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In this study, acute serum specimens from clinically reported JE cases were obtained for laboratory confirmation from hospitals in Shandong (92 cases), Zhejiang (192 cases), and Guangdong (77 cases) between 2018 and 2020. These specimens were stored at -80 °C and transported on dry ice to the Department of Arbovirus, National Institute for Viral Disease Control and Prevention, China CDC, for JEV serological tests and nucleic acid detection.
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All 361 specimens were negative for JEV nucleotides, and only 70 serum specimens were positive for JEV IgM antibodies.
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Seventy laboratory-confirmed JE cases from three coastal provinces of China between 2018 and 2020 were included. The highest number of cases was reported in 2018. The sex ratio of 48 males to 22 females was 2.18:1. Their mean age was 29.63 ± 25.17 years. Thirty-three individuals were 0–14 years old, 11 were 15–40 years old, and 26 were > 40 years old. Farmers, students, and children accounted for the largest proportion of JE cases. A considerable proportion of cases (24/70, 34.28%) were classified as severe. In addition, approximately one-third (21/70) of the patients received the JE vaccination. The remaining two-thirds (49/70) were unvaccinated against JE or had unknown vaccination status (Table 1). Individuals aged > 40 years accounted for the largest proportion of cases in Shandong province, whereas those aged 0–14 years dominated Zhejiang and Guangdong provinces (Figure 1).
Table 1. Summary of basic characteristics of the laboratory-confirmed case of JE
Year Main class Detail class Shandong (31 cases) Zhejiang (24 cases) Guangdong (15 cases) 0–14 15–40 > 40 0–14 15–40 > 40 0–14 15–40 > 40 2018-2020 Gender Male 3 2 15# 13*# 5 2 6 2 Female 2 2 7 2 2 7* Occupation Farmer 1 20 1 1 2 Student 3 8 1 8 Scattered children 2 7 5 Worker 1 4 1 Job-waiting people 1 1 Unknown 2 1 Clinic classification Mild 2 1 3 3 2 1 6 1 Moderate 2 1 5 4 3 4 Severity 1 2 10 7 1 1 2 1 Extreme Severity 2 1 1 Unclassified 2 1 JE vaccination status Vaccinated 2 10 9 Unvaccinated 2 1 6 2 1 1 4 1 Unknown 1 3 16 3 6 1 1 Note. *: indicates the G1 JEV infection case is included in this group. #: indicates the G5 JEV infection case is included in this group. JE, Japanese encephalitis. Figure 1. Geographical location of the serum specimens and demographic characteristics of the JE case for our survey. The provinces highlighted in blue from north to south are Shandong, Zhejiang, and Guangdong. The pyramid shows the number of laboratory-confirmed JE cases and the age and gender of participants from each province. A total of 70 laboratory-confirmed cases of JE are observed, with more males than females. The number of cases from Shandong, Zhejiang, and Guangdong provinces was 31, 24, and 15, respectively. The majority of cases in Shandong province were > 40 years old, whereas the majority of cases in Zhejiang province and Guangdong province were 0–14 years old.
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Of the 36 specimens with identifiable infection genotypes, two cases of G1 (5.6%), 32 cases of G3 (88.8%), and two cases of G5 (5.6%) JEV infections were identified using the cross-neutralization test. Thirty-two patients in Shandong, Zhejiang, and Guangdong provinces were confirmed to be infected with G3 JEV. One case in Zhejiang and Guangdong provinces was G1 JEV. One case from Shandong and Zhejiang provinces was confirmed to be infected with G5 JEV (Table 2). Seven specimens tested negative for the G1, G3, and G5 JEV nAbs. The JEV genotype in the other 27 cases could not be inferred using a cross-neutralization test. Nine specimens were positive for three nAbs, 17 were positive for G1 and G3 JEV nAbs but negative for G5 JEV nAbs, and one specimen was positive for G3 and G5 JEV nAbs but negative for G1 JEV nAbs (Table 2).
Table 2. Results of PRNT90 and the information of JE cases with definite JEV infection genotype result
No. Provincea Year Age Genderb Days after onsetc Titers of nAbs Genotyped Clinic classification Vaccination
statuse(1:-) G1 G3 G5 1 ZJ 2019 14 M − 320 20 < 10 G1 Severe UK 2 GD 2019 8 F 4 10 < 10 < 10 G1 Extremely severe V 3 SD 2018 18 M 4 40 320 40 G3 Mild UK 4 SD 2018 19 F 14 10 2560 80 G3 Severe UK 5 SD 2018 53 M 5 20 320 10 G3 Extremely severe UK 6 SD 2018 57 M − 160 5120 < 10 G3 Unclassified UK 7 SD 2018 60 M 20 20 80 < 10 G3 Unclassified UK 8 SD 2018 67 M 13 10 40 < 10 G3 Moderate No 9 SD 2018 67 F 21 < 10 160 < 10 G3 Severe No 10 SD 2018 73 M 31 < 10 40 < 10 G3 Severe UK 11 SD 2018 74 M 7 < 10 40 < 10 G3 Mild No 12 SD 2019 2m M 7 < 10 20 < 10 G3 Mild No 13 SD 2019 55 F − < 10 20 < 10 G3 Unclassified UK 14 SD 2020 34 M 10 320 1280 320 G3 Moderate No 15 SD 2020 49 M 7 40 2560 < 10 G3 Severe UK 16 SD 2020 54 F 3 < 10 20 < 10 G3 Unclassified No 17 SD 2020 54 M 5 160 640 < 10 G3 Moderate UK 18 SD 2020 55 F 11 < 10 10 < 10 G3 Mild UK 19 SD 2020 60 M 0 < 10 20 < 10 G3 Unclassified UK 20 SD 2020 63 M 7 < 10 10 < 10 G3 Severe UK 21 ZJ 2018 1 M 6 10 80 10 G3 Mild V 22 ZJ 2018 10 M − 20 640 10 G3 Severe UK 23 ZJ 2018 15 M − 320 1280 10 G3 Moderate UK 24 ZJ 2019 14 M − 80 320 < 10 G3 Severe V 25 ZJ 2019 15 M 11 10 40 < 10 G3 Mild UK 26 ZJ 2019 55 M 17 40 320 < 10 G3 Unclassified No 27 ZJ 2020 1 M 16 10 160 < 10 G3 Mild V 28 ZJ 2020 30 F 11 10 40 < 10 G3 Mild No 29 ZJ 2020 31 M 7 20 320 < 10 G3 Moderate UK 30 GD 2018 3 F 18 < 10 10 < 10 G3 Unclassified No 31 GD 2018 71 M 25 < 10 10 < 10 G3 Unclassified UK 32 GD 2020 10m M 2 < 10 10 < 10 G3 Moderate V 33 GD 2020 8 M 6 40 1280 10 G3 Moderate V 34 GD 2020 66 M 4 < 10 10 < 10 G3 Mild No 35 SD 2020 58 M 8 40 160 640 G5 Severe UK 36 ZJ 2019 2 M 8 40 40 320 G5 Moderate V 37 SD 2020 14 F 7 < 10 < 10 < 10 − Mild No 38 SD 2020 61 F 5 < 10 < 10 < 10 − Moderate UK 39 SD 2020 65 M 13 < 10 < 10 < 10 − Severe UK 40 SD 2020 70 M 5 < 10 < 10 < 10 − Severe UK 41 ZJ 2020 1 M 4 < 10 < 10 < 10 − Moderate No 42 GD 2018 11 F 10 < 10 < 10 < 10 − Mild V 43 GD 2019 5 F 22 < 10 < 10 < 10 − Mild V 44 SD 2018 14 M 7 10 20 < 10 − Severe UK 45 SD 2018 32 F 27 10 20 < 10 − Severe UK 46 SD 2018 53 F 13 20 20 < 10 − Severe UK 47 SD 2018 62 F 10 20 20 < 10 − Moderate No 48 SD 2018 64 M 3 10 20 < 10 − Severe No 49 SD 2019 9 F 5 10 20 < 10 − Unclassified V 50 SD 2020 7 M 5 20 40 < 10 − Moderate V 51 ZJ 2018 10 M − 80 80 < 10 − Severe V 52 ZJ 2018 49 M 13 10 10 < 10 − Severe UK 53 ZJ 2019 14 M 5 20 20 < 10 − Mild V 54 GD 2018 1 M 1 20 40 < 10 − Moderate No 55 GD 2018 8 F 9 20 20 < 10 − Mild V 56 GD 2018 14 F 18 20 10 < 10 − Severe V 57 GD 2019 8 M 35 20 40 < 10 − Mild V 58 GD 2019 10 M 26 80 160 < 10 − Mild No 59 GD 2019 14 F − 20 10 < 10 − Severe No 60 GD 2020 3 M 1 10 20 < 10 − Moderate V 61 ZJ 2018 26 M 6 < 10 20 20 − Extremely severe UK 62 SD 2018 53 M 5 20 40 10 − Severe UK 63 ZJ 2018 1 F 8 40 80 20 − Severe No 64 ZJ 2018 6 M − 160 320 160 − Moderate V 65 ZJ 2018 11 M 8 160 320 10 − Unclassified V 66 ZJ 2018 12 M 9 10 20 10 − Severe V 67 ZJ 2018 18 M 5 20 20 20 − Unclassified UK 68 ZJ 2018 22 F 3 40 80 20 − Severe UK 69 ZJ 2019 4 F 18 10 10 10 − Severe UK 70 ZJ 2019 8 M − 160 160 20 − Unclassified V Note. aSD, Shandong Province; ZJ, Zhejiang Province; GD, Guangdong Province. bGender: M, male; F, female. cDays after onset, the days from onset at serum collection. dGenotype, the genotype of JEV that caused JE of the patient. eUK, unknown; No, unvaccinated; V, vaccinated. JE, Japanese encephalitis. -
To explore the relationship between vaccination status and the clinical classification of the 70 cases, the clinical classification of the 21 cases with a vaccination history was primarily mild (33.3%, 7/21) or moderate (38.1%, 8/21). The clinical classification of the 49 patients with no or unknown vaccination history was primarily mild (24.5%, 12/49) or severe (42.9%, 21/49). No statistically significant differences were observed between the two groups (Table 3). The incidence of symptoms such as acute onset, fever, depression, and dysfunction of consciousness was similar in the different vaccination status groups (all > 50%). The incidence of dizziness, nausea, irritability, convulsions, small and localized twitches, and recurrent or continuous twitches was similar (10%–50%). Abdominal pain, diarrhea, and circulatory failure were less common (< 10%). No statistically significant differences were observed between vaccination status and clinical symptoms (Table 4).
Table 3. Comparison of the difference in clinical staging in different vaccination status
Clinical typing Vaccination history, n (%) χ2 P value Yes (n = 21) NO/Ominous (n = 49) Mild 7 (33.3) 12 (24.5) 0.581 0.553 Moderate 8 (38.1) 11 (22.4) 1.82 0.242 Severe 4 (19.0) 21 (42.9) 3.63 0.091 Extremely severe 1 (4.8) 3 (6.1) 0.051 1 Unclassified 1 (4.8) 2 (4.1) 0.017 1 Table 4. Comparison of clinical symptoms in in different vaccination status
Clinical symptoms Vaccination history, n (%) χ2 P value Yes (n = 21) NO/Ominous (n = 49) Acute onset 14 (66.7) 46 (93.9) 2.694 0.131 Fever 16 (76.2) 41 (83.7) 0.039 1 <39 °C 7 (33.3) 21 (42.9) 0.287 0.779 39-40 °C 6 (28.6) 13 (26.5) 0.144 0.762 >40 °C 3 (14.3) 7 (14.3) 0.016 1 Headache 8 (38.1) 27 (55.1) 1.241 0.381 Dizziness 8 (38.1) 17 (34.7) 0.284 0.777 Abdominal pain 0 (0.0) 3 (6.1) 1.248 0.559 Diarrhea 2 (9.5) 4 (8.2) 0.082 1 Nausea 6 (28.6) 18 (36.7) 0.219 0.778 Vomiting 11 (52.4) 17 (34.7) 3.101 0.096 Jet vomiting 3 (14.3) 3 (6.1) 1.541 0.332 Depression 14 (66.7) 36 (73.5) 0.016 1 Irritability 1 (4.8) 11 (22.4) 2.955 0.15 Drowsiness 9 (42.9) 30 (61.2) 1.516 0.236 Dysphoria 5 (23.8) 20 (40.8) 1.466 0.251 Convulsions 3 (14.3) 11 (22.4) 0.429 0.74 Dysfunction of consciousness 11 (52.4) 27 (55.1) 0.019 1 Small localized twitches 3 (14.3) 9 (18.4) 0.082 1 Recurrent or continuous twitches 4 (19.0) 9 (18.4) 0.048 1 Respiratory failure 2 (9.5) 12 (24.5) 1.775 0.308 Cirulatory failure 0 (0.0) 3 (6.1) 1.248 0.559
doi: 10.3967/bes2024.078
Serological Investigation into the Infected Genotypes of Patients with Japanese Encephalitis in the Coastal Provinces of China
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Abstract:
Objective Genotypes (G) 1, 3, and 5 of the Japanese encephalitis virus (JEV) have been isolated in China, but the dominant genotype circulating in Chinese coastal areas remains unknown. We searched for G5 JEV-infected cases and attempted to elucidate which JEV genotype was most closely related to human Japanese encephalitis (JE) in the coastal provinces of China. Methods In this study, we collected serum specimens from patients with JE in three coastal provinces of China (Guangdong, Zhejiang, and Shandong) from 2018 to 2020 and conducted JEV cross-neutralization tests against G1, 3, and 5. Results Acute serum specimens from clinically reported JE cases were obtained for laboratory confirmation from hospitals in Shandong (92 patients), Zhejiang (192 patients), and Guangdong (77 patients), China, from 2018 to 2020. Seventy of the 361 serum specimens were laboratory-confirmed to be infected with JEV. Two cases were confirmed to be infected with G1 JEV, 32 with G3 JEV, and two with G5 JEV. Conclusion G3 was the primary infection genotype among JE cases with a definite infection genotype, and the infection caused by G5 JEV was confirmed serologically in China. -
Key words:
- Japanese encephalitis virus /
- Serological investigation /
- Plaque reduction neutralization test /
- Cross-neutralization test /
- Genotype
The authors declared no conflict of interest.
&These authors contributed equally to this work.
注释:1) AUTHOR CONTRIBUTIONS: 2) CONFLICT OF INTEREST: -
Figure 1. Geographical location of the serum specimens and demographic characteristics of the JE case for our survey. The provinces highlighted in blue from north to south are Shandong, Zhejiang, and Guangdong. The pyramid shows the number of laboratory-confirmed JE cases and the age and gender of participants from each province. A total of 70 laboratory-confirmed cases of JE are observed, with more males than females. The number of cases from Shandong, Zhejiang, and Guangdong provinces was 31, 24, and 15, respectively. The majority of cases in Shandong province were > 40 years old, whereas the majority of cases in Zhejiang province and Guangdong province were 0–14 years old.
Table 1. Summary of basic characteristics of the laboratory-confirmed case of JE
Year Main class Detail class Shandong (31 cases) Zhejiang (24 cases) Guangdong (15 cases) 0–14 15–40 > 40 0–14 15–40 > 40 0–14 15–40 > 40 2018-2020 Gender Male 3 2 15# 13*# 5 2 6 2 Female 2 2 7 2 2 7* Occupation Farmer 1 20 1 1 2 Student 3 8 1 8 Scattered children 2 7 5 Worker 1 4 1 Job-waiting people 1 1 Unknown 2 1 Clinic classification Mild 2 1 3 3 2 1 6 1 Moderate 2 1 5 4 3 4 Severity 1 2 10 7 1 1 2 1 Extreme Severity 2 1 1 Unclassified 2 1 JE vaccination status Vaccinated 2 10 9 Unvaccinated 2 1 6 2 1 1 4 1 Unknown 1 3 16 3 6 1 1 Note. *: indicates the G1 JEV infection case is included in this group. #: indicates the G5 JEV infection case is included in this group. JE, Japanese encephalitis. Table 2. Results of PRNT90 and the information of JE cases with definite JEV infection genotype result
No. Provincea Year Age Genderb Days after onsetc Titers of nAbs Genotyped Clinic classification Vaccination
statuse(1:-) G1 G3 G5 1 ZJ 2019 14 M − 320 20 < 10 G1 Severe UK 2 GD 2019 8 F 4 10 < 10 < 10 G1 Extremely severe V 3 SD 2018 18 M 4 40 320 40 G3 Mild UK 4 SD 2018 19 F 14 10 2560 80 G3 Severe UK 5 SD 2018 53 M 5 20 320 10 G3 Extremely severe UK 6 SD 2018 57 M − 160 5120 < 10 G3 Unclassified UK 7 SD 2018 60 M 20 20 80 < 10 G3 Unclassified UK 8 SD 2018 67 M 13 10 40 < 10 G3 Moderate No 9 SD 2018 67 F 21 < 10 160 < 10 G3 Severe No 10 SD 2018 73 M 31 < 10 40 < 10 G3 Severe UK 11 SD 2018 74 M 7 < 10 40 < 10 G3 Mild No 12 SD 2019 2m M 7 < 10 20 < 10 G3 Mild No 13 SD 2019 55 F − < 10 20 < 10 G3 Unclassified UK 14 SD 2020 34 M 10 320 1280 320 G3 Moderate No 15 SD 2020 49 M 7 40 2560 < 10 G3 Severe UK 16 SD 2020 54 F 3 < 10 20 < 10 G3 Unclassified No 17 SD 2020 54 M 5 160 640 < 10 G3 Moderate UK 18 SD 2020 55 F 11 < 10 10 < 10 G3 Mild UK 19 SD 2020 60 M 0 < 10 20 < 10 G3 Unclassified UK 20 SD 2020 63 M 7 < 10 10 < 10 G3 Severe UK 21 ZJ 2018 1 M 6 10 80 10 G3 Mild V 22 ZJ 2018 10 M − 20 640 10 G3 Severe UK 23 ZJ 2018 15 M − 320 1280 10 G3 Moderate UK 24 ZJ 2019 14 M − 80 320 < 10 G3 Severe V 25 ZJ 2019 15 M 11 10 40 < 10 G3 Mild UK 26 ZJ 2019 55 M 17 40 320 < 10 G3 Unclassified No 27 ZJ 2020 1 M 16 10 160 < 10 G3 Mild V 28 ZJ 2020 30 F 11 10 40 < 10 G3 Mild No 29 ZJ 2020 31 M 7 20 320 < 10 G3 Moderate UK 30 GD 2018 3 F 18 < 10 10 < 10 G3 Unclassified No 31 GD 2018 71 M 25 < 10 10 < 10 G3 Unclassified UK 32 GD 2020 10m M 2 < 10 10 < 10 G3 Moderate V 33 GD 2020 8 M 6 40 1280 10 G3 Moderate V 34 GD 2020 66 M 4 < 10 10 < 10 G3 Mild No 35 SD 2020 58 M 8 40 160 640 G5 Severe UK 36 ZJ 2019 2 M 8 40 40 320 G5 Moderate V 37 SD 2020 14 F 7 < 10 < 10 < 10 − Mild No 38 SD 2020 61 F 5 < 10 < 10 < 10 − Moderate UK 39 SD 2020 65 M 13 < 10 < 10 < 10 − Severe UK 40 SD 2020 70 M 5 < 10 < 10 < 10 − Severe UK 41 ZJ 2020 1 M 4 < 10 < 10 < 10 − Moderate No 42 GD 2018 11 F 10 < 10 < 10 < 10 − Mild V 43 GD 2019 5 F 22 < 10 < 10 < 10 − Mild V 44 SD 2018 14 M 7 10 20 < 10 − Severe UK 45 SD 2018 32 F 27 10 20 < 10 − Severe UK 46 SD 2018 53 F 13 20 20 < 10 − Severe UK 47 SD 2018 62 F 10 20 20 < 10 − Moderate No 48 SD 2018 64 M 3 10 20 < 10 − Severe No 49 SD 2019 9 F 5 10 20 < 10 − Unclassified V 50 SD 2020 7 M 5 20 40 < 10 − Moderate V 51 ZJ 2018 10 M − 80 80 < 10 − Severe V 52 ZJ 2018 49 M 13 10 10 < 10 − Severe UK 53 ZJ 2019 14 M 5 20 20 < 10 − Mild V 54 GD 2018 1 M 1 20 40 < 10 − Moderate No 55 GD 2018 8 F 9 20 20 < 10 − Mild V 56 GD 2018 14 F 18 20 10 < 10 − Severe V 57 GD 2019 8 M 35 20 40 < 10 − Mild V 58 GD 2019 10 M 26 80 160 < 10 − Mild No 59 GD 2019 14 F − 20 10 < 10 − Severe No 60 GD 2020 3 M 1 10 20 < 10 − Moderate V 61 ZJ 2018 26 M 6 < 10 20 20 − Extremely severe UK 62 SD 2018 53 M 5 20 40 10 − Severe UK 63 ZJ 2018 1 F 8 40 80 20 − Severe No 64 ZJ 2018 6 M − 160 320 160 − Moderate V 65 ZJ 2018 11 M 8 160 320 10 − Unclassified V 66 ZJ 2018 12 M 9 10 20 10 − Severe V 67 ZJ 2018 18 M 5 20 20 20 − Unclassified UK 68 ZJ 2018 22 F 3 40 80 20 − Severe UK 69 ZJ 2019 4 F 18 10 10 10 − Severe UK 70 ZJ 2019 8 M − 160 160 20 − Unclassified V Note. aSD, Shandong Province; ZJ, Zhejiang Province; GD, Guangdong Province. bGender: M, male; F, female. cDays after onset, the days from onset at serum collection. dGenotype, the genotype of JEV that caused JE of the patient. eUK, unknown; No, unvaccinated; V, vaccinated. JE, Japanese encephalitis. Table 3. Comparison of the difference in clinical staging in different vaccination status
Clinical typing Vaccination history, n (%) χ2 P value Yes (n = 21) NO/Ominous (n = 49) Mild 7 (33.3) 12 (24.5) 0.581 0.553 Moderate 8 (38.1) 11 (22.4) 1.82 0.242 Severe 4 (19.0) 21 (42.9) 3.63 0.091 Extremely severe 1 (4.8) 3 (6.1) 0.051 1 Unclassified 1 (4.8) 2 (4.1) 0.017 1 Table 4. Comparison of clinical symptoms in in different vaccination status
Clinical symptoms Vaccination history, n (%) χ2 P value Yes (n = 21) NO/Ominous (n = 49) Acute onset 14 (66.7) 46 (93.9) 2.694 0.131 Fever 16 (76.2) 41 (83.7) 0.039 1 <39 °C 7 (33.3) 21 (42.9) 0.287 0.779 39-40 °C 6 (28.6) 13 (26.5) 0.144 0.762 >40 °C 3 (14.3) 7 (14.3) 0.016 1 Headache 8 (38.1) 27 (55.1) 1.241 0.381 Dizziness 8 (38.1) 17 (34.7) 0.284 0.777 Abdominal pain 0 (0.0) 3 (6.1) 1.248 0.559 Diarrhea 2 (9.5) 4 (8.2) 0.082 1 Nausea 6 (28.6) 18 (36.7) 0.219 0.778 Vomiting 11 (52.4) 17 (34.7) 3.101 0.096 Jet vomiting 3 (14.3) 3 (6.1) 1.541 0.332 Depression 14 (66.7) 36 (73.5) 0.016 1 Irritability 1 (4.8) 11 (22.4) 2.955 0.15 Drowsiness 9 (42.9) 30 (61.2) 1.516 0.236 Dysphoria 5 (23.8) 20 (40.8) 1.466 0.251 Convulsions 3 (14.3) 11 (22.4) 0.429 0.74 Dysfunction of consciousness 11 (52.4) 27 (55.1) 0.019 1 Small localized twitches 3 (14.3) 9 (18.4) 0.082 1 Recurrent or continuous twitches 4 (19.0) 9 (18.4) 0.048 1 Respiratory failure 2 (9.5) 12 (24.5) 1.775 0.308 Cirulatory failure 0 (0.0) 3 (6.1) 1.248 0.559 -
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