Enterovirus Outbreaks and Emerging Infectious Diseases
This page provides a survey of disease outbreaks and newly emerging infections that have appeared over the last decade or two, specifically focusing on enterovirus outbreaks, and new infectious diseases manifesting symptoms similar to those caused by the virus described on this website. The purpose of this survey is to identify any emerging viruses that may be the same as the virus described on this website.
Out of all the viral outbreaks and newly-discovered viruses detailed on this page, these in particular are worth noting:
• A new genotype V of coxsackievirus B4 was sequenced in China in 2014. Since my lab tests showed I have an active CVB4 infection, perhaps it was this new Chinese strain of CVB4 that I caught.
• A new HIV—like viral disease appeared in China 2009. This Chinese virus produces many symptoms very similar to those produced by the virus described on this website.
• A suspected virulent new strain of coxsackievirus B1 identified by the Centers for Disease Control that killed five babies in the US in 2007.
• The virulent new FY-19 strain of coxsackievirus B3 identified in China in 2008. This coxsackievirus B3 seems to exhibit an unusually rapid incubation period.
• The coxsackievirus B3 outbreak in Greece in 2002, in which three women died from the infection.
Several other new enteroviruses have also been discovered in the last decade or two: enterovirus B75 was found in Spain and circulating in Europe, and is associated with viral (aseptic) meningitis; enterovirus B84 was found in China; enterovirus B93 and enterovirus D94 were found in the Congo and are associated with acute flaccid paralysis; enterovirus C104 was found in Switzerland and is associated with respiratory tract infections, otitis media (ear infection) and possibly brain and central nervous system infection; enterovirus C109 was identified from an outbreak of acute pediatric respiratory illness in Nicaragua, but the symptoms of EV-C109 are not fully known. Thirteen other new enterovirus serotypes (enterovirus B79 to B88, B97, B100 and B101) were also discovered in this last decade or two using molecular identification methods.
Note that enterovirus serotypes from the enterovirus B species are often capable of forming persistent non-cytolytic infections, and thus may in principle be able to cause chronic disease (whereas enterovirus A, C and D species are only capable of causing acute infections, which are rapidly cleared by the immune system within weeks).
There now follows a description of each individual disease outbreak and newly emerging infection, in chronological order.
New Enterovirus B84 – China 2016
A new enterovirus B species virus named enterovirus B84 (EV-B84) was isolated from a patient with acute flaccid paralysis in the Guangdong province of China in 2004. Enterovirus B84 it is not thought to be a prevalent serotype in China or worldwide.
New Coxsackievirus B4 Genotype Circulating in Inner Mongolia – China 2014
This paper notes that CVB4 strains belonging to genotype II, which were once common in Europe and the Americas, seemingly disappeared and gave way to genotype III and IV strains, which appear to be the dominant circulating strains in the world. However, they found that all Chinese CVB4 strains belonged to a newly identified genotype called genotype V. Could this Chinese CVB4 genotype V be the virus I caught?
Enterovirus 68 Outbreak – USA 2014
As of November 2014, 70 children in the US have been partially paralyzed with polio-like symptoms ranging from restricted movement in one limb to severe weakness in both legs and arms. Many of the children tested positive for enterovirus 68 (aka enterovirus D68), which is being considered a possible cause. There have been 11 deaths so far in children who tested positive for D68.
New Enterovirus, Type C105 – Peru and Congo 2012
A new polio-like enterovirus named enterovirus C105 (EV-C105) was discovered in children from Peru and the Congo in 2012. Enterovirus 105 is also suspected of causing paralysis in children across the US.
New Enterovirus, Type C117 – Lithuania 2010
A novel enterovirus, designated EV-C117, was found in a child hospitalized with pneumonia in Vilnius, Lithuania. The researchers note that although it was not possible to say for sure whether this new enterovirus was the cause of the pneumonia, a close relationship has been found between the development of severe lower respiratory tract infections requiring hospitalization, and infections caused by EV-D68, EV-C104 and EV-C109, which are molecularly similar to EV-C117.
Enterovirus D68 Acute Respiratory Illness Clusters – Asia, Europe, USA 2008 to 2010
Several different clusters of respiratory illness and severe disease around the world have been associated with human enterovirus 68 (EV-D68) infection. Enterovirus 68 symptoms include: cough, difficulty breathing,intercostal retractions, wheezing, asthma exacerbation, bronchiolitis (a lower respiratory tract infection) and pneumonia. However, the full spectrum of illness that EV-D68 can cause is unknown. Enteroviruses in general cause symptoms that typically include: mild upper respiratory illness, febrile rash illness, and neurologic illness (such as aseptic meningitis and encephalitis). By contrast, EV-D68 has been associated almost exclusively with respiratory disease. Nevertheless, EV-D68 has occasionally caused central nervous system infection.
Enterovirus 68 shares biological and molecular properties with both enteroviruses and rhinoviruses. The fact that EV-68 has some similarity with rhinoviruses may mean that it exhibits a fast 12 hour incubation period like rhinoviruses do. Enterovirus D68 is classed as an enterovirus D (enterovirus D contains 4 enterovirus serotypes: EV-D68, EV-D70, EV-D94 & EV-D111), and enterovirus D70 is known to have an incubation period of 12 hours.
Enteroviruses are normally acid resistant which enables them to replicate in the digestive tract. However EV-D68, like rhinoviruses, is acid sensitive, which may explain why EV-6D8 has only been found in the respiratory tract, and not the digestive tract. All in all, EV-D68 does not look like it could be the virus described on this website.
Morbidity and Mortality Weekly: Non-Polio Enterovirus and Human Parechovirus Surveillance
The five most common serotypes of enterovirus infections reported in 2006 to 2008 in the United States were: coxsackievirus B1, echovirus 6, echovirus 9, echovirus 18, and coxsackievirus A9. Coxsackievirus B1 was the predominant serotype detected. The report notes that coxsackievirus B1 generally shows an epidemic pattern of circulation, with irregular intervals of increased circulation usually lasting 2-3 years.
New Enterovirus, Type C109 – Nicaragua 2010
A new respiratory enterovirus, named enterovirus 109 (EV-109), was identified from an outbreak of acute pediatric respiratory illness in Managua, Nicaragua in 2007 / 2008. The symptoms of EV-109 virus are not fully known.
Morrissey’s Mystery Throat Virus – 2009
UK singer Morrissey cancelled many performances, and even collapsed on stage, due to the affects of a chronic throat virus. This mystery virus continued to plague him throughout the year. He said: “I’ve endured a titanic struggle against an intolerable virus”.
New Enterovirus, Type C104 – Switzerland 2009
A new respiratory enterovirus, named enterovirus C104 (EV-C104), was found in a 2009 study in Switzerland. The symptoms of this new EV-1C04 virus are not completely known, but include: respiratory tract infections and otitis media (ear infection). It is also thought that EV-C104 may be able to infect the central nervous system. Enterovirus C104 cannot be detected by conventional methods, and EV-C104 does not grow in a viral culture, so it is near impossible to test for in patients.
New HIV/AIDS—Like Disease – China 2009 and Ongoing
There is a nasty new pathogen emerging in China, referred to as the mystery HIV-like disease virus or the fear of AIDS disease virus (though in fact this virus is not HIV-related, as patients with this virus test negative for HIV). This Chinese virus can induce profound mental state changes in certain people, plummeting these people into extreme anxiety disorder, depression and suicidal ideation.
This Chinese virus passes easily to other people via saliva, and often transmits to friends and to whole families, though only a relatively small percentage of people infected display the severe symptoms; many infected people display no overt symptoms.
Reported symptoms of the Chinese “HIV/AIDS-like” disease virus include: flu-like feeling, chronic low-grade fever, upper respiratory tract infections, white tongue coating, ongoing fatigue and weakness, mental and physical fatigue after exertion, dizziness, nausea, headaches, swollen lymph nodes, chest pain, overall soreness of joints, poor sleep, night sweats, poor memory and cognitive dysfunction, problems with gums, gum bleeding, gastrointestinal tract problems, chronic diarrhea, weight loss, hair loss, inappropriate sweating, pinhead sized red spots underneath the skin, purpura skin rash, difficulties in standing and breathing, persistent paresthesias. Mood problems include: extreme anxiety, depression, suicidal ideation, and irritability.
A great web site that lists the symptoms of the Chinese “HIV/AIDS-like” virus in more detail, and provides a lot of information on the Chinese virus, is this one: New HIV/AIDS-Like Virus China and this one: New HIV-Like Virus in China.
The mental and physical symptoms of the Chinese “HIV/AIDS-like” disease virus are quite similar to those of the virus described on this site; that is to say, they might be the same virus.
However, there are some difference in symptoms: a lot of people in China experience severe chronic chest pain when they contract the Chinese “HIV/AIDS-like” virus — intense constant chest pain that lasts for months or years. This chronic chest pain is absent in people who caught the virus described on this website, so the symptoms of my virus and the Chinese “HIV/AIDS-like” virus are slightly different in this respect. Also, systemic rash and skin peeling symptoms (on palms of hands and soles of feet, and sometimes the whole legs) appear to be common in this Chinese “HIV/AIDS-like” disease, but these symptoms are not usually caused by my virus. The Chinese “HIV/AIDS-like” virus also often causes: the skin to become stiff and lose its elasticity (with reports that indentations in the skin made by finger pressure take a long time to disappear, due to this stiffness); the gums to bleed; the joints to make cracking or popping sounds when moved (crepitus); the muscles to constantly twitch. None of these symptoms are present in people that caught the virus described on this website.
Published studies on this Chinese “HIV/AIDS-like” virus:
Some newspaper and media articles about this Chinese “HIV/AIDS-like” virus:
Mystery Virus Outbreak – Uttar Pradesh, India 2009
Viral encephalitis outbreak In Uttar Pradesh, India: enterovirus suspected.
Recombinant Enterovirus A71 Outbreak – Fuyang, Anhui Province, China 2008
An enterovirus A71 outbreak in Fuyang, China killed 22 children and hospitalized hundreds of others. Enterovirus A71 can cause hand, foot and mouth disease (HFMD), which has the symptoms of: fever, blisters and ulcers in the mouth, or rashes on the hands and feet, and can result in brain, heart and lung damage. Some studies indicated that the virus responsible for the Fuyang outbreak was an emerging recombination of enterovirus A71 and coxsackievirus A16.
Note that enterovirus A71 is very rare in the United States, Canada and Europe; it is usually found in hotter, tropical countries.
Coxsackievirus B3 Aseptic Meningitis Outbreak – Shandong Province, China 2008
In the summer of 2008, an aseptic meningitis outbreak occurred in southern Shandong Province, China, caused by coxsackievirus B3. The most common clinical symptoms were fever, vomiting, headache, lethargy, and rash. No sequelae or deaths were reported. It was found that the Shandong strains of coxsackievirus B3 had around 80% similarity with the common Nancy strain of coxsackievirus B3.
Virulent New FY-19 Strain of Coxsackievirus B3 – Fuyang, Anhui Province, China 2008
A study in China found a new strain of coxsackievirus B3 virus in a patient with severe HFMD clinical symptoms from Fuyang, China in 2008. This novel strain has been named the FY-19 strain of coxsackievirus B3. This new FY-19 strain has different genetic and biological characteristics to the more common Nancy strain of coxsackievirus B3. It also caused fatal pathology in suckling mice.
The study found that: “viral replication kinetic analysis suggested that the FY-19 proliferation increased rapidly and peaked at 14 hours post-infection“. If I understood correctly, this means as soon as this virus gets into the body, it replicates fast, reaching a peak after just 14 hours.
Echovirus 6 Outbreak – Montenegro 2008
An echovirus 6 outbreak in Montenegro caused meningitis / acute neurological syndrome in 125 people, mostly children. All patients were hospitalized. Interestingly, echovirus 6 has been shown to be able to create a long term, steady-state infection in the body (it can become a noncytopathic / noncytolytic virus, as more recently described by Dr Nora Chapman, et al). So this echovirus 6 serotype is a possible candidate for our chronic enterovirus infection.
Onychomadesis Outbreak – Valencia, Spain 2008
In Valencia, Spain, an outbreak of onychomadesis (loss of fingernails due to illness) occurred in patients after they contracted hand, foot, and mouth disease (HFMD). Onychomadesis is rare, and does not normally occur in HFMD, so this phenomenon was a bit of a mystery. However, after investigation it was proposed that a combination of an regular enterovirus that causes HFMD, plus a pre-existing chronic coxsackievirus B1 infection in these patients, may have caused the onychomadesis arising after HFMD. HFMD followed by onychomadesis was also reported in Finland in 2008. The phenomenon of HFMD followed by onychomadesis was first reported in 2000 in 5 children in Chicago, Illinois, USA.
One may speculate that this coxsackievirus B1 that plays a pivotal role in precipitating onychomadesis may be the same virulent coxsackievirus B1 that killed five babies the US in 2007.
Mutated Coxsackievirus B1 Virus — USA 2007
The Centers for Disease Control have stated that there may be a new more virulent strain of coxsackievirus B1 (CVB1) in circulation, as there has been a large increase in coxsackievirus B1 infections reported in the United States, and these coxsackievirus B1 infections have sometimes caused severe neonatal disease, as well as five baby deaths, just in 2007 (bear in mind that coxsackievirus B1 infection is normally not fatal).
In the years up to 2005, coxsackievirus B1 accounted for only 2.3% of all enteroviruses reported in the United States, but then from 2007, coxsackievirus B1 became the most commonly reported serotype, accounting for 25% of all reported enterovirus infections with known serotypes. This, the CDC suggest, is evidence for an emerging new coxsackievirus B1 strain.
The true extent of the illnesses and fatalities caused by this new strain of coxsackievirus B1 is likely to be much greater than the figures provided, since (1) nonpolio enterovirus infections are not nationally reportable, (2) diagnostic testing for enteroviruses often is not pursued in clinical settings, and (3) serotype identification from enterovirus-positive specimens is not performed routinely.
Two New Enteroviruses, Type B93 and D94 – Congo 2007
Two new respiratory enteroviruses, named enterovirus 93 and enterovirus 94, were found in a 2007 study. These newly-discovered viruses are associated with acute flaccid paralysis. Neutralizing antibodies against enterovirus 94 were found in a surprisingly large number of individuals, indicating that EV-94 is not a new virus.
13 New Enteroviruses, B79 to B88, B97, B100 and B101 – Various Countries 2007
Thirteen new enteroviruses, named B79 to B88, B97, B100 and B101, were isolated from patients in various countries (USA, Oman, Bangladesh and Cote d’Ivoire) from 1979 to 2003, and were sequenced in a 2007 study. These serotypes were all found to belong to the enterovirus B species.
Enterovirus – Latvia 2006
Enterovirus aseptic meningitis in Latvia:
Mystery Virus Outbreak – Uttar Pradesh, India 2006
Viral encephalitis outbreak In Uttar Pradesh, India, was an enterovirus:
Outbreak of coxsackievirus A9 Aseptic Meningitis – Gansu, China 2005
Coxsackievirus A9 (CVA9) can cause aseptic meningitis, paralysis, exanthema, pneumonitis of infants, and hepatitis. Interestingly, coxsackievirus A9 is linked to chronic myopathy and chronic polymyositis. Polymyositis symptoms include a marked weakness and/or loss of muscle mass in the proximal musculature, particularly in the shoulders and pelvic girdle. Given that weak pelvic girdle symptoms are caused by the virus described on this website, this might make coxsackievirus A9 a possible candidate.
New Enterovirus, Type B75 – Spain 2005
A new enterovirus, named enterovirus 75 (EV-B75), was found in Spain and circulating in Europe, is associated with viral (aseptic) meningitis:
Fatal Coxsackievirus B3 Virus Outbreak – Crete, Greece 2002
Three women died in an outbreak of coxsackievirus B3 that occurred in Crete, Greece in 2002. The fatalities were associated with myocarditis and/or pericarditis, and the symptoms in these three people included upper respiratory tract infection, myalgia, arthralgia, tachycardia, chest pain. Laboratory tests showed high concentrations of creatine phosphokinase-MB (a sensitive indicator for acute myocardial infarction) and lactate dehydrogenase.
Enterovirus – Gran Canaria, Spain 2000
Enterovirus aseptic meningitis outbreak in Spain:
Enterovirus – Denmark 2000
Enterovirus aseptic meningitis outbreak in Denmark:
Echovirus 4 Variant – Israel and Palestinian Authority Areas 1997
A large outbreak of aseptic meningitis:
Mystery Virus Outbreak – Sarawak, Malaysia 1997
In Sarawak 1997, dozens of otherwise healthy children died as a result of a mystery virus outbreak, which killed via fatal viral encephalitis and cardiac failure. It appears that this outbreak may have been due to the normally non-fatal enterovirus 71 acting in tandem with another unidentified mystery virus. (Note: the media called it a “coxsackievirus outbreak”, but this is incorrect: no coxsackievirus has been found in connection with this Sarawak outbreak).
Epidemic of Peripheral and Optic Neuropathy – Cuba, 1991 to 1993
More than 50,000 people in Cuba developed clinical manifestations of optic and peripheral neuropathy from 1991 to 1993. This epidemic of neuropathy was triggered by a virus that was later found to have similarity to coxsackievirus A9 and coxsackievirus B4. It was found that the risk of developing this neuropathy disease was reduced in individuals with higher serum levels of the following nutrients: lycopene, which was most strongly associated with a reduced risk of disease, and to a lesser extent, higher serum levels of alpha-carotene, beta-carotene and selenium. The risk was also reduced in individuals whose diets contained higher levels methionine, animal protein, animal fat, and B-complex vitamins (notably vitamin B12, riboflavin, niacin and pyridoxine).
Other Newly Discovered Viruses
In the last few decades, many hitherto unknown human viruses have been discovered. These include:
human metapneumovirus virus — discovered 2001, causes upper and lower respiratory tract infection, and occasionally severe pneumonia.
mimivirus — discovered 1992, may cause some forms of pneumonia.
Ebolavirus genus :
Bundibugyo virus — discovered 2008, one of four ebolaviruses that causes Ebola virus disease in humans.
parvovirus 4 — discovered 2005, might cause influenza-like syndrome, encephalitis, and fetal hydrops.
human bocavirus 1 — discovered 2005, linked to lower respiratory tract infections and gastroenteritis.
human bocavirus 2 — discovered 2009, linked to respiratory tract infections and possibly gastroenteritis.
bufavirus — discovered 2012, found in the feces of patients with gastroenteritis.
WU virus — discovered 2007, found in respiratory secretions, may be pathogenic in the immunocompromised
KI virus — discovered 2007, found in respiratory secretions, may be pathogenic in the immunocompromised
MW polyomavirus — discovered 2012, found in the stool
human polyomavirus 7 — discovered 2010, found in skin of healthy adults
human polyomavirus 8 — discovered 2010, found in skin of healthy adults
human polyomavirus 8 — discovered 2010, associated with trichodysplasia spinulosa, a rare skin disease
human polyomavirus 9 — discovered 2011, found in skin of healthy adults
human polyomavirus 11 — discovered 2013, found in the stool
human polyomavirus 12 — discovered 2013, found in skin of healthy adults
human polyomavirus 13 — discovered 2014, might have an affinity for vascular endothelial cells
merkel cell polyomavirus — discovered 2008, suspected to cause the skin cancer Merkel cell carcinoma
torque teno virus — discovered 1997, found in 10% of blood donors, might be linked to liver disorders.
melaka virus — discovered 2006, causes respiratory tract infection.
Liao ning virus — discovered 2006, might cause encephalitis.
menangle virus — discovered 1997, inhibits interferon signaling, causes a flu-like illness in humans.
Hendra virus — discovered 1995, causes severe and often fatal disease in humans.
Nipah virus — discovered 1999, in humans may be asymptomatic, or cause acute respiratory syndrome and fatal encephalitis.
Andes virus — discovered 1996, causes hantavirus cardiopulmonary syndrome, which is often fatal.
Laguna Negra virus — discovered 1997, causes hantavirus cardiopulmonary syndrome, which is often fatal.
Australian bat lyssavirus — discovered 1996, causes a fatal rabies-like illness in humans.
SARS coronavirus — discovered 2003, causes severe acute respiratory syndrome (SARS).
human coronavirus NL63 — discovered 2004, might cause upper respiratory tract infections, severe lower respiratory tract infection, croup and bronchiolitis.
human coronavirus HKU1 — discovered 2005, causes respiratory tract infection.
titi-monkey adenovirus — discovered 2009, causes respiratory illness in humans.
Enterovirus genus of the Picornaviridae family:
enterovirus B75 — discovered 2005, associated with viral (aseptic) meningitis.
enterovirus B79 to B88, B97, B100 and B101 — discovered in a single study in 2007.
enterovirus B84 — discovered 2004, associated with acute flaccid paralysis.
enterovirus B93 — discovered 2007, associated with acute flaccid paralysis.
enterovirus D94 — discovered 2007, associated with acute flaccid paralysis.
enterovirus C104 — discovered 2009, causes respiratory tract infections, otitis media, and may be able to infect the central nervous system.
enterovirus C105 — discovered 2012, a polio-like virus linked to paralysis in children.
enterovirus C109 — discovered 2010, isolated from outbreak of acute pediatric respiratory illness.
enterovirus C117 — discovered 2010, might cause lower respiratory tract infection.
Parechovirus genus of the Picornaviridae family:
Ljungan virus — discovered mid-1990s, associated with malformations, intrauterine fetal death, and sudden infant death in humans, possibly linked to diabetes, neurological and other illnesses in humans.
Cardiovirus genus of the Picornaviridae family:
Saffold virus 1 to 9 — discovered 2007, found in 90% of humans, may cause severe infections of the central nervous system, might catalyze serious diseases.
Kobuvirus genus of the Picornaviridae family:
aichivirus A — discovered 1989, causes acute gastroenteritis.
Cosavirus genus of the Picornaviridae family:
cosavirus A to D —discovered 2008, linked to acute flaccid paralysis and diarrhea.
Salivirus genus of the Picornaviridae family:
Salivirus — discovered 2009, linked to gastroenteritis.
Senecavirus genus of the Picornaviridae family:
Senecavirus A — discovered 2009, no known symptoms in human infection, potently oncolytic, so the virus is being developed as an anti-cancer therapy.
human hepegivirus 1 — discovered 2015?, similar to hepatitis C virus.
cyclovirus-Vietnam — discovered 2013, a human cyclovirus that infects the central nervous system.
Lujo virus — discovered 2009 after outbreak of viral hemorrhagic fever, human infection usually fatal.
Chapare virus — discovered 2008, causes Chapare hemorrhagic fever.
astrovirus VA1 — discovered 2009, causes acute gastroenteritis, encephalitis.
The clinical signs, symptoms and pathogenesis for many of these viruses are not fully known at this stage.
Notes on These Newly Discovered Viruses
Viruses from the Cardiovirus genus cause serious disease, mainly in rodents, including diabetes, myocarditis, encephalomyelitis, and multiple sclerosis-like disseminated encephalomyelitis. Saffold virus is a particular Cardiovirus that can infect humans. Currently 9 Saffold virus types have been discovered (SAFV-1 to 9). Studies on SAFV-3 show that it is a very common virus, found in more than 90% of older children and adults.
Melaka virus symptoms are very similar to that of flu infections: fever, cough and sore throat. Torque teno virus is ubiquitous: found in more than 90% of adults worldwide, but human pathogenicity has not yet been established. Human metapneumovirus is ubiquitous: there is almost 100% seropositivity for hMPV antibodies in adults. Aichivirus A is found in 80 to 99% of the population.
The virus described on this website has low prevalence in the general population (see here for how this is known). Thus newly discovered viruses like SAFV-3, TT virus and hMPV, which are very prevalent, cannot possibly be candidates for the virus described on this website.