The Laboratory Virology and Serology Reporting Scheme, 1991 to 2000

The Laboratory Virology and Serology (LabVISE) Reporting Scheme is a passive surveillance scheme based on voluntary reports of infectious agents contributed by virology and serology laboratories around Australia. This article reports on the LabVISE data collected between 1991 and 2000 and was published in Communicable Diseases Intelligence Vol 26 No 3, September 2002. This article can be viewed in 15 HTML documents and is also available in PDF format.

Page last updated: 03 October 2002

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Results - Part B: Analysis of data by pathogen, continued

Picornaviruses

The family Picornaviridae consists of two groups: the rhinoviruses and enteroviruses. Enteroviruses consist of five subgroups and these comprise a total of 67 serotypes: 31 echoviruses, 23 coxsackie A viruses, 6 coxsackie B viruses, 3 polioviruses and 4 'new' enteroviruses 68-71 (identified since 1970).31 Reports of Picornaviridae to LabVISE are shown in Table 21.

Table 21. Laboratory reports to LabVISE of Picornaviridae 1991 to 2000

Virus
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 Total
Enterovirus not typed
673
781
943
1,101
891
742
484
538
753
815
7,721
Rhinovirus (all types)
653
683
868
905
650
662
549
420
501
420
6,311
Echovirus
155
497
502
443
206
49
25
149
264
193
2,483
Poliovirus
194
186
121
106
71
35
24
44
52
40
873
Coxsackie B virus
155
136
113
87
21
49
27
18
21
32
659
Coxsackie A virus
58
43
82
36
12
22
10
12
25
19
319
Enterovirus 71
13
15
1
-
34
-
-
9
15
6
93


Enteroviruses (general)

Picornavirus reports averaged 7.5 per cent of the annual reports to LabVISE throughout the study period. Enteroviruses made up nearly two-thirds of the total picornavirus reports (12,148, 65%) and 4.7 per cent of the total LabVISE reports.

Of enteroviruses with typing information, echovirus comprised 56 per cent, poliovirus 19.7 per cent, Coxsackie B virus 14.9 per cent and coxsackie A virus 7.2 per cent.

Coxsackie A viruses

Coxsackie A viruses reported to LabVISE between 1991 and 2000 are shown in Table 22.

Table 22. Laboratory reports to LabVISE of coxsackie A virus, 1991 to 2000, by serotype

Virus
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 Total
Coxsackie virus A9
45
19
62
2
9
9
5
8
10
11
180
Coxsackie virus A16
9
21
18
34
1
12
5
3
15
8
126
Coxsackie virus A2
2
-
-
-
-
-
-
-
-
-
2
Coxsackie virus A10
-
-
-
-
1
-
-
1
-
-
2
Coxsackie virus A7
-
-
-
-
-
1
-
-
-
-
1
Coxsackie virus A21
-
-
1
-
-
-
-
-
-
-
1
Coxsackie virus A (untyped)
2
3
1
-
1
-
-
-
-
-
7
Total
58
43
82
36
12
22
10
12
25
19
319


Diagnoses in which coxsackie A viruses were identified were most commonly in patients with skin or mucous membrane disease (38%) and meningitis (21%), and most often identified in specimens of nasopharyngeal swabs (25%). Most coxsackie A viruses are not readily isolated by cell culture except serotypes A9 and A16. As a result these were the most commonly isolated serotypes reported by LabVISE. Coxsackie A9 infections have occurred in outbreaks in 1985, 1988 and 1993 (Figure 11).30

Top of pageFigure 11. Laboratory reports to LabVISE of coxsackie A9 infections, 1991 to 2000, by month of specimen collection

Figure 11. Laboratory reports to LabVISE of coxsackie A9 infections, 1991 to 2000, by month of specimen collection

This virus is associated with aseptic meningitis in adults and children. Coxsackie virus A16 is the etiologic agent of hand, foot and mouth disease. In Western countries, cases of this disease among children in the same family are often seen. The infection is typified by fever followed by the appearance of oral vesicles and peripheral exantham on the skin of the hands and feet.31 The clinical syndromes associated with coxsackie A viral infections are summarised in Table 23.

Table 23. Clinical syndromes associated with coxsackie A viral infection*

 
Clinical syndrome
Coxsackie A serotypes
Illnesses associated with many enteroviruses in addition to coxsackie A Aseptic meningitis
Encephalitis
Paralysis
1-11,14, 16-18, 22, 24
2,5,6,7,9
4,6,7,9,11,14,21
Illnesses more characteristic of particular groups or serotypes of coxsackie A Herpangina
Hand, foot and mouth syndrome
Exanthem
Epidemic conjunctivitis
2-6, 8, 10, 22
5,7,9,10,16
2,4,5,9,16
24
Undefined/uncertain etiologic role of coxsackie A viruses Haemolytic uraemic syndrome
Myositis
Guillain-Barré syndrome
Mononucleosis
4
9
2,5,9
5,6

*Modified from reference 31


Coxsackie B viruses

Coxsackie B viruses were most often identified in patients presenting with meningitis (31%), lower respiratory tract illness (18%) and gastroenteritis (11%). Specimens of nasopharyngeal swabs (32%), faeces (26%) or cerebrospinal fluid (23%) were the most common sources.

Coxsackie B4 and B5 were the most common serotypes of coxsackie B viruses identified in LabVISE. Coxsackie B4 is associated with respiratory disease (summer gripe) mostly in children under 5 years of age. Coxsackie B5 is associated with meningitis and occurs in children and adults.31

Coxsackie B serotypes identified in LabVISE reports between 1991 and 2000 are shown in Table 24.

Table 24. Laboratory reports to LabVISE of coxsackie B viruses, 1991 to 2000, by year and serotype

Virus
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 Total
Coxsackie virus B5
40
65
26
15
4
15
1
7
7
5
185
Coxsackie virus B4
61
4
11
12
2
8
5
6
3
16
128
Coxsackie virus B1
6
57
51
4
-
-
1
-
1
4
124
Coxsackie virus B2
34
2
8
23
4
20
6
1
10
6
114
Coxsackie virus B3
13
6
15
31
11
3
14
2
-
-
95
Coxsackie virus B6
-
1
1
2
-
-
-
1
-
-
5
Coxsackie virus B untyped
1
1
1
-
-
3
-
1
-
1
8
Total
155
136
113
87
21
49
27
18
21
32
659


There were a number of outbreaks of coxsackie B4 viruses in 1991, 1993-1994, 1996 and 2000. Coxsackie B5 outbreaks occurred in 1991-1992, 1993 and 1996 (Figure 12).

Top of pageFigure 12. Laboratory reports to LabVISE of coxsackie B4 and B5 viruses, 1991 to 2000, by month of specimen collection

Figure 12. Laboratory reports to LabVISE of coxsackie B4 and B5 viruses, 1991 to 2000, by month of specimen collection

The clinical syndromes associated with coxsackie B viral infection are summarised in Table 25.

Table 25. Clinical syndromes associated with coxsackie B viral infection*

 
Clinical syndrome
Coxsackie   B serotypes
Illnesses associated with many enteroviruses in addition to coxsackie B viruses Aseptic meningitis
Encephalitis
Paralysis
1-6
1-3,5,6
1-6
Illnesses more characteristic of particular groups or serotypes of coxsackie B viruses Exanthem
Pleurodynia
Pericarditis
Myocarditis
Generalised disease of the newborn
1,3,4,5
1-5
1-5
1-5
1-5
Undefined/uncertain etiologic role of coxsackie B viruses Haemolytic uraemic syndrome
Mononucleosis-like syndrome
2,4
5

*Modified from reference 31


Echoviruses

Echoviruses identified in LabVISE reports between 1991 and 2000 are shown in Table 26.

Table 26. Laboratory reports to LabVISE of echovirus, 1991 to 2000, by serotype

Virus
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 Total
Echovirus type 30
1
3
198
247
28
3
1
26
17
121
645
Echovirus type 11
10
13
141
26
4
1
5
50
166
7
423
Echovirus type 9
5
216
22
7
41
4
1
22
32
5
355
Echovirus type 6
9
85
10
107
12
1
1
5
16
1
247
Echovirus type 7
4
39
74
-
2
24
4
-
1
33
181
Echovirus type 17
59
38
4
-
-
-
-
2
-
-
103
Echovirus type 22
19
13
9
9
13
1
1
14
12
8
99
Echovirus type 14
7
15
23
12
35
4
-
1
-
1
98
Echovirus type 3
-
-
-
27
16
-
-
-
5
2
50
Echovirus type 25
2
31
5
1
3
-
-
-
3
-
45
Echovirus type 18
3
3
1
2
2
1
-
15
-
1
28
Echovirus type 4
2
14
-
-
1
1
1
5
1
-
25
Echovirus type 5
3
2
5
1
-
4
4
5
1
-
25
Echovirus type 16
14
9
-
-
-
-
-
-
-
-
23
Echovirus type 1
4
1
-
-
3
-
-
1
-
3
12
Echovirus type 33
1
-
-
-
1
1
1
-
4
4
12
Echovirus type 21
2
4
4
-
-
-
-
-
-
-
10
Echovirus type 31
1
1
-
-
1
-
1
-
1
2
7
Echovirus type 15
1
-
3
-
1
1
-
-
-
-
6
Echovirus type 24
2
1
-
-
3
-
-
-
-
-
6
Echovirus type 19
-
2
1
-
-
-
-
-
1
-
4
Echovirus type 2
-
1
-
-
-
-
1
1
1
-
4
Echovirus type 20
-
3
-
-
-
-
-
-
-
-
3
Echovirus type 23
-
-
-
1
1
-
-
-
-
-
2
Echovirus type 32
2
-
-
-
-
-
-
-
-
-
2
Echovirus type 8
-
2
-
-
-
-
-
-
-
-
2
Echovirus type 34
1
-
-
-
-
-
1
-
-
-
2
Echovirus type 12
-
-
1
-
-
-
-
-
-
-
1
Echovirus type 13
-
-
-
-
1
-
-
-
-
-
1
Echovirus not typed/pending
3
1
1
3
38
3
3
2
3
5
62
Total
155
497
502
443
206
49
25
149
264
193
2,483


The most commonly identified echovirus serotypes during the study period were echovirus types 30, 11 and 9. Diagnoses in which echoviruses were identified were predominantly in cases of meningitis (41%) and were often isolated from cerebrospinal fluid.

Echovirus 30 was the most common echovirus serotype identified in LabVISE during the study period. Echovirus 30 has caused large outbreaks of aseptic meningitis in many regions of the world during the last 40 years. Periods of increased reporting of echovirus 30 were evident in 1993 to 1994 and again in 2000 (Figure 13).

Top of pageFigure 13. Laboratory reports to LabVISE of echovirus 30, 1991 to 2000, by month of specimen collection

Figure 13. Laboratory reports to LabVISE of echovirus 30, 1991 to 2000, by month of specimen collection/p

Periods of increased activity of echovirus 11 associated with aseptic meningitis occurred at intervals of 2-4 years with major peaks in 1993 and 1999. More than half the cases were in children under 5 years (Figure 14).

Figure 14. Laboratory reports to LabVISE of echovirus 11, 1991 to 2000, by month of specimen collection

Figure14. Laboratory reports to LabVISE of echovirus 11, 1991 to 2000, by month of specimen collection

The clinical syndromes associated with infection with echovirus are shown in Table 27.

Top of pageTable 27. Clinical syndromes associated with echoviruses*

 
Clinical syndrome
Associated echovirus serotypes
Illnesses associated with many enteroviruses in addition to echoviruses Aseptic meningitis
Encephalitis
Paralysis
All except 24,26,29,32
2-4,6,7,9,11,14,17-19,25
1-4,6,7,9,11,14,16,18,19,30
Illnesses more characteristic of particular groups or serotypes of echovirus Exanthem
Generalised disease of the newborn
Neonatal diarrhoea
Chronic meningoencephalitis in agammaglobulinemics
9,16 also 1-8,11,14,18,19,25,30,32,33
4,6,7,9,11,12,14,19,21,51
11,14,18
2,3,5,9,11,19,24,25,30,33
Undefined/uncertain etiologic role for echovirus Myositis
Haemolytic uraemic syndrome
Guillan-Barré syndrome
Infectious lymphocytosis
9,11
22
6,22
25

*Modified from reference 31


Polioviruses

Polioviruses are the cause of poliomyelitis, an infection of the central nervous system, which may result in acute flaccid paralysis. Poliovirus infection occurs via the gastrointestinal tract and in more than 90 per cent of cases, causes an inapparent infection.24 Acute flaccid paralysis occurs in less than one per cent of infections. Three serotypes are recognised and immunity is serotype specific.31 The oral polio vaccine, which has been in widespread use in Australia and throughout the world for the last 50 years, is a mixture of the three serotypes. Naturally occurring ('wild type') or live attenuated vaccine polioviruses circulate to a varying extent, depending on the impact of polio vaccine on transmission.31

Oral polio vaccination has placed the global eradication of poliomyelitis within reach. Numerous regions of the world, including the Western Pacific Region (which includes Australia) have been declared polio-free. The last case of poliomyelitis in Australia occurred in 1972 and the Western Pacific Region was declared polio-free in October 2000. However, continued surveillance is required since there is a continuing possibility of importation of cases of poliovirus from endemic areas. Surveillance for poliovirus in Australia comprises reporting of poliomyelitis as a notifiable disease to the NNDSS, surveillance of all cases of acute flaccid paralysis, surveillance of vaccine associated paralytic polio cases, surveillance of enteroviruses and intratypic differentiation of all polioviruses isolated in Australia.

Poliovirus laboratory reports to LabVISE between 1991 and 2000 are shown in Table 28.

Table 28. Laboratory reports to LabVISE of poliovirus, 1991 to 2000, by type

Virus
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 Total
Poliovirus type 1 (uncharacterised)
40
71
43
41
27
15
9
12
26
22
306
Poliovirus type 2 (uncharacterised)
54
45
35
41
29
14
9
25
16
8
276
Poliovirus type 3 (uncharacterised)
26
32
31
14
13
1
4
6
8
8
143
Poliovirus type 1 (vaccine strain)
-
-
-
-
-
1
-
1
-
-
2
Poliovirus type 2 (vaccine strain)
-
-
-
-
-
2
2
-
1
-
5
Poliovirus type 3 (vaccine strain)
-
-
-
-
-
-
-
-
-
1
1
Poliovirus not typed/pending
74
38
12
10
2
2
-
-
1
1
144


Thirty-seven per cent of poliovirus diagnoses were associated with a diagnosis of gastrointestinal disease and 50 per cent of the specimens in which poliovirus was identified were stool samples. No wild-type poliovirus has been isolated from any case of acute flaccid paralysis.32 Continued surveillance of poliovirus will be required until the circulation of wild-type polio can be shown to have ceased. There is concern over the potential for live attenuated virus from the oral polio vaccine persisting in water supplies and possibly reverting toward wild-type neurovirulent phenotypes. This is one reason some countries such as the USA have changed to using an inactivated polio vaccine.33

Top of page

Enteroviruses 71 and enterovirus (not typed)

Since the revision of the classification system of the taxonomic scheme for picornaviruses in 1970, four new serotypes have been discovered. These are enteroviruses 68-71. These 'new' enteroviruses are associated with distinct clinical symptoms and show a defined geographical distribution. In Australia, only enteroviruses 70 and 71 have been reported. Infections with enterovirus 70 occurred in a cluster in New South Wales in 1990, but since then, there have been no more reports of this virus to LabVISE.30

Enterovirus 71, the most recently discovered enterovirus has been recognised as a cause of cutaneous and central nervous system disease since 1969. Enterovirus 71 is the only non-poliovirus enterovirus known to have the potential to cause epidemic paralytic disease.

The relatively large number of untyped enteroviruses may reflect laboratory practices whereby reports to LabVISE are made only on initial identification or after exclusion of polioviruses, and further identification data are not sent.

Report to LabVISE of enterovirus 71 and enterovirus (untyped) are shown in Table 29.

Table 29. Laboratory reports to LabVISE of enterovirus 71 and enterovirus (untyped), 1991 to 2000

Virus
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 Total
Enterovirus type 71
13
15
1
-
34
-
-
9
15
6
93
Enterovirus not typed/pending
673
781
943
1,101
891
742
484
538
753
815
7,721


Enterovirus 71 was first reported in Australia in 1972. A major outbreak of enterovirus 71 occurred in south-east Australia in 1986. Clinical diagnosis during this outbreak was largely skin and mucous membrane disease, meningitis (23%) and respiratory disease (20%).30 An outbreak of hand, foot, and mouth disease caused by an enterovirus was reported in Western Australia in 1999.34 In this outbreak, nine of 14 (64%) children developed neurological disease and four of these had long-term sequelae.

Rhinovirus

Rhinoviruses are a cause of the common cold with a worldwide distribution.35] Rhinoviruses infect humans from early childhood with recurrent infection throughout life. In temperate regions, there are annual seasonal peaks in incidence. Rhinovirus laboratory reports to LabVISE between 1991 and 2000 are shown in Table 30. [Table 30. Laboratory reports to LabVISE of rhinovirus, 1991 to 2000

Virus
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 Total
Rhinovirus (all types)
653
683
868
905
650
662
549
420
501
420
6,311


LabVISE reports of rhinovirus show an annual peak in late winter and early spring (Figure 15).

Figure 15. Laboratory reports to LabVISE of rhinovirus infections, 1991 to 2000, by month of specimen collection

Figure 15. Laboratory reports to LabVISE of rhinovirus infections, 1991 to 2000, by month of specimen collection


This article was published in Communicable Diseases Intelligence Volume 26, No 3, September 2002

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