{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,17]],"date-time":"2026-10-17T06:00:01Z","timestamp":1792216801449,"version":"4.4.0"},"reference-count":36,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T00:00:00Z","timestamp":1756425600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Johns Hopkins Center of Excellence in Influenza Research and Response","award":["HHS 75N93021C000045"],"award-info":[{"award-number":["HHS 75N93021C000045"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>Background: While enteroviruses (EVs) are recognized causes of diverse illnesses, little is known about the epidemiology and molecular characteristics of uncommon enterovirus C (EV-C) types, including EV-C104, EV-C105, and EV-C109. Methods: We conducted genomic surveillance of EVs at the Johns Hopkins Health System between 2018 and 2024 (a total of 3715 samples), identifying EV-C104, EV-C105, and EV-C109 in respiratory samples. VP4-VP2 and whole-genome sequencing were used to assess genetic diversity and intra-host evolution. Results: Five EV-C105 infections were identified primarily in pediatric patients, presenting with a range of clinical features including fever, gastrointestinal symptoms, and cerebellitis. Prolonged EV-C104 and EV-C109 infections were identified in two immunocompromised adults. EV-C104 persisted for over five months and showed evidence of viral genomic changes (intra-host evolution). EV-C109 was detected over a four-month period. Phylogenetic analysis revealed a novel EV-C105 clade (C3) closely related to recent USA strains. EV-C104 genomes aligned with genotype B sequences from the USA and Europe, while EV-C109 sequences were similar to 2014\u20132015 strains from the Netherlands. Conclusions: These findings highlight the emergence, persistence, and genetic evolution of uncommon EV-C types in Maryland, especially among immunocompromised hosts, emphasizing the importance of continued genomic surveillance and clinical correlations.<\/jats:p>","DOI":"10.3390\/v17091183","type":"journal-article","created":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T12:25:57Z","timestamp":1756470357000},"page":"1183","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Molecular Characterization of Emerging and Uncommon Enteroviruses C104, C105, and C109 in Respiratory Samples from Maryland, USA, 2018\u20132024"],"prefix":"10.3390","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6890-7915","authenticated-orcid":false,"given":"Amary","family":"Fall","sequence":"first","affiliation":[{"name":"Johns Hopkins School of Medicine, Department of Pathology, Division of Medical Microbiology, Meyer B-121, 600 N. Wolfe St., Baltimore, MD 21287, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ting X.","family":"Zhuang","sequence":"additional","affiliation":[{"name":"Johns Hopkins School of Medicine, Department of Pathology, Division of Medical Microbiology, Meyer B-121, 600 N. Wolfe St., Baltimore, MD 21287, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alaina","family":"Dodge","sequence":"additional","affiliation":[{"name":"Johns Hopkins School of Medicine, Department of Pathology, Division of Medical Microbiology, Meyer B-121, 600 N. Wolfe St., Baltimore, MD 21287, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Abdullah","sequence":"additional","affiliation":[{"name":"Johns Hopkins School of Medicine, Department of Pathology, Division of Medical Microbiology, Meyer B-121, 600 N. Wolfe St., Baltimore, MD 21287, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie M.","family":"Norton","sequence":"additional","affiliation":[{"name":"Johns Hopkins School of Medicine, Department of Pathology, Division of Medical Microbiology, Meyer B-121, 600 N. Wolfe St., Baltimore, MD 21287, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-7159-7889","authenticated-orcid":false,"given":"David","family":"Villafuerte","sequence":"additional","affiliation":[{"name":"Johns Hopkins School of Medicine, Department of Pathology, Division of Medical Microbiology, Meyer B-121, 600 N. Wolfe St., Baltimore, MD 21287, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3248-1761","authenticated-orcid":false,"given":"Andrew","family":"Pekosz","sequence":"additional","affiliation":[{"name":"W. Harry Feinstone Department of Molecular Microbiology and Immunology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21287, USA"},{"name":"Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1304-5289","authenticated-orcid":false,"given":"Eili","family":"Klein","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA"},{"name":"Center for Disease Dynamics, Economics and Policy, Washington, DC 20005, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Heba H.","family":"Mostafa","sequence":"additional","affiliation":[{"name":"Johns Hopkins School of Medicine, Department of Pathology, Division of Medical Microbiology, Meyer B-121, 600 N. Wolfe St., Baltimore, MD 21287, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"976","DOI":"10.1016\/S0140-6736(13)60286-X","article-title":"Enterovirus 71 encephalitis: A new vaccine on the horizon?","volume":"381","author":"Pallansch","year":"2013","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e64","DOI":"10.1016\/S1473-3099(15)00543-5","article-title":"Global emergence of enterovirus D68: A systematic review","volume":"16","author":"Midgley","year":"2016","journal-title":"Lancet Infect. Dis."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e00803-18","DOI":"10.1128\/MRA.00803-18","article-title":"Characterization of the Genome Sequences of Enterovirus C109 from Two Respiratory Disease Cases in Florida, 2016","volume":"7","author":"Ng","year":"2018","journal-title":"Microbiol. Resour. 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