Enteroviruses

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????????????
??? ?????????????????? ????/????? 2009-03-30
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??13???????????
????

• ??????
• ??????,????????
• ??????????
• ????????????
• ??????,????????-2???
• ????
• EV71????
• ???????
• ????

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??lt??????gt???????
4?18,??CDC?????
???????????????HEV71
????
????
?????
??4?23?
EV71???????????
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?????38??????????

• 2008.05.02

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???????? 1. ?????? 2. ?? 3. ?? 4. ??? 5.???
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2008?????????????
??????????????

• ????489073???,????37.01/100,000
• ????1165? ,??????? 0.24
• ??126?,????0.0095/100,000,???????? 0.26

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??????????

• ????????(Picornaviridae)???,????????,
  ????????????
• ???????RNA??,RNA?????
• ?????( 30 nm), 20???????
• ???VP1-VP4????,VP1-VP3?????,VP4???RNA???
• ????????,???????????
• ?????,???CPE,?????
• ????????????????????????????,???,????

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??????????

• 30nm
• ??????
• ???

Courtesy of Linda M. Stannard, University of Cape
Town, S.A.h
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??????????

• ???????????????????,1909?????????,1949?,?????????
  ????,????????????
• ?????1948??????Coxsackie?,?????????????????,?????
  ?????????????????????????????????????????,???????A
  ??B??
• ????1951???????????????????,???????????????,?????
  ?????????
• ???????,?????????????(6971),??,?????102?

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?????????

• gt ?-????? ?????
• gt ????? ????
• ???
• ?

10
??????????????
?? ?????NPEV? ?????????,??

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????(hand-foot-mouth disease,HFMD)

•  ???????,???????????????
• 1957?????????,???Seddon?1957???????,1958????Robins
  on????????????CoxA16,?????????????,????CoxA16?????
  
• 1959???HFMD??,HFMD???????,?????????
• ???????????????????????EV 71??????????
• ??, ??, ????, ??????????????????
• ?????
• ???1?

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HFMD???

• ???????????????,????
• CoxA5,A10, A16, A19, EV71,???????????
• ?B???, ?CoxA16 ? EV71????
• ???? ?-????? ????? ????? ???? ????
• ?????????,??????????
• HFMD???????,???????,????????, ?
• ??EV71????????, ?????????????
• ?80???90??,????????????
• CoxA16??,2008?,CoxA16 ?EV71 ??????
• ?????, EV71????????????

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????CoxA16

• 1957?????????HFMD,???Seddon?1957???????,1958????Ro
  binson????????????CoxA16,?????????????,????CoxA16?
  ????
• 1959???HFMD??,??????????????????????????????

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????71?(enterovirus 71,EV71)
???RNA???,?????,A?????? 1972?EV71????????,1974?Sch
midt??????????????20?????????????(19691973?)????E
V71? ??,?????????EV71?????? EV71?????HFMD????????
??????????????????,?????????????????????,EV71?????
???????????,??????????????(acute flaccid
paralysis,AFP)????????(non-polio
enterovirus,NPEV),EV71??????3-7??
??EV71?,????12??????????,?????????????35?? ????
?????,??????????
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??EV71??????????????,?????????????????????????,???
?,EV71???HFMD?????,???????????????,????? 1975????
?44??????HFMD 20??90????,EV 71?????????1997??????
?????EV 71?????????,48???2628???,?46???29?????,?
?????1.5?? 1998????????EV 71??????????????????,?6?
?10??????,????129106?,????405?,??78?,???????5?????
?,????????????????????????????????????
16
??????????????
17
????
???????,??????,??????????????? ???????????,??????
??,??????????????? ???????????????,???????????????
??? ?????????????
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??HFMD???

• 1981?,??????????HFMD??
• 1987???????CVA16
• 1995???,?????????????????????????HFMD??????EV71???
  
• 2007?,?????????????,????HFMD??39,606?,??14????????
  ?????EV71???????HFMD?????,??????Echo3 ?/? CVA16?
• 2008?????HFMD????,?HEV71???,CVA16????EV?????

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EV71???????/????????????
??? ???? ????
A ?? 1970
B1 ???????????????????????? 19721987
B2 ??? 19811987
B3 ????????????? 19971999
B4 ???????????????? 19972002
B5 ???? 2003
C1 ????????????????????????? 19862005
C2 ???????????????? 19952002
C3 ????? 1997?2003
C4 ????????????? 19982007
C5 ?? 2005
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????????????-HFMD
(?)???? ??????7???????,??????????????58g/?,??????
???????,4?????(12h?)?????,-20?????????,??????????-
70???? (?)????? ???????????,????????,?????????????
???????????3??,????1.02.0ml??????????????????,4??
???(12h?)?????,-20?????????,??????????-70???? (?)?
??? ?????(??05?)????(??1430?)???????????????IgM?
,?? (??720?)??????35ml??,??????????,???,????,???
??-20???????????
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(?)????? ??????3????????,??????????????,??????????
???????,????????????????35ml???(?????)?????,????
???????,???????,4?????(12h?)?????,-20?????????,???
???????-70???? (?)??? ???????????????,???????????
??????,??????????35ml???(????????)?????,?????????
??,?????????????4?????(12h?)?????,-20?????????,???
???????-70????
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????????????
???? ???? ???? ??? ?? ??
???? ???? ???? ?? ??? ???20? ?????2ml -70C ??
??????? ?? ???(5??) 1ml -70C ??
??????? ?? ???515? 1ml -70C ??
??????? ?? ??3?? 1ml -70C ??
??????? ??? ??? 1ml -70C ??
??????? ?? ??? 1? -70C ??
??????? ??? ???? 1? -70C ??
??(1)???????????????(2)?????,????????????,??????
???????(3)???,????????,????????????????????????,?
??????????????????,??????????????
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????????

• ?????????????????????
• ????????????,??????????
• ????????????,??????????
• ?????????????
• ??????????????????????,
• ?????????,?????
• ????????????????,??????
• ???????,?????
• ???????????????
• ???????,??????????????
• ?,????????2-4?????

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??HFMD????????????

• ????1998-2008?????2007-2008????
• ?????????,???EV71???????,???
• ??HFMD???????????????????????

• 1998????????????,?48.7??????75??
• ????92?????????HEV71?
• 2. 2007??????????????,?8?????,???????????,HEV71??8
  4,CVA16??162008?????????????,???????????,??????
  CVA16??(?62),???????????
• 3. 2008???HEV71????99 ????

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???????????(???EMAIL??)

• ????
• EV71 ? ???????????81.59

• ????
• EV71 ? ???????????96.43

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??????????
????????????????????????????????????????????????
???,?????????????,??????????? ?????????????????,?
???????????????????,????????????????? ???????????
????RD?HEp-2?Vero?,????????????????????????????
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?????????-?????????
????/??
ELISA/HI/PA
????
????
???? ????, ???? ??????
????
????
????
????
????
ELISA
??
????
????
RT-PCR
??????PCR
New molecular tools for epidemiology studies and
diagnosis
????
??PCR
LAMP
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???????????????
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???????

• ??????????????????,???????????????????????????????
  ???????????????,???????????????????,??????????????
  ?
• ????????
• (1)??????????????
• (2)????????????????????
• (3)????????????????????

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??????????????
gt ???? - ?????????? - ?????????? -
?????????? - ?????????? - ?????? -
??????? - ??
gt ???? - ???????? - ???????? - ?????????
- ?????? - ??????????? - ??????? - ??
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???????????????

• ?????????????
• ?????
• ?????????????
• ???????
• ????????????(????)
• ??????HLA?????????????
• ???????????????????B? ?
  
• ECHO?EV71????

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???????????
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????
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? ? ? ?
????
??????
???
???? ????
1
2
3
4
5
6
14
gt28
?
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5,?????????????
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????????????
36
?????

• ????? ????????????????????,?
• ??????????,?????
  71?(EV71)
• ?????? ????????????, ?????
• 5?????
• ?? ???????????????????.? ?
• ???????????
• ?????? ?A??????(Cox A16)?EV71??,?
• 
  B????????????????????
• ??? ? A????????
• ??????(??????? ,Bornholm disease)
• ???B????????

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• ??? - B?????????????,????????????????????????
• ????? ??????????????????
• ?????? ??A???????B??????????????????????????
• ????? ??B????????????????????????????????,??????
  ????,?????,?????????????,????
• ??? ????????????,????????A24(CoxA24)?????
  70?(EV70) (??????)
• ???/??? ?B???????????

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Thank you!