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Echovirus - Pathogen Safety Data Sheet

SECTION I - INFECTIOUS AGENT

NAME: Echovirus

SYNONYM OR CROSS REFERENCE: Human enterovirus B Footnote 1, enteric cytopathogenic human orphan (ECHO) virus, Boston exanthem disease

CHARACTERISTICS: Echoviruses are members of the genus Enterovirus and family Picornaviridae. Parechoviruses were previously classified as members of the genus Enterovirus, but have recently been separated into their own genus based on their unique biological propertiesFootnote 2. Echoviruses are small non-enveloped viruses with a single-stranded positive-sense RNA genome. Echoviruses are 30 nm in diameter. There are 28 serotypes of Human echoviruses, which are all classified in the species human enterovirus B Footnote 1.

SECTION II - HAZARD IDENTIFICATION

PATHOGENICITY/TOXICITY: The majority of infections are asymptomatic.  The most common symptomatic manifestation of infection is an acute nonspecific febrile illness with or without exanthem Footnote 1. Echoviruses are frequently associated with aseptic meningitis. Symptoms include acute onset of fever, headache, photophobia, nausea and vomiting.  Fever may subside for several days and then recur. Generally, symptoms resolve in about 1 week. Severe illness and death are uncommon and most patients completely recover Footnote 3Footnote 4. Other clinical syndromes have been less commonly associated with echovirus infections, including paralysis, encephalitis, respiratory disease, diarrhea, hepatic disturbance, exanthems and enanthems, conjunctivitis, asthenia, pericarditis, and myocarditis Footnote 1Footnote 4-7. Epidemics in neonatal intensive care units have very high morbidity and mortality ratesFootnote 8.

EPIDEMIOLOGY: Worldwide distribution.  In temperate climates, incidence peaks during the summer and fall months; in the tropics, transmission occurs year-round Footnote 3.  Enteroviruses, including echoviruses, predominantly affect children. Other risk factors include lower socioeconomic status, large household size, crowded living conditions, living in urban areas, and areas with poorer sanitation Footnote 3Footnote 4.

HOST RANGE: Humans Footnote 9.

INFECTIOUS DOSE: The dose required to infect 50% of volunteers in one study was calculated to be 919 pfu for Echovirus 12 Footnote 10.

MODE OF TRANSMISSION: Transmitted by fecal-oral (most significant), respiratory, transplacental, perinatal, and self-inoculation routes Footnote 1Footnote 3. Fomites may also transmit viruses Footnote 3.

INCUBATION PERIOD: Variable, typically 2 – 10 days Footnote 9.

COMMUNICABILITY: Can be transmitted from person-to-person Footnote 3. Viral agents can be excreted for 3-4 weeks from the pharynx, and 5-6 weeks in stool Footnote 5.

SECTION III - DISSEMINATION

RESERVOIR: Humans Footnote 4Footnote 9

ZOONOSIS: No evidence of spread from animal to humans Footnote 9.

VECTORS: Insects (flies or cockroaches) are a possible mechanical vector, although this has not yet been conclusively determinedFootnote 4Footnote 9.

SECTION IV - STABILITY AND VIABILITY

DRUG SUSCEPTIBILITY/RESISTANCE: No antiviral medications are currently approved for the treatment of enterovirus infections. Pleconaril has shown antiviral activity against echoviruses in vitro Footnote 11.

SUSCEPTIBILITY/RESISTANCE TO DISINFECTANTS: Echoviruses are susceptible to 0.3% formaldehyde and 0.3 – 0.5 ppm free chlorine. They are resistant to 70% alcohol, substituted phenolic, ether, and various detergents Footnote 9.

PHYSICAL INACTIVATION: Can be inactivated by heat (>56 °C), ultraviolet light, and drying Footnote 1Footnote 3.

SURVIVAL OUTSIDE HOST: Can survive 7 days on dry inanimate surfaces Footnote 12. Echoviruses can survive for weeks in water, body liquids, and sewage Footnote 1.

SECTION V - FIRST AID / MEDICAL

SURVEILLANCE: Traditionally diagnosed by the isolation of viral particles from clinical specimens; however, PCR-based tests are becoming more commonFootnote 13. The use of viral culture is declining as not all serotypes grow well in culture.

Note: All diagnostic methods are not necessarily available in all countries.

FIRST AID/TREATMENT: Most cases are self-limiting and recover with supportive care. No antiviral therapy is available Footnote 3.

IMMUNIZATION: None

PROPHYLAXIS: None

SECTION VI - LABORATORY HAZARDS

LABORATORY-ACQUIRED INFECTIONS: At least three cases of laboratory-acquired infections have been reported Footnote 14.

SOURCES/SPECIMENS: Cerebrospinal fluid, blood, tissues, stool, and rectal and throat swabs Footnote 1Footnote 13.

PRIMARY HAZARDS: Parenteral inoculation, oral ingestion Footnote 4, and aerosols Footnote 1.

SPECIAL HAZARDS: None

SECTION VII - EXPOSURE CONTROLS / PERSONAL PROTECTION

RISK GROUP CLASSIFICATION: Risk Group 2.

CONTAINMENT REQUIREMENTS: Containment Level 2 facilities, equipment, and operational practices for work involving infectious or potentially infectious materials, animals, or cultures.

PROTECTIVE CLOTHING: Lab coat. Gloves when direct skin contact with infected materials or animals is unavoidable. Eye protection must be used where there is a known or potential risk of exposure to splashes Footnote 15.

OTHER PRECAUTIONS: All procedures that may produce aerosols, or involve high concentrations or large volumes should be conducted in a biological safety cabinet (BSC). The use of needles, syringes, and other sharp objects should be strictly limited. Additional precautions should be considered with work involving animals or large scale activities Footnote 15.

SECTION VIII - HANDLING AND STORAGE

SPILLS: Allow aerosols to settle and, wearing protective clothing, gently cover spill with paper towels and apply an appropriate disinfectant, starting at the perimeter and working towards the centre. Allow sufficient contact time before clean up Footnote 15.

DISPOSAL: Decontaminate all wastes that contain or have come in contact with the infectious organism by autoclave, chemical disinfection, gamma irradiation, or incineration before disposing Footnote 15.

STORAGE: The infectious agent should be stored in leak-proof containers that are appropriately labelled Footnote 15.

SECTION IX - REGULATORY AND OTHER INFORMATION

REGULATORY INFORMATION: The import, transport, and use of pathogens in Canada is regulated under many regulatory bodies, including the Public Health Agency of Canada, Health Canada, Canadian Food Inspection Agency, Environment Canada, and Transport Canada. Users are responsible for ensuring they are compliant with all relevant acts, regulations, guidelines, and standards.

UPDATED: December 2011

PREPARED BY: Pathogen Regulation Directorate, Public Health Agency of Canada.

Although the information, opinions and recommendations contained in this Pathogen Safety Data Sheet are compiled from sources believed to be reliable, we accept no responsibility for the accuracy, sufficiency, or reliability or for any loss or injury resulting from the use of the information. Newly discovered hazards are frequent and this information may not be completely up to date.

Copyright © Public Health Agency of Canada, 2011 Canada

REFERENCES

Footnote 1
Romero, J. R. (2007). Enteroviruses and Parechoviruses. In P. R. Murray (Ed.), Manual of Clinical Microbiology (9th ed., pp. 1392-1404). Washington D.C.: ASM Press.
Footnote 2
Joki-Korpela, P., & Hyypia, T. (2001). Parechoviruses, a novel group of human picornaviruses. Annals of Medicine, 33(7), 466-471.
Footnote 3
Khetsuriani, N., & Parashar, U. D. (2007). Enteric Viral Infections. In D. C. Dale (Ed.), Infectious Diseases: The Clinician's Guide to Diagnosis, Treatment and Prevention (17th ed., ). New York: WebMD Corporation. Retrieved from http://online.statref.com/document.aspx?FxId=65&DocID=1&grpalias=
Footnote 4
Pallansch, M., & Roos, R. (2007). Enteroviruses: Polioviruses, Coxsackieviruses, Echoviruses, and Newer Enteroviruses. In D. M. Knipe, P. M. Howley, D. E. Griffin, M. A. Martin, R. A. Lamb, B. Roizman & S. E. Straus (Eds.), Fields Virology (5th ed., pp. 839-894). Philadelphia PA: Lippincott Williams & Wilkins.
Footnote 5
Busowski, M. T. (2009). Echoviruses.
Footnote 6
Lukashev, A. N., Lashkevich, V. A., Koroleva, G. A., & Karganova, G. G. (2002). Phylogenetic and serological characterization of echovirus 11 and echovirus 19 strains causing uveitis. Archives of Virology, 147(1), 131-142.
Footnote 7
Grimwood, K., Huang, Q. S., Sadleir, L. G., Nix, W. A., Kilpatrick, D. R., Oberste, M. S., & Pallansch, M. A. (2003). Acute flaccid paralysis from echovirus type 33 infection. Journal of Clinical Microbiology, 41(5), 2230.
Footnote 8
Centers for Disease Control and Prevention (CDC). (2010). Nonpolio enterovirus and human parechovirus surveillance --- United States, 2006-2008. MMWR.Morbidity and Mortality Weekly Report, 59(48), 1577-1580.
Footnote 9
Ray, G. C. (2004). Enteroviruses. In K. J. Ryan, & G. C. Ray (Eds.), Sherris Medical Microbiology: An Introduction to Infectious Disease (4th ed., pp. 531-539). New York: McGraw Hill.
Footnote 10
Schiff, G. M., Stefanovic, G. M., & Young, E. C. (1984). Studies of echovirus-12 in volunteers: Determination of minimal infectious dose and the effect of previous infection on infectious dose. Journal of Infectious Diseases, 150(6), 858-866.
Footnote 11
Pevear, D. C., Tull, T. M., Seipel, M. E., & Groarke, J. M. (1999). Activity of pleconaril against enteroviruses. Antimicrobial Agents and Chemotherapy, 43(9), 2109-2115.
Footnote 12
Kramer, A., Schwebke, I., & Kampf, G. (2006). How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infectious Diseases, 6
Footnote 13
Muir, P. (2009). Enteroviruses. Medicine, 37(12), 691-694.
Footnote 14
Pike, R. M. (1976). Laboratory associated infections: summary and analysis of 3921 cases. Health Laboratory Science, 13(2), 105-114.
Footnote 15
Public Health Agency of Canada. (2004). In Best M., Graham M. L., Leitner R., Ouellette M. and Ugwu K. (Eds.), Laboratory Biosafety Guidelines (3rd ed.). Canada: Public Health Agency of Canada.