Hyejin Kim

Accuracy of Diagnostic Methods and Surveillance Sensitivity for Human Enterovirus, South Korea, 1999–2011

The epidemiology of enteroviral infection in South Korea during 1999–2011 chronicles nationwide outbreaks and changing detection and subtyping methods used over the 13-year period. Of 14,657 patients whose samples were tested, 4,762 (32.5%) samples were positive for human enterovirus (human EV); as diagnostic methods improved, the rate of positive results increased. A seasonal trend of outbreaks was documented. Genotypes enterovirus 71, echovirus 30, coxsackievirus B5, enterovirus 6, and coxsackievirus B2 were the most common genotypes identified. Accurate test results correlated clinical syndromes to enterovirus genotypes: aseptic meningitis to echovirus 30, enterovirus 6, and coxsackievirus B5; hand, foot and mouth disease to coxsackievirus A16; and hand, foot and mouth disease with neurologic complications to enterovirus 71. There are currently no treatments specific to human EV infections; surveillance of enterovirus infections such as this study provides may assist with evaluating the need to research and develop treatments for infections caused by virulent human EV genotypes.

The recent ancestry of Middle East respiratory syndrome coronavirus in Korea has been shaped by recombination

Middle East respiratory syndrome coronavirus (MERS-CoV) causes severe cases of human respiratory disease. Since 2012, the victims have mainly come from the Middle East countries or sporadically from some other geographical regions seeded by the travelers who visited the Middle East. Such an introduction through travelling led to the emergence of a MERS-CoV outbreak in Korea in May 2015, which caused more than 140 confirmed human cases in less than a month. Using 70 complete genome sequences of MERS-CoV isolates, including the most recent sequences for the Korean and Chinese isolates, we reconstructed the phylogenetic relationships of the complete genome and the individual protein coding regions. The Korean MERS-CoV strain clustered in the previously established Hafr-Al-Batin-1_2013 clade together with two Saudi Arabian and one Chinese strain sampled in 2015. Although these four strains remained monophyletic in the entire protein-coding region, this clade showed different phylogenetic relationships across the genome, indicating a shared unique recombination pattern that is different from previously reported putative recombination strains. Our findings suggest that the recent ancestor of the Korean and its related MERS-CoV strains is characterized by unique mosaic genome pattern that is different from other putative recombinants.

Combination effects of peramivir and favipiravir against oseltamivir-resistant 2009 pandemic influenza A(H1N1) infection in mice.

Antiviral drugs are being used for therapeutic purposes against influenza illness in humans. However, antiviral-resistant variants often nullify the effectiveness of antivirals. Combined medications, as seen in the treatment of cancers and other infectious diseases, have been suggested as an option for the control of antiviral-resistant influenza viruses. Here, we evaluated the therapeutic value of combination therapy against oseltamivir-resistant 2009 pandemic influenza H1N1 virus infection in DBA/2 mice. Mice were treated for five days with favipiravir and peramivir starting 4 hours after lethal challenge. Compared with either monotherapy, combination therapy saved more mice from viral lethality and resulted in increased antiviral efficacy in the lungs of infected mice. Furthermore, the synergism between the two antivirals, which was consistent with the survival outcomes of combination therapy, indicated that favipiravir could serve as a critical agent of combination therapy for the control of oseltamivir-resistant strains. Our results provide new insight into the feasibility of favipiravir in combination therapy against oseltamivir-resistant influenza virus infection.

Inhibition of Pseudomonas aeruginosa with a recombinant RNA-based viral vector expressing human β-defensin 4

BackgroundHarassed with extensive epithelial burn wounds, patients can be affected by complications, such as infection, hypovolemic shock, hypothermia, and respiratory failure. Immediate first aid and followed supportive cares are critical for the prevention of severe complications. However, secondary bacterial infection is hard to be controlled in burn patients, and Pseudomonas aeruginosa (P. aeruginosa) is one of the top listed pathogens perturbing burn wounds beyond the antibiotics spectrum.ResultsTo find the way for efficacious protection from the pseudomonas-mediated complications in burn patients, we assessed the in vitro and in vivo inhibitory values of human β-defensin 4 (hBD4), which is known as a member of the cationic, antimicrobial peptides found in human cells of many kinds. The Newcastle disease virus (NDV) was used as a viral vector for the expression of hBD4 in burn wounds. Expressed from the recombinant NDV (rNDV-hBD4), hBD4 effectively inhibited the pseudomonal growths in cell culture media. In a mouse model, severely burn-injured skin was recovered by the direct installation of the rNDV-hBD4 infected cells in the burn wounds whereas that of control mice remained severely damaged.ConclusionsWe suggest that the application of hBD4 may protect burn patients from secondary pseudomonal infection and provide a therapeutic potential for burn wound treatment.

1136Surveillance of Acute Flaccid Paralysis (AFP) in the Republic of Korea during 2012-2013

Background. Acute flaccid paralysis (AFP) is described as sudden onset of flaccid paralysis in one or more limbs in children and mainly caused by polioviruses. AFP surveillance was managed by World Health Organization (WHO) for standard progress of poliomyelitis eradication. Methods. This study aimed to investigate clinical and etiological characterization of paralysis cases through a nationwide AFP surveillance during 2012-2013. The AFP surveillance was conducted through reporting and laboratory testing according to the WHO recommendations. Results. In total of 178 case of AFP between 2012 and 2013, none of case was confirmed poliomyelitis. The non-polio AFP rate were 1.24 in 2012 and 1.11 in 2013 (nonpolio AFP cases/100,000 children <15years, respectively). The patients aged < 5 years accounted for the largest proportion (69.1%) of the cases. The analysis of the temporal distribution showed that occurrences were distributed randomly throughout the year, with the highest occurrence from May to July (73 cases; 41.0%). The major clinical manifestation of AFP was meningoencephalitis (71 cases; 39.9%) and the GuillainBarré Syndrome (22 cases; 12.4%). Non-polio enterovirus (NPEV) infection was diagnosed in 81 patients (45.5%), the major genotype was EV 71 (55 cases; 67.9%). In addition, present study demonstrated that while patients with AFP are not infected with wild poilovirus, they are highly positive for EV. Conclusion. The AFP surveillance systems comply with WHO-specified epidemiological and laboratory performance standards. Therefore this surveillance was important report for our knowledge of epidemic characteristics, clinical symptom associated with AFP in Korea. Disclosures. Y. S. Yoon, Korea Centers for Diseases Control and Prevention: Member, Educational support H. Kim, Korea Centers for Diseases Control and Prevention: Employee, Educational support S. W. Lee, Korea Centers for Diseases Control and Prevention: Member, Educational support J. Y. Hyeon, Korea Centers for Diseases Control and Prevention: Member, Educational support