Key result
Enterovirus prevalence was significantly higher in patients with severe acute respiratory illness (5.8%) compared to asymptomatic controls (3.4%, P=0.002), with high genotypic diversity observed.
Case-Control (n=5,940)
Yes
Absolute Event Rate: 5.8% vs 3.4%
p-value: p=0.002
Enteroviruses are prevalent in both symptomatic respiratory patients and asymptomatic individuals in South Africa, with a high diversity of circulating genotypes but no clear association between specific species and disease severity.
Enteroviruses can cause outbreaks of severe acute respiratory illness (SARI) and EV-A, -B, -C, and -D species have different pathogenic profiles and circulation patterns. We aimed to characterize and determine the prevalence of enterovirus genotypes among South African patients with respiratory illness and controls during June 2012 to July 2014. Syndromic SARI and influenza-like illness (ILI) surveillance was performed at two sentinel sites. At each site nasopharyngeal/oropharyngeal specimens were collected from SARI and ILI patients as well as controls. Specimens were tested for enterovirus by real-time PCR. Positive specimens were further genotyped by sequencing a region of the VP1 gene. The prevalence of enterovirus was 5.8% (87/1494), 3.4% (103/3079), and 3.4% (46/1367) among SARI, ILI, and controls, respectively (SARI/controls, P = 0.002 and ILI/control, P = 0.973). Among the 101/236 (42.8%) enterovirus-positive specimens that could be genotyped, we observed a high diversity of circulating enterovirus genotypes (a total of 33 genotypes) from all four human enterovirus species with high prevalence of Enterovirus-B (60.4%; 61/101) and Enterovirus-A (21.8%; 22/101) compared to Enterovirus-C (10.9%; 11/101) and Enterovirus-D (6.9%; 7/101) (P = 0.477). Of the enterovirus genotypes identified, Echovirus 30 (9.9%, 10/101), Coxsackie virus B5 (7.9%, 8/101) and Enterovirus-D68 (6.9%, 7/101) were most prevalent. There was no difference in disease severity (SARI or ILI compared to controls) between the different enterovirus species (P = 0.167). We observed a high number of enterovirus genotypes in patients with respiratory illness and in controls from South Africa with no disease association of EV species with disease severity.
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Hellferscee et al. (2017) conducted a case-control in Severe acute respiratory illness (SARI) and influenza-like illness (ILI) (n=5,940). Enterovirus infection vs. Asymptomatic controls was evaluated on Prevalence of enterovirus (p=0.002). Enterovirus prevalence was significantly higher in patients with severe acute respiratory illness (5.8%) compared to asymptomatic controls (3.4%, P=0.002), with high genotypic diversity observed.
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