Epidemiology and control measures of an outbreak of neonatal echovirus 11 infections in Guangdong, China: A retrospective analysis

The objective of this study was to investigate the outbreak of echovirus 11 (ECHO 11) infection in newborns at a hospital in Guangdong Province, China, and to study the effectiveness of prevention and control measures to infer the epidemiological characteristics of ECHO 11 and explore the effective measures for its prevention and control. We performed retrospective analyses of hospital records and laboratory test data. In this outbreak, ten cases of ECHO 11 infection were identified, of which nine cases were nosocomial infections. Most of the cases (90%) were severe, and three died. The onset time interval of 10 patients was 1-4 days, most of which occur in 1-2 days. There were eight (80%) males and two females (20%). The gestational age of the patients was 31 to 40 weeks (mean, 35+4 weeks;median, 35+4 weeks). The onset time was 3-26 days (average 9 days;median 8 days). The birth weights of the patients ranged from 1,650 g to 3,450 g (mean 2,385 g;median 2,250 g). We concluded that neonatal infection with ECHO 11 will lead to serious symptoms and high mortality, and is prone to outbreaks of nosocomial infection. We speculate that ECHO 11 is most likely to spread via contact transmission;however, we do not rule out the possibility of droplet transmission. Prevention and control measures can effectively prevent and control hospital enteroviral infections.

Clinical characteristics and effectiveness of antiviral agents in hospitalized children with infectious mononucleosis in China:A multicenter retrospective study

Importance:The clinical characteristics of infectious mononucleosis(IM)in Chinese children have not been evaluated in multicenter studies,and the effectiveness of antiviral treatment are controversial.Objective:To investigate the clinical characteristics of Chinese children with IM and current status of antiviral therapy for affected patients.Methods:Hospitalized patients with IM were enrolled between 2018 and 2020 in five children’s hospitals in China.The clinical characteristics were compared among four age groups:<3 years,3-<6 years,6-<10 years,and≥10 years.The clinical characteristics of IM and effectiveness of antiviral therapy were compared among patients receiving acyclovir(ACV),ganciclovir(GCV),and no antiviral therapy(i.e.,non-antiviral group).Results:In total,499 patients were analyzed;most patients were 3-<6 years of age.The most common symptoms and signs included fever(100%),lymphadenopathy(98.6%),pharyngitis(86.4%),eyelid edema(76.8%),and snoring(72.9%).There were significant differences in rash,hepatomegaly,and liver dysfunction among the four age groups.Patients aged<3 years had a lower incidence of liver dysfunction and a higher incidence of rash.Among the 499 patients,50.1%were treated with GCV,26.3%were treated with ACV,and 23.6%received no antiviral therapy.Compared with the non-antiviral group,patients in the ACV and GCV groups had longer durations of fever(P<0.001).There were no significant differences in the incidences of complications among the three treatment groups.Interpretation:The incidence of IM in Chinese children peaked at 3-<6 years of age.Clinical features of IM varied according to age.Patients receiving antiviral therapy exhibited more serious clinical manifestations than did patients without antiviral therapy.The effectiveness of antiviral therapy for IM requires further analysis.

Dynamics of severe acute respiratory syndrome coronavirus 2 genome variants in the feces during convalescence

In response to the current coronavirus disease 2019(COVID-19)pandemic,it is crucial to understand the origin,transmission,and evolution of severe acute respiratory syndrome coronavirus 2(SARS-Co V-2),which relies on close surveillance of genomic diversity in clinical samples.Although the mutation at the population level had been extensively investigated,how the mutations evolve at the individual level is largely unknown.Eighteen time-series fecal samples were collected from nine patients with COVID-19 during the convalescent phase.The nucleic acids of SARS-CoV-2 were enriched by the hybrid capture method.First,we demonstrated the outstanding performance of the hybrid capture method in detecting intra-host variants.We identified 229 intra-host variants at 182 sites in 18 fecal samples.Among them,nineteen variants presented frequency changes>0.3 within 1-5 days,reflecting highly dynamic intrahost viral populations.Moreover,the evolution of the viral genome demonstrated that the virus was probably viable in the gastrointestinal tract during the convalescent period.Meanwhile,we also found that the same mutation showed a distinct pattern of frequency changes in different individuals,indicating a strong random drift.In summary,dramatic changes of the SARS-CoV-2 genome were detected in fecal samples during the convalescent period;whether the viral load in feces is sufficient to establish an infection warranted further investigation.