Coxsackievirus B
Boston University
Research Occupational Health Program (ROHP)
617-358-7647
Agent
Coxsackieviruses are members of the Enterovirus genus (non-polio enteroviruses) in the family Picornaviridae. Enteroviruses are transient inhabitants of the gastrointestinal tract, and are stable at an acidic pH. Picornaviruses are small, ether-insensitive viruses with a RNA genome. Coxsackie viruses fall into two groups, A and B. There are 23 serotypes with Coxsackie A group and six serotypes within Coxsackie B (serotypes 1-6).
Coxsackie A was first isolated during poliomyelitis outbreaks in 1947 from feces of paralyzed children in Coxsackie, New York. Coxsackie B was isolated one year later from cases of aseptic meningitis.
Disease/Infection
Myositis, pleurodynia, encephalitis, aseptic meningitis, paralysis (infrequently), pericarditis, myocarditis, epidemic myalgia, acute respiratory infection, and conjunctivitis
Pathogenicity
Around 90% of infections caused by non-polio enteroviruses are asymptomatic or result in self-limited febrile illness. Severity of symptoms depend on age, immune status, and gender of the host.
Coxsackievirus B (CVB) is a significant cause of viral myocarditis. Studies suggest that 70% of the general public will be exposed to cardiotropic viruses with half of these developing acute viral myocarditis. Peak age group for myocarditis caused by CVB is young adults, ages 20-39, and males more than females. Although a majority of subjects recover without issue from acute myocarditis, some 10-20% with symptoms can go onto develop chronic disease, that of dilated chronic cardiomyopathy.
Group B viruses are also the dominant form causing of aseptic meningitis in adults and children. In general, all enteroviruses account for about 5% of all acute encephalitis in tested samples.
- Special Populations at Risk
Immune deficiency, malnourished, pregnancy, and newborns
Biosafety Information
Risk Group/ABSL2
Risk Group 2
Biosafety level 2 Practices
Modes of Transmission
| Transmission | |
| Skin Exposure (Needlestick, animal bite, or scratch): | Yes |
| Mucous Membrane Exposure Splash to Eye(s), Nose or Mouth: | Yes |
| Inhalation: | Yes |
| Ingestion: | Yes |
Host Range/Reservoir
Humans
Symptoms
The majority of Coxsackie infections are asymptomatic and self-limiting. Though Coxsackie A is typically responsible for the syndrome of Hand-Foot- and-Mouth Disease, it is Coxsackie B that is associated more with the cardiovascular complications such as myocarditis and especially in infants and the younger population, as well as aseptic meningitis/encephalitis cases.
An acute viral disease may be characterized by paroxysmal spasmodic pain in chest which may be intensified by movement. It is usually accompanied by fever and headache. Most will recover in 1 week but a relapse can occur.
Incubation Period
3-5 days
Viability
Sensitive to formaldehyde, glutaraldehyde, strong acids, sodium hypochlorite and free residual chlorine. Sensitive to UV mediated inactivation. Can be resistant to inactivation by common laboratory disinfectants such as alcohol and cresols.
Survival Outside Host
Can survive for months under favorable conditions of neutral pH, moisture, and low temperature; enhanced by presence of organic matter.
Information for Lab Workers
Laboratory PPE
Personal protective equipment includes but is not limited to laboratory coats or gowns, disposable gloves, and safety glasses. Face shields may be recommended based on risk assessment.
Containment
BSL-2 practices, containment equipment, and facilities are recommended for all activities utilizing Coxsackie virus infectious culture fluids, environmental samples, clinical materials, and potentially infectious materials collected for any purpose. ABSL-2 practices, containment equipment, and facilities are recommended for studies of virulent viruses in animals.
In Case of Exposure/Disease
- For injuries in the lab which are major medical emergencies (heart attacks, seizures, etc…).
- Medical Campus: call or have a coworker call the Control Center at 617-414–4144
- Charles River Campus: call or have a coworker call campus security at 617-353-2121.
You will be referred to or transported to the appropriate health care location by the emergency response team. - For lab exposures (needle sticks, bite, cut, scratch, splash, etc…) involving animals or infectious agents, or for unexplained symptoms or illness call the ROHP 24/7 hour number (1-617-358-ROHP (7647); or, 8-ROHP (7647) if calling from an on-campus location) to be connected with the BU Research Occupational Health Program (ROHP) medical officer. ROHP will refer you to the appropriate health care location.
- Under any of these scenarios, always inform the physician of your work in the laboratory and the agent(s) that you work with.
- Provide the wallet-size agent ID card to the physician.
Vaccination
There is no general vaccine available
Information for First Responders/Medical Personnel
Public Health Issues
Person to person transmission can occur through fecal oral route and via infected feces and body fluids. Can also occur through ocular and respiratory routes. Contact precautions should be used.
Diagnosis/Surveillance
Monitor for symptoms; confirm by serology, virus isolation, or PCR from lesions or nasopharyngeal and fecal specimens
First Aid/Post Exposure Prophylaxis
Perform one of the following actions:
| Skin Exposure (Needlestick or scratch): | Immediately go to the sink and thoroughly wash the wound with soap and water for 15 minutes. Decontaminate any exposed skin surfaces with an antiseptic scrub solution. |
| Mucous Membrane Splash to Eye(s), Nose or Mouth: | Exposure should be irrigated vigorously. |
| Splash Affecting Garments: | Remove garments that may have become soiled or contaminated and place them in a double red plastic bag. |
Treatment
There is no approved treatment for CVB. Persons infected with Coxsackie need supportive therapy, such as bed rest and fluids.
References
Heymann, D. Control of Communicable Diseases Manual 19th Edition, APHA Press, 2008
Knipe D. Fields Virology 6th Edition, Lippencott Williams and Williams, 2013
Government of Canada, Pathogen Safety Data Sheets: Infections Substances – Coxsackievirus
Biosafety in Microbiological and Biomedical Laboratories (BMBL) 5th Edition. US Government Printing Office, Washington, 2007.
Mandell, Douglas, and Bennett’s Principles and practices of Infectious Disease 6th Edition, Elsevier, 2005.
5/29/19