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. 2013 Apr 22;8(4):e61650.
doi: 10.1371/journal.pone.0061650. Print 2013.

Characterization of the non-polio enterovirus infections associated with acute flaccid paralysis in South-Western India

Rongala Laxmivandana  1 , Prasanna Yergolkar, Varanasi Gopalkrishna, Shobha D Chitambar
Affiliations

Characterization of the non-polio enterovirus infections associated with acute flaccid paralysis in South-Western India

Rongala Laxmivandana et al. PLoS One. .

Abstract

Non-polio enteroviruses (NPEVs) have been reported frequently in association with acute flaccid paralysis (AFP) cases during Polio Surveillance Programs (PSPs) worldwide. However, there is limited understanding on the attributes of their infections. This study reports characteristics of NPEVs isolated from AFP cases, investigated during PSPs held in 2009-2010, in Karnataka and Kerala states of south-western India having varied climatic conditions. NPEV cell culture isolates derived from stool specimens that were collected from 422 of 2186 AFP cases (<1-14 years age) and 17 of 41 asymptomatic contacts; and details of all AFP cases/contacts were obtained from National Polio Laboratory, Bangalore. The distribution of NPEV infections among AFP cases and circulation pattern of NPEV strains were determined by statistical analysis of the data. Genotyping of all NPEV isolates was carried out by partial VP1 gene sequencing and phylogenetic analysis. NPEV positive AFP cases were significantly higher in children aged <2 years; with residual paralysis; in summer months; and in regions with relatively hot climate. Genotyping of NPEVs identified predominance of human enteroviruses (HEV)-B species [81.9%-Echoviruses (E): 57.3%; coxsackieviruses (CV) B: 15%; numbered EVs: 8.9%; CVA9: 0.7%] and low levels of HEV-A [14.5%-CVA: 6%; numbered EVs: 8.5%] and HEV-C [3.6%-CVA: 2.6%; numbered EVs: 1%] species, encompassing 63 genotypes. EV76 (6.3%) and each of E3, CVB3 and E9 (4.97%) were found frequently during 2009 while E11 (6.7%), CVB1 (6.1%), E7 (5.1%) and E20 (5.1%) were detected commonly in 2010. A marked proportion of AFP cases from children aged <2 years; presenting with fever; and from north and south interior parts of Karnataka state was detected with E/numbered EVs than that found with CVA/CVB. This study highlights the extensive genetic diversity and diverse circulation patterns of NPEV strains in AFP cases from different populations and climatic conditions.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. NPEV positivity in AFP cases of the present study.
(A) Age-wise distribution. (B) Month-wise distribution.
Figure 2
Figure 2. Meteorological zone wise analysis of NPEV positivity in AFP cases of the present study.
(A) Demographic and climatological factors of different meteorological zones of south-western India. *Retrieved from , , , , . (B) Meteorological zone wise NPEV positivity. (C) Map of different meteorological zones of Karnataka and Kerala states of south-western India.
Figure 3
Figure 3. Distribution of NPEV types in AFP cases of the present study.
□ and ▪ denote strains from 2009 and 2010 respectively.
Figure 4
Figure 4. Phylogenetic tree based on VP1 sequence (nucleotide position: 2602–2977) of HEV-A strains of south- western India.
▴ denotes strain from AFP case of the present study. Reference strains are shown with GenBank accession numbers. Scale indicates genetic distance.
Figure 5
Figure 5. Phylogenetic tree based on VP1 sequence (nucleotide position: 2602?2977) of HEV-B strains of south-western India (SWI).
▴ denotes strain from AFP case of the present study. Strains which formed sub-clusters with >70% bootstrap support are collapsed. Reference strains are shown with GenBank accession numbers. Scale indicates genetic distance.
Figure 6
Figure 6. Phylogenetic tree based on VP1 sequence (nucleotide position: 2602–2977) of HEV-C strains of south- western India.
▴ denotes strain from AFP case of the present study. Reference strains are shown with GenBank accession numbers. Scale indicates genetic distance.
See this image and copyright information in PMC

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