Novel Human Parechovirus 3 Diversity, Recombination, and Clinical Impact Across 7 Years: An Australian Story

Figures

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  Figure 1.. Seasonality of hospitalized human parechovirus (HPeV) cases across the Queensland, Australia, spring/fall period. The solid lines represent total diagnosed HPeV cases within the state within that outbreak period, and the smaller, dashed lines underneath represent the respective cases captured for the study, which were genotyped as HPeV3. Note all 2013–2014 samples that were diagnosed were also captured for the study. Y-axis shows number of cases.

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  Figure 2.. Maximum likelihood phylogenetic analyses using 1000 bootstraps of all available Australian human parechovirus 3 (HPeV3) genomes’ coding sequence regions upstream of the recombination breakpoint (nt 1–3114), including 2 non-AR, non-Australian (Yamagata-2008 and CAU14/82015/KR) HPeV3 reference strains. Node colors indicate strain genomes generated in this study and are color coded by Australian state where they were collected: blue, Queensland hospital; green, Western Australian hospital; orange, Queensland community; gray, previously published Australian AR genomes collected during 2014–2016 from New South Wales, Victoria, and Tasmania.

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  Figure 3.. Maximum likelihood phylogenetic analyses of available human parechovirus 3 Australian recombinant (AR) strains coding sequences as a function of time and categorized by geographic area of origin. The Nextstrain plot shows the progressive evolution of the AR strain for most of the disease outbreak periods.

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  Figure 4.. Total human parechovirus 3 (HPeV3) and Australian recombinant (AR) strain prevalence in the Queensland community (blue) and hospital-based (peach) cohorts each month over an interval period spanning the first observed HPeV disease outbreak. Only an overlap of several months from November to January was available for both datasets. Red bar indicates duration of the first HPeV3 disease outbreak; the dashed line portion indicates uncertainty in when the outbreak began. Y-axis shows number of cases.

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  Figure 5.. Clinical features relating to Australian recombinant status over the 4 sampled epidemic periods. Abbreviations: MRI, magnetic resonance imaging; N, no; PICU, pediatric intensive care unit; Y, yes.