Epidemiology

David M. Morens; Mark A. Pallansch

doi:10.1128/9781555818326.ch1

Chapter 1 : Epidemiology

Authors: David M. Morens¹, Mark A. Pallansch²

VIEW AFFILIATIONS HIDE AFFILIATIONS

Affiliations: 1: Epidemiology Section, School of Public Health, and Department of Tropical Medicine, School of Medicine, University of Hawaii, Biomed D103,1960 East-West Road, Honolulu, Hawaii 96822; 2: Enterovirus Section, Respiratory and Enteric Viruses Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Adanta, Georgia 30333

Content Type: Monograph

Publication Year: 1995

Category: Clinical Microbiology; Viruses and Viral Pathogenesis

Book DOI: 10.1128/9781555818326

Chapter DOI: 10.1128/9781555818326.ch1

MyBook is a cheap paperback edition of the original book and will be sold at uniform, low price.

Preview this chapter:

Epidemiology, Page 1 of 2

< Previous page | Next page > /docserver/preview/fulltext/10.1128/9781555818326/9781555810924_Chap01-1.gif /docserver/preview/fulltext/10.1128/9781555818326/9781555810924_Chap01-2.gif

Abstract:

Salient organizing principles for understanding the epidemiology of enterovirus infection and disease include evolutionary and adaptational strategies, the interaction of the virus with its human host and the environment, and characteristic modes of transmission. The epidemiology of a particular agent, or of a disease associated with a particular agent, reflects not only the properties of the agent, host, and environment but also the mode of transmission. The spectrum of enteroviral infection and disease can be better understood and categorized according to epidemiologic features that include modes of transmission as well as evolutionary-adaptational aspects of the relationships between the viral agents, their human hosts, and the environment. The chapter provides a discussion on molecular epidemiology that focuses on three of the most useful techniques: partial genome sequencing, analysis of RNA genome relationships by screening oligonucleotide mapping of the entire genome, and analysis of viral epitope distribution by use of monoclonal antibodies. In recent years, molecular techniques have been increasingly used to study the epidemiology of other polioviruses. The technique of oligonucleotide mapping produces characteristic patterns for given strains of viruses that have been referred to as "fingerprints." Fingerprint studies of wild and vaccine polioviruses have revealed many fascinating aspects of poliovirus molecular epidemiology. Molecular epidemiology promises new insights into the origin, evolution, and prevention of human enteroviruses.

Citation: Morens D, Pallansch M. 1995. Epidemiology, p 3-23. In Rotbart H (ed), Human Enterovirus Infections. ASM Press, Washington, DC. doi: 10.1128/9781555818326.ch1

Highlighted Text: Show | Hide

Full text loading...

References

/content/book/10.1128/9781555818326.chap1

1. Acharya, D.,, and B. K. Chakladar. 1989. The epidemiological study of paralytic poliomyelitis cases in Kasturba Hospital, Manipal. J. Commun. Dis. 21: 183– 189.

2. Aleraj, B.,, V. Kruzic,, and B. Borcic. 1990. [Epidemiology of enteroviral meningitis in Croatia 1958-1988 with special emphasis on the great epidemic of 1988.] Lijec-Vjesn 112: 305– 309.

3. Alexander, J. P.,, L. E. Chapman,, M. A. Pallansch,, W. T. Stephenson,, T. J. Torok,, and L. J. Anderson. 1993. Coxsackievirus B2 infection and aseptic meningitis: a focal outbreak among members of a high school football team. J. Infect. Dis. 167: 1201– 1205.

4. Andrus, J. K.,, C. A. de Quadros,, and J. M. Olive. 1992. The surveillance challenge: final stages of eradication of poliomyelitis in the Americas. Morbid. Mortal. Weekly Rep. 41: 21– 26.

5. Artenstein, M. S.,, E. C. Cadigan,, and E. L. Beuscher. 1964. Epidemic coxsackie virus infection with mixed clinical manifestations. Ann. Intern. Med. 60: 196– 203.

6. Assaad, F.,, R. Gispen,, M. Kleemola,, L. Syrucek,, and K. Esteves. 1980. Neurological diseases associated with viral and Mycoplasma pneumoniae infections. Bull. W.H.O. 58: 297– 311.

7. Brandful, J. A. M.,, N. Takeda,, T. Yoshii, et al. 1991. A study of the evolution of coxsackievirus A24 variant in Ghana by viral RNA fingerprinting analysis. Res. Virol. 142: 57– 65.

8. Brown, E. H. 1972. Enterovirus infections. Br. Med. J. 2: 169– 171.

9. Center for Disease Control. 1978. Poliomyelitis—Netherlands. Morbid. Mortal. Weekly Rep. 27: 222.

10. Center for Disease Control. 1979. Poliomyelitis—Pennsylvania, Maryland. Morbid. Mortal. Weekly Rep. 28: 49– 50.

11. Centers for Disease Control. 1981. Poliomyelitis Surveillance Summary 1919. U.S. Department of Health and Human Services, Atlanta.

12. Centers for Disease Control and Prevention. 1993. Isolation of wild poliovirus type 3 among members of a religious community objecting to vaccination—Alberta, Canada, 1993. Morbid. Mortal. Weekly Rep. 42: 337– 339.

13. Centers for Disease Control and Prevention. 1993. Progress toward global eradication of poliomyelitis, 1988-1991. Morbid. Mortal. Weekly Rep. 42: 486– 487, 493– 495.

14. Clark, C. S.,, A. B. Bjornson,, G. M. Schiflf, et al. 1977. Sewage worker's syndrome. Lancet i: 1009.

15. Clemmer, D. I.,, F. Li,, D. R. Le Blanc,, and J. P. Fox. 1966. An outbreak of subclinical infection with coxsackievirus B3 in southern Louisiana. Am. J. Epidemiol. 83: 123– 129.

16. Cooney, M. L.,, C. E. Hall,, and J. P. Fox. 1972. The Seatde Virus Watch. III. Evaluation of isolation methods and summary of infections detected by virus isolation. Am. J. Epidemiol. 96: 286– 305.

17. Crainic, R.,, P. Couillin,, B. Blondel, et al. 1983. Natural variation of poliovirus neutralization epitopes. Infect. Immun. 41: 1217– 1225.

18. D'Alessio, D. J.,, T. E. Minor,, C. I. Allen,, A. A. Tsiatis,, and D. B. Nelson. 1981. A study of the proportions of swimmers among well controls and children with enterovirus-like illness shedding or not shedding an enterovirus. Am. J. Epidemiol. 113: 533– 541.

19. Denis, F. A. 1973. Coxsackie group A in oysters and mussels. Lancet i: 1262.

20. Drulak, M.,, A. M. Wallbank,, I. Lebtag,, L. Werboski,, and L. PofFenroth. 1978. The relative effectiveness of commonly used disinfectants in inactivation of coxsackievirus B5. J. Hyg. Camb. 81: 389– 397.

21. Favero, M. S., 1980. Sterilization, disinfection, and antisepsis in the hospital, p. 952– 959. In E. H. Lennette,, A. Balows,, W. J. Hausler, Jr.,, and J. P. Truant (ed.), Manual of Clinical Microbiology, 3rd ed. American Society for Microbiology, Washington, D.C.

22. Feachem, R.,, H. Garelick,, and J. Slade. 1981. Enteroviruses in the environment. Trop. Dis. Bull. 78: 185– 230.

23. Ferguson, M.,, D. I. Magrath,, P. D. Minor,, and G.T. Schild. 1986. WHO collaborative study on the use of monoclonal antibodies for the intratypic differentiation of poliovirus strains. Bull. W.H.O. 64: 239– 246.

24. Gelfand, H. M.,, A. H. Holguin,, G. E. Marchetti,, and P. M. Feorino. 1963. A continuing surveillance of enterovirus infections in healthy children in six United States cities. I. Viruses isolated during 1960 and 1961. Am. J. Hyg. 78: 358– 375.

25. Gelfand, H. M.,, D. R. LeBlanc,, J. P. Fox,, and D. P. Conwell. 1957. Studies on the development of natural immunity to poliomyelitis in Louisiana. II. Description and analysis of episodes of infection observed in study group households. Am. J. Hyg. 65: 367– 385.

26. Glikmann, G.,, M. Moynihan,, I. Petersen,, and B. F. Vestergaard. 1983. Intratypic dif ferentiation of poliovirus strains by enzyme- linked immunosorbent assay (ELISA): poliovi rus type 1. Dev. Biol. Stand. 55: 199– 208.

27. Glikmann, G.,, M. Pedersen,, and I. Petersen. 1987. Intratypic differentiation of poliovirus strains by enzyme-linked immunosorbent assay (ELISA): poliovirus type 2 and poliovirus type 3. J. Virol. Methods 18: 25– 36.

28. Goyal, S. M.,, C. P. Gerba,, and J. L. Melnick. 1979. Human enteroviruses in oysters and their overlying waters. Appl. Environ. Microbiol. 37: 572– 581.

29. Guo, R.,, E. H. Tang,, H. Wang, et al. 1987. Preliminary studies on antigenic variation of poliovirus using neutralizing monoclonal antibodies. J. Gen. Virol. 68: 989– 994.

30. Hawley, H. B.,, D. P. Morin,, M. E. Geraghty,, J. Tomkow,, and A. Phillips. 1973. Coxsackievirus B epidemic at a boy's summer camp. Isolation of virus from swimming water. JAMA 226: 33– 36.

31. Helfand, R. F.,, A. S. Khan,, M. A. Pallansch,, J. P. Alexander,, H. B. Meyers,, R. A. DeSantis,, L. S. Schonberger,, and L. J. Anderson. 1994. Echovirus 30 infection and aseptic meningitis in parents of children attending a day care center. J. Infect. Dis. 169: 1133– 1138.

32. Hilton, D. A.,, S. Variend,, and J. H. Pringle. 1993. Demonstration of coxsackie virus RNA in formalin-fixed tissue sections from childhood myocarditis cases by in situ hybridization and the polymerase chain reaction. J. Pathol. 170: 45– 51.

33. Honig, E. I.,, J. L. Melnick,, P. Isacson, et al. 1956. An endemiological study of enteric virus infections. Poliomyelitis, Coxsackie, and orphan (ECHO) viruses isolated from normal children in 2 socio-economic groups. J. Exp. Med. 103: 247– 262.

34. Horstmann, D. M. 1955. Poliomyelitis: severity and type of disease in different age groups. Ann. N.Y.Acad. Sci. 61: 956– 967.

35. Horstmann, D. M. 1967. Enterovirus infection of the central nervous system. The present and future of poliomyelitis. Med. Clin. N. Am. 61: 681– 693.

36. Horstmann, D. M.,, J. Emmons,, L. Gimpel,, T. Subrahmanyan,, and J. T. Riordan. 1973. Enterovirus surveillance following a community-wide oral poliovirus vaccination program: a 7-year study. Am. J. Epidemiol. 97: 173– 186.

37. Hovi, T. 1989. The outbreak of poliomyelitis in Finland in 1984-1985: significance of antigenic variation of type 3 polioviruses and site specificity of antibody responses in antipolio immunization. Adv. Virus. Res. 37: 243– 275.

38. Hovi, T.,, K. Cantell,, A. Huovilainen,, E. Kinnunen, et al. 1986. Outbreak of paralytic poliomyelitis in Finland: widespread circulation of antigenically altered poliovirus type 3 in a vaccinated population. Lancet i: 1427– 1432.

39. Howe, H. A., 1953. Poliomyelitis, p. 300– 337. In T. M. Rivers, (ed.), Viral and Rickettsial Infections of Man. J. B. Lippincott, Philadelphia.

40. Hughes, M. S.,, E. M. Hoey,, and P. V. Coyle. 1993. A nucleotide sequence comparison of coxsackievirus B4 isolates from aquatic samples and clinical specimens. Epidemiol. Infect. 110: 389– 398.

41. Hughes, P. J.,, D. M. A. Evans,, P. D. Minor, et al. 1986. The nucleotide sequence of a type 3 poliovirus isolated during a recent outbreak of poliomyelitis in Finland. J. Gen. Virol. 67: 2093– 2102.

42. Hull, H. F.,, and N. A. Ward. 1992. Progress towards the global eradication of poliomyelitis. World Health Stat. Q. 45: 280– 284.

43. Huovilainen, A.,, T. Hovi,, L. Kinnunen, et al. 1987. Evolution of poliovirus during an outbreak: sequential type 3 poliovirus isolates from several persons show shifts of neutralization determinants. J. Gen. Virol. 68: 1373– 1378.

44. Huovilainen, A.,, L. Kinnunen,, M. Ferguson,, and T. Hovi. 1988. Antigenic variation among 173 strains of type 3 poliovirus isolated in Finland during the 1984 to 1985 outbreak. J. Gen. Virol. 69: 1941– 1948.

45. Irvine, D. H.,, A. B. H. Irvine,, and P. S. Gardner. 1967. Outbreak of ECHO virus type 30 in a general practice. Br. Med. J. 4: 774– 776.

46. Ishiko, H.,, N. Takeda,, K. Miyamura, et al. 1992. Phylogenetically different strains of a variant of coxsackievirus A24 were repeatedly introduced but discontinued circulating in Japan. Arch. Virol. 126: 179– 193.

47. Ishiko, H.,, N. Takeda,, K. Miyamura, et al. 1992. Phylogenetic analysis of a coxsackievirus A24 variant: the most recent worldwide pandemic was caused by progenies of a virus prevalent around 1981. Virology 187: 748– 759.

48. Jarzabek, Z.,, J. Zabicka,, A. John, et al. 1992. Application of monoclonal antibody panels in the virological and epidemiological review of poliomyelitis in Poland, 1981-1990. Bull. W.H.O. 70: 327– 333.

49. Jenista, J. A.,, K. R. Powell,, and M. A. Menegus. 1984. Epidemiology of neonatal enterovirus infection. J. Pediatr. 104: 685– 690.

50. Johnston, S. L.,, G. Sanderson,, P. K. Pattemore, et al. 1993. Use of polymerase chain reaction for diagnosis of picornavirus infection in subjects with and without respiratory symptoms. J. Clin. Microbiol. 31: 111– 117.

51. Keeling, P. J.,, S. Jeffrey,, A. L. Caforio, et al. 1992. Similar prevalence of enteroviral genome within the myocardium from patients with idiopathic dilated cardiomyopathy and controls by the polymerase chain reaction. Br. Heart J. 68: 554– 559.

52. Kelen, A. E.,, and N. A. Labzoffsky. 1967. Variations in the prevalence of enterovirus infections in Ontario, 1956-1965. Can. Med. Assoc. J. 97: 797– 801.

53. Kew, O.,, L. De,, C. -E Yang,, B. Nottay,, E. da Silva,, and M. Pallansch,. 1993. The role of virological surveillance in the global initiative to eradicate poliomyelitis, p. 215– 246. In E. Kurstak (ed.), Control of Virus Diseases. Marcel Dekker, Inc., New York.

54. Kew, O. M.,, and B. K. Nottay. 1984. Molecular epidemiology of polioviruses. Rev. Infect. Dis. 6( Suppl. 2): S499– S504.

55. Kew, O. M.,, B. K. Nottay,, M. H. Hatch,, J. H. Nakano,, and J. F. Obijeski. 1981. Multiple genetic changes can occur in the oral poliovaccines upon replication in humans. J. Gen. Virol. 56: 337– 347.

56. Kew, O. M.,, B. K. Nottay,, M. H. Hatch,, J. C. Hierholzer,, and J. F. Obijeski. 1983. Oligonucleotide fingerprint analysis of enterovirus 70 isolates from the 1980 to 1981 pandemic of acute hemorrhagic conjunctivitis: evidence for a close genetic relationship among Asian and American strains. Infect. Immun. 41: 631– 635.

57. Kew, O. M.,, B. K. Nottay,, R. Rico-Hesse,, and M. A. Pallansch,. 1990. Molecular epidemiology of wild poliovirus transmission, p. 199– 221. In E. Kurstak,, R. G. Marusyk,, F. A. Murphy,, and M. H.V. van Regenmortel (ed.), Applied Virology Research, vol. 2. Plenum Publishing, New York.

58. Kew, O. M.,, M. A. Pallansch,, B. K. Nottay,, R. Rico-Hesse,, L. De,, and C.-F. Yang,. 1990. Genotypic relationships among wild polioviruses from different regions of the world, p. 357– 365. In M. A. Brinton, and F. X. Heinz (ed.), New Aspects of Positive-Strand RNA Viruses. American Society for Microbiology, Washington, D.C.

59. Khajura, R.,, N. Datta,, R. Kumar,, T. Kaur,, M. K. Kaushal,, S. Singhi,, and V. Kumar. 1989. Impact of annual immunization programme with oral polio vaccine on the prevalence of paralytic poliomyelitis. Indian J. Pediatr. 56: 343– 347.

60. Khatib, R.,, J. L. Chason,, B. K. Silberberg,, and A. M. Lerner. 1980. Age-dependent pathogenicity of group B coxsackieviruses in Swiss-Webster mice: infectivity for myocardium and pancreas. J. Infect.Dis. 141: 394– 403.

61. Kinnunen, L.,, A. Huovilainen,, T. Poyry,, and T. Hovi. 1990. Rapid molecular evolution of wild type 3 poliovirus during infection in individual hosts. J. Gen. Virol. 71: 317– 324.

62. Kinnunen, L.,, T. Poyry,, and T. Hovi. 1991. Generation of virus genetic lineages during an outbreak of poliomyelitis. J. Gen. Virol. 72: 2483– 2489.

63. Kogon, A.,, I. Spigland,, T. E. Frothingham, et al. 1969. The Virus Watch program: a continuing surveillance of viral infections in metropolitan New York families.VII. Observations on viral excretion, seroimmunity, intrafamilial spread and illness association in coxsackie and echovirus infections. Am. J. Epidemiol. 89: 51– 61.

64. Kono, R. 1975. Apollo 11 disease or acute hemorrhagic conjunctivitis: a pandemic of a new enterovirus infection of the eyes. Am. J. Epidemiol. 101: 383– 390.

65. Kunin, C. M. 1962. Virus-tissue union and the pathogenesis of enterovirus infections, J. Immunol. 8: 556– 569.

66. Kutitova, O. K.,, G. I. Lipskaia,, and S. V. Maslova. 1990. [The molecular epidemiology of poliomyelitis: the characteristics of the strains isolated from patients in Moscow in 1973-1986.] Zh. Mikrobiol. Epidemiol. Immunobiol. 1990: 43– 49.

67. Lehan, P. H.,, E. W. Chick,, I. L. Doto, et al. 1957. An epidemic illness associated with a recently recognized enteric virus (Echo virus type 4). I. Epidemiologic and clinical features. Am. J. Hyg. 66: 63– 75.

68. Lerner, A. M.,, J. O. Klein,, J. D. Cherry,, and M. Finland. 1963. New viral exanthems. N. Engl. J. Med. 269: 678– 685.

69. Lin, K. H.,, N. Takeda,, K. Miyamura,, S. Yamazaki,, and C. W. Chen. 1991. The nucleotide sequence of 3C proteinase region of the coxsackievirus A24 variant: comparison of the isolates in Taiwan in 1985-1988. Virus Genes 5: 121– 131.

70. Lin, K. H.,, H. L. Wang,, M. M. Sheu, et al. 1993. Molecular epidemiology of a variant of coxsackievirus A24 in Taiwan: two epidemics caused by phylogenetically distinct viruses from 1985 to 1989. J. Clin. Microbiol. 31: 1160– 1166.

71. Loria, R. M.,, N. Shadoff,, S., Kibrick,, and S. Breitman. 1976. Maturation of intestinal defenses against peroral infection with group B coxsackievirus in mice. Infect. Immun. 13: 1397– 1401.

72. Magrath, D. I.,, D. M. A. Evans,, M. Ferguson, et al. 1986. Antigenic and molecular properties of type 3 poliovirus responsible for an outbreak of poliomyelitis in a vaccinated population. J. Gen. Virol. 67: 899– 905.

73. Mahadevan, S.,, S. Ananthakrishnan,, S. Srinavasan,, P. Nalini,, and R. K. Puri. 1989. Poliomyelitis: the Pondicherry experience. J. Trop. Med. Hyg. 92: 416– 421.

74. Matsumoto, K.,, T. Kobayashi,, and Y. Kimura. 1990. Isolation and preliminary characterization of antigenic variant of echovirus type 11. J. Med. Virol. 31: 253– 258.

75. McLean, D. M.,, M. A. Coleman,, and R. P. B. Larke. 1966. Viral infections of Toronto children during 1965. I. Enteroviral disease. Can. Med. Assoc. J. 94: 839– 843.

76. Melnick, J. L., 1989. Enteroviruses, p. 191– 263. In A. S. Evans (ed)., Viral Infections of Humans, Epidemiology and Control, 3rd ed. Plenum, New York.

77. Melnick, J. L.,, E. W. Shaw,, and E. C. Curnen. 1949. A virus isolated from patients diagnosed as nonparalytic poliomyelitis or aseptic meningitis. Proc. Soc. Exp. Biol. Med. 71: 344– 349.

78. Meyer, H. M.,, R. T. Johnson,, I. P. Crawford,, H. E. Dascomb,, and N. G. Rogers. 1960. Central nervous system syndromes of "viral" etiology. A study of 713 cases. Am. J. Med. 29: 334– 347.

79. Minor, P. D.,, A. John,, M. Ferguson,, and J. P. Icenogle. 1986. Antigenic and molecular evolution of the vaccine strain of type 3 poliovirus during the period of excretion by a primary vaccinee. J. Gen. Virol. 67: 693– 706.

80. Miyamura, K.,, M. Tanimura,, N. Takeda,, R. Kono,, and S. Yamazaki. 1986. Evolution of enterovirus 70 in nature: all isolates were recendy derived from a common ancestor. Arch. Virol. 89: 1– 14.

81. Miyamura, K.,, K. Yamashita,, N. Takeda, et al. 1988. The first epidemic of acute hemorrhagic conjunctivitis due to a coxsackievirus A24 variant in Okinawa, Japan, in 1985-1986. Jpn. J. Med. Sri. Biol. 41: 159– 174.

82. Moore, B. E.,, B. P. Sagik,, and C. A. Sorber. 1979. Procedure for the recovery of airborne human enteric viruses during spray irrigation of treated waste water. Appl. Environ. Microbiol. 38: 688– 693.

83. Moore, M. 1982. Enteroviral disease in the United States, 1970-1979. J. Infect. Dis. 146: 103– 108.

84. Morens, D. M.,, M. A. Pallansch,, and M. Moore,. 1991. Polioviruses and other enteroviruses, p. 427– 497. In R. B. Belshe (ed.), Textbook of Human Virology, 2nd ed. Mosby Yearbook, St. Louis.

85. Nottay, B. K.,, O. M. Kew,, M. H. Hatch,, J. T. Heyward,, and J. F. Obijeski. 1981. Molecular variation of type 1 vaccine-related and wild polioviruses during replication in humans. Virology 108: 405– 423.

86. O'Neil, K. M.,, M. A. Pallansch,, J. A. Winkelstein,, T. M. Lock,, and J. F. Modlin. 1986. Chronic group A Coxsackievirus infection in agammaglobulinemia: demonstration of genomic variation of serotypically identical isolates persistendy excreted by the same patient. J. Infect. Dis. 157: 183– 186.

87. Onorato, I. M.,, D. M. Morens,, L. B. Schonberger,, M. H. Hatch,, R. M. Kaminski,, and J. P. Turner. 1985. Acute hemorrhagic conjunctivitis caused by enterovirus type 70: an epidemic in American Samoa. Am. J. Trop. Med. Hyg. 34: 984– 991.

88. Otatume, S.,, and P. A.-K. Addy. 1975. Ecology of enteroviruses in tropics. I. Circulation of enteroviruses in healthy infants in tropical urban areas. Jpn. J. Microbiol. 19: 201– 209.

89. Patriarca, P. A.,, I. M. Onorato,, V. Sklar, et al. 1983. Acute hemorrhagic conjunctivitis: investigation of a large-scale community outbreak in Dade County, Florida. JAMA 249: 1283– 1289.

90. Payne, A. M.-M., 1955. Poliomyelitis as a world problem, p. 393– 400. In M. Fishbein (ed.), Poliomyelitis Papers and Discussions Presented at the Third International Poliomyelitis Conference. J. B. Lippincott, Philadelphia.

91. Poyry, T.,, L. Kinnunen,, and T. Hovi. 1989. Restricted variability of a 17 nucleotide stretch within the 5'-noncoding region of poliovirus genome. Epidemiol. Infect. 103: 671– 683.

92. Pöyry, T.,, L. Kinnunen,, J. Kapsenberg,, O. Kew,, and T. Hovi. 1990. Type 3 poliovirus/ Finland/1984 is genetically related to common Mediterranean strains. J. Gen. Virol. 71: 2535– 2541.

93. Prabhakar, B. S.,, M.V. Haspel,, P. R. McClintock,, and A. L. Notkins. 1982. High frequency of antigenic variants among naturally occurring human coxsackie B4 virus isolates identified by monoclonal antibodies. Nature (London) 300: 374– 376.

94. Prabhakar, B. S.,, M. A. Menegus,, and A. L. Notkins. 1985. Detection of conserved and nonconserved epitopes on Coxsackievirus B4: frequency of antigenic change. Virology 146: 302– 306.

95. Public Health Laboratory Service. 1976. Hand, foot and mouth disease. Br. Med. J. 1: 350.

96. Rico-Hesse, R.,, M. A. Pallansch,, B. K. Nottay,, and O. M. Kew. 1987. Geographic distribution of wild poliovirus type 1 genotypes. Virology 160: 311– 322.

97. Rossouw, E.,, C. W. A. Tsilimigras,, and B. D. Schoub. 1991. Molecular epidemiology of a coxsackievirus B3 outbreak. J. Med. Virol. 34: 165– 171.

98. Rotbart, H. A. 1990. Diagnosis of enteroviral meningitis with the polymerase chain reaction. J. Pediatr. 117: 85– 89.

99. Rotbart, H. A.,, J. P. Kinsella,, and R. L. Wasserman. 1990. Persistent enterovirus infection in culture-negative meningoencephalitis: Demonstration by enzymatic RNA amplification. J. Infect. Dis. 161: 787– 791.

100. Sabin, A. B. 1991. Perspectives on rapid elimination and ultimate global eradication of paralytic poliomyelitis caused by polioviruses. Eur. J. Epidemiol. 7: 95– 120.

101. Spigland, I.,, J. P. Fox,, L. R. Elveback, et al. 1966. The Virus Watch program: a continuing surveillance of virus infections in metropolitan New York families. II. Laboratory methods and preliminary report on infections revealed by virus isolation. Am. J. Epidemiol. 83: 413– 435.

102. Sutter, R. W.,, P. A. Patriarca,, S. Brogan, et al. 1991. Outbreak of paralytic poliomyelitis in Oman: evidence for widespread transmission among fully vaccinated children. Lancet 338: 715– 720.

103. Takeda, N.,, K. Miyamura,, T. Ogino, et al. 1984. Evolution of enterovirus type 70: oligonucleotide mapping analysis of RNA genome. Virology 134: 375– 388.

104. Takeda, N.,, M. Tanimura,, and K. Miyamura. 1994. Molecular evolution of the major capsid protein VP1 of enterovirus 70. J. Virol. 68: 854– 862.

105. Thoren, A.,, A. J. Robinson,, T. Maguire,, and R. Jenkins. 1992. Two-step PCR in the retrospective diagnosis of enteroviral viraemia. Scand. J. Infect. Dis. 24: 137– 141.

106. Tsilimigras, C. W. A.,, E. Rossouw,, and B. D. Schoub. 1989. Outbreak of poliomyelitis in South Africa investigated by oligonucleotide mapping. J. Med. Virol. 28: 52– 56.

107. Tsilimigras, C. W. A.,, E. Rossouw,, and B. D. Schoub. 1991. Molecular epidemiology of an outbreak of poliomyelitis in South Africa in 1987/1988. J. Med. Virol. 35: 121– 127.

108. van Niekerk, A. B. W.,, B. D. Schoub,, C. Chezzi, et al. 1994. Outbreak of poliomyelitis in Namibia. Lancet 343: 51.

109. Vonsover, A.,, R. Handsher,, M. Neuman, et al. 1993. Molecular epidemiology of type 1 polioviruses isolated in Israel and defined by restriction fragment length polymorphism assay. J. Infect. Dis. 167: 199– 203.

110. Ward, N.,, J. Milstien,, H. Hull,, and B. Hull. 1993. A global overview and hope for the eradication of poliomyelitis by the year 2000. Trop. Geogr. Med. 45: 198– 202.

111. Wong, C. Y.,, J. J. Woodruff,, and J. F. Woodruff. 1977. Generation of cytotoxic lymphocytes during coxsackievirus B-3 infection. III. Role of sex. J. Immunol. 119: 591– 597.

112. Wright, P. F.,, R. J. Kim-Farley,, C. A. de Quadros,, S. E. Robertson,, R. M. Scott,, N. A. Ward,, and R. H. Henderson. 1991. Strategies for the global eradication of poliomyelitis by the year 2000. N. Engl. J. Med. 325: 1774– 1779.

113. Zheng, D. P.,, L. B. Zhang,, Z. Y. Fang, et al. 1993. Distribution of wild type 1 poliovirus genotypes in China. J. Infect. Dis. 168: 1361– 1367.