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Volume 18, Number 11—November 2012

Antigenic Diversity of Enteroviruses Associated with Nonpolio Acute Flaccid Paralysis, India, 2007–2009

C. Durga RaoComments to Author , Prasanna Yergolkar1, and K. Subbanna Shankarappa12
Author affiliations: Author affiliations: Indian Institute of Science, Bangalore, India (C.D. Rao, K.S. Shankarappa); National Institute of Virology–World Health Organization–South East Asia Region Polio Laboratory Network, Victoria Hospital, Bangalore (P. Yergolkar); National Institute of Virology, Bangalore (P. Yergolkar); Victoria Hospital, Bangalore (P. Yergolkar)

Main Article

Figure 4

Phylogenetic tree of viral protein 1 sequences of coxsackievirus B1–B6 isolates generated in comparison with those of strains belonging to different genotypes of B1, B2, B3, B4, B5, and B6 serotypes, India, 2007–2009. Multiple sequence alignments were performed by using ClustalW program ( and phylogenetic analysis by MEGA5 program (12) with pairwise comparison and maximum composite likelihood nucleotide substitution model. Phylogenetic trees were constructed by UPGM

Figure 4. . . . Phylogenetic tree of viral protein 1 sequences of coxsackievirus B1–B6 isolates generated in comparison with those of strains belonging to different genotypes of B1, B2, B3, B4, B5, and B6 serotypes, India, 2007–2009. Multiple sequence alignments were performed by using ClustalW program ( and phylogenetic analysis by MEGA5 program (13) with pairwise comparison and maximum composite likelihood nucleotide substitution model. Phylogenetic trees were constructed by UPGMA (unweighted pair group method using arithmetic averages) with statistical significance of the phylogenetic analyses estimated by bootstrap analysis with 1,000 pseudoreplicate datasets.

Main Article

  1. Field Guide. Surveillance of acute flaccid paralysis. 3rd ed. Child Health Division, Department of Family Welfare, Ministry of Health & Family Welfare, New Delhi, September 2005 [cited 2012 Jun 28].
  2. Centers for Disease Control and Prevention. Progress toward poliomyelitis eradication—India, January 2009–October 2010. MMWR Morb Mortal Wkly Rep. 2010;59:15815.PubMedGoogle Scholar
  3. Global Polio Eradication Initiative [cited 2012 Mar 21].
  4. World Health Organization. Immunization and vaccine development. Polio eradication, VPD surveillance, 2011 [cited 2012 Mar 21].]
  5. National Polio Surveillance Project. A Government of India–WHO collaboration [cited 2012 Jun 8].
  6. Pallansch  M, Roos  R. Enteroviruses: polioviruses, coxsackieviruses, echoviruses, and newer enteroviruses. In: Knipe DM, Howley PM, Griffin DE, Lamb RA, Martin MA, Roizman B, et al. Fields virology. 5th ed. Philadelphia: Lippincott Williams & Wilkins; 2007:839–93.
  7. Solomon  T, Willison  H. Infectious causes of acute flaccid paralysis. Curr Opin Infect Dis. 2003;16:37581. DOIPubMedGoogle Scholar
  8. Picornaviridae [cited 2012 Mar 21].
  9. Nix  WA, Oberste  MS, Pallansch  MA. Sensitive, seminested PCR amplification of VP1 sequences for direct identification of all enterovirus serotypes from original clinical specimens. J Clin Microbiol. 2006;44:2698704. DOIPubMedGoogle Scholar
  10. Oberste  MS, Maher  K, Flemister  MR. Comparison of classic and molecular approaches for the identification of untypeable enteroviruses. J Clin Microbiol. 2000;38:11704.PubMedGoogle Scholar
  11. Dhole  TN, Ayyagari  A, Chowdhary  R, Shakya  AK, Shrivastav  N, Datta  T, Non-polio enteroviruses in acute flaccid paralysis children of India: vital assessment before polio eradication. J Paediatr Child Health. 2009;45:40913. DOIPubMedGoogle Scholar
  12. World Health Organization. Polio laboratory manual. 4th ed. Geneva: The Organization; 2004.
  13. Tamura  K, Peterson  D, Peterson  N, Stecher  G, Nei  M, Kumar  S. MEGA5: molecular evolutionary genetics analysis using maximum likelihood, evolutionary distance, and maximum parsimony methods. Mol Biol Evol. 2011;28:27319. DOIPubMedGoogle Scholar
  14. Khetsuriani  N, Lamonte-Fowlkes  A, Oberst  S, Pallansch  MA. Enterovirus surveillance—United States, 1970–2005. MMWR Surveill Summ. 2006;55:120.PubMedGoogle Scholar
  15. Centers for Disease Control and Prevention. Nonpolio enterovirus and human parechovirus surveillance—United States, 2006–2008. MMWR Morb Mortal Wkly Rep. 2010;59:157780.PubMedGoogle Scholar
  16. Kapoor  A, Victoria  J, Simmonds  P, Slikas  E, Chieochansin  T, Naseem  A, A highly prevalent and genetically diversified Picornaviridae genus in south Asian children. Proc Natl Acad Sci U S A. 2008;105:204827. DOIPubMedGoogle Scholar
  17. Victoria  JG, Kapoor  A, Li  L, Blinkova  O, Slikas  B, Wang  C, Metagenomic analyses of viruses in stool samples from children with acute flaccid paralysis. J Virol. 2009;83:464251. DOIPubMedGoogle Scholar
  18. Blinkova  O, Kapoor  A, Victoria  J, Jones  M, Wolfe  N, Naeem  A, Cardioviruses are genetically diverse and cause common enteric infections in south Asian children. J Virol. 2009;83:463141. DOIPubMedGoogle Scholar
  19. Greninger  AL, Runckel  C, Chiu  CY, Haggerty  T, Parsonnet  J, Ganem  D, The complete genome of Klassevirus—a novel picornavirus in pediatric stool. Virol J. 2009;6:82. DOIPubMedGoogle Scholar
  20. Reuter  G, Boros  A, Pankovics  P. Kobuviruses-a comprehensive review. Rev Med Virol. 2011;21:3241. DOIPubMedGoogle Scholar
  21. van der Sanden  S, Koopmans  M, Uslu  G, van der Avoort  H. Epidemiology of enterovirus 71 in the Netherlands, 1963 to 2008. J Clin Microbiol. 2009;47:282633. DOIPubMedGoogle Scholar
  22. van der Sanden  S, van der Avoort  H, Lemey  P, Uslu  G, Koopmans  M. Evolutionary trajectory of the VP1 gene of human enterovirus 71 genogroup B and C viruses. J Gen Virol. 2010;91:194958. DOIPubMedGoogle Scholar
  23. Yu  H, Chen  W, Chang  H, Tang  R, Zhao  J, Gan  L, Genetic analysis of the VP1 region of enterovirus 71 reveals the emergence of genotype A in central China in 2008. Virus Genes. 2010;41:14. DOIPubMedGoogle Scholar
  24. Avellón  A, Casas  I, Trallero  G, Pérez  C, Tenorio  A, Palacios  G. Molecular analysis of echovirus 13 isolates and aseptic meningitis, Spain. Emerg Infect Dis. 2003;9:93441. DOIPubMedGoogle Scholar
  25. Mullins  JA, Khetsuriani  N, Nix  WA, Oberste  MS, LaMonte  A, Kilpatrick  DR, Emergence of echovirus type 13 as a prominent enterovirus. Clin Infect Dis. 2004;38:707. DOIPubMedGoogle Scholar
  26. Iwai  M, Yoshida  H, Matsuura  K, Fujimoto  T, Shimizu  H, Takizawa  T, Molecular epidemiology of echoviruses 11 and 13, based on an environmental surveillance conducted in Toyoma Prefecture, 2002–2002. Appl Environ Microbiol. 2006;72:63817. DOIPubMedGoogle Scholar
  27. Lindberg  AM, Polacek  C. Molecular analysis of the prototype coxsackievirus B5 genome. Arch Virol. 2000;145:20521. DOIPubMedGoogle Scholar
  28. Wikswo  ME, Khetsuriani  N, Fowlkes  AL, Zheng  X, Penaranda  S, Verma  N, Increased activity of coxsackievirus B1 strains associated with severe disease among young infants in the United States, 2007–2008. Clin Infect Dis. 2009;49:e4451. DOIPubMedGoogle Scholar
  29. Saeed  M, Zaidi  SZ, Naeem  A, Masroor  M, Masroor  M, Sharif  S, Epidemiology and clinical findings associated with enteroviral acute flaccid paralysis in Pakistan. BMC Infect Dis. 2007;7:6. DOIPubMedGoogle Scholar
  30. Oderinde  BS, Olabode  AO, Harry  TO, Baba  MM, Bukbuk  DN, Ogunmola  OO. Non-polio enteroviruses implicated in acute flaccid paralysis in northern Nigeria. Research Journal of Medicine and Medical Sciences. 2007;2:258.
  31. Ortner  B, Huang  C-W, Schmid  D, Mutz  I, Wewalka  G, Allerberger  F, Epidemiology of enterovirus types causing neurological disease in Austria 1999–2007: detection of clusters of echovirus 30 and enterovirus 71 and analysis of prevalent genotypes. J Med Virol. 2009;81:31724. DOIPubMedGoogle Scholar
  32. Persu  A, Baicus  A, Stavri  S, Combiescu  M. Non-polio enteroviruses associated with acute flaccid paralysis (AFP) and facial paralysis (FP) cases in Romania, 2001–2008. Roum Arch Microbiol Immunol. 2009;68:206.PubMedGoogle Scholar
  33. Bingjun  T, Yoshida  H, Yan  W, Lin  L, Tsuji  T, Shimizu  H, Molecular typing and epidemiology of non-polio enteroviruses isolated from Yunnan Province, the People’s Republic of China. J Med Virol. 2008;80:6709. DOIPubMedGoogle Scholar
  34. Ooi  MH, Wong  SC, Lewthwaite  P, Cardosa  MJ, Solomon  T. Clinical features, diagnosis, and management of enterovirus 71. Lancet Neurol. 2010;9:1097105. DOIPubMedGoogle Scholar
  35. Lee  TC, Guo  HR, Su  HJ, Yang  YC, Chang  HL, Chen  KT. Diseases caused by enterovirus 71 infection. Pediatr Infect Dis J. 2009;28:90410. DOIPubMedGoogle Scholar
  36. Wang  YF, Chou  CT, Lei  HY. A mouse-adapted anterovirus 71 strain causes neurological disease in mice after oral infection. J Virol. 2004;78:791624. DOIPubMedGoogle Scholar
  37. Lin  TY, Twu  SJ, Ho  MS, Chang  LY, Lee  CY. Enterovirus 71 outbreaks, Taiwan: occurrence and recognition. Emerg Infect Dis. 2003;9:2913. DOIPubMedGoogle Scholar
  38. Wu  Y, Yeo  A, Phoon  MC, Tan  EL, Poh  CL, Quak  SH, The largest outbreak of hand, foot and mouth disease in Singapore in 2008: the role of enterovirus 71 and coxsackievirus A strains. Int J Infect Dis. 2010;14:e107681. DOIPubMedGoogle Scholar
  39. De  W, Changwen  K, Wei  L, Monaqin  C, Jin  Y, Conq  M, A large outbreak of hand, foot, and mouth disease caused by EV71 and CAV16 in Guangdong, China, 2009. Arch Virol. 2011;156:94553. DOIPubMedGoogle Scholar

Main Article

1These authors contributed equally to this article.

2Current affiliation: University of Horticultural Sciences, Bagalkot, India.

Page created: October 15, 2012
Page updated: October 15, 2012
Page reviewed: October 15, 2012
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