %, 106/108) presented as influenza-like illness (ILI), and two were clinically diagnosed as viral meningitis. Older children aged ≥12 years had a higher hospitalization rate (21 %) than younger children (4 %). A BLAST query of GenBank with the Hunan E33 strain VP1 gene sequence gave a close match to an E33 isolate from Pakistan, based on a partial VP1 gene sequence. Phylogenetic analyses of the complete E33 VP1 gene sequences from our study revealed an independent cluster with nucleotide sequences that diverge from E33 from other countries by >12 %. Due to limited E33 VP1 gene sequence data in GenBank and passive EV surveillance in China and most other parts of the world (excepting hand, foot, and mouth disease surveillance in Asia), the approximate origin of Hunan E33 could not be determined.

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Acknowledgments

We thank all the staffs in Shimen prefectural CDC who conducted field investigations and collected the clinical specimens. We thank all the staffs in Changde municipal CDC and Hunan provincial CDC who participated or organized the emergency response to the outbreak. We also thank Dr. W. Allan Nix for the revision of the manuscript, Dr. M. Steven Oberste (US CDC) for helpful discussion of the manuscript, and Dr. Dustin C. Yang (US CDC) for modifying the manuscript. This work was supported by a grant of Key Technologies Research and Development Program from Ministry of Science and Technology (Grant numbers: 2013ZX10004-202, 2012ZX10004201-003).

Conflict of interest

All authors: No reported conflicts.

Author information

Authors and Affiliations

  1. Key Laboratory of Medical Virology of Ministry of Health, Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China

    Xiaojuan Tan, Xuejun Ma, Baomin Zhang & Wenbo Xu

  2. Hunan provincial Center for Disease Control and Prevention, Changsha, Hunan, China

    Lidong Gao, Yunzhi Liu & Fuqiang Liu

  3. Changde municipal Center for Disease Control and Prevention, Changde, Hunan, China

    Junxiong Nie

  4. Shimen prefectural Center for Disease Control and Prevention, Changde, Hunan, China

    Daihong Zhan

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  1. Xiaojuan Tan
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  9. Wenbo Xu
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Corresponding author

Correspondence to Wenbo Xu.

Additional information

X. Tan, L. Gao, and X. Ma contributed equally to this work.

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Tan, X., Gao, L., Ma, X. et al. An outbreak of echovirus 33 in schools in China in 2013. Arch Virol 159, 2233–2241 (2014). https://doi.org/10.1007/s00705-014-2059-6

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  • DOI: https://doi.org/10.1007/s00705-014-2059-6

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