Characterization of severe hand, foot, and mouth disease in Shenzhen, China, 2009-2013

Abstract

Hand, foot, and mouth disease (HFMD) is caused by human enteroviruses, especially by enterovirus 71 (EV71) and coxsackievirus A16 (CA16). Patients infected with different enteroviruses show varied clinical symptoms. The aim of this study was to determine whether the etiological spectrum of mild and severe HFMD changed, and the association between pathogens and clinical features. From 2009 to 2013, a total of 2,299 stool or rectal specimens were collected with corresponding patient data. A dynamic view of the etiological spectrum of mild and severe HFMD in Shenzhen city of China was provided. EV71 accounted for the majority proportion of severe HFMD cases and fatalities during 2009-2013. CA16 and EV71 were gradually replaced by coxsackievirus A6 (CA6) as the most common serotype for mild HFMD since 2010. Myoclonic jerk and vomiting were the most frequent severe symptoms. Nervous system complications, including aseptic encephalitis and aseptic meningitis were observed mainly in patients infected by EV71. Among EV71, CA16, CA6, and CA10 infection, fever and pharyngalgia were more likely to develop, vesicles on the hand, foot, elbow, knee and buttock were less likely to develop in patients infected with CA10. Vesicles on the mouth more frequently occurred in the patients with CA6, but less in the patient with EV71. Associations between diverse enterovirus serotypes and various clinical features were discovered in the present study, which may offer further insight into early detection, diagnosis and treatment of HFMD.

Ongoing change of severe hand, foot, and mouth disease pathogens in Yunnan, China, 2012 to 2016

“…EV‐A71 has usually been identified as the most prevalent pathogen causing serious HFMD, and CV‐A16 is thought to be associated with mild HFMD and self‐limiting symptoms. However, CV‐A16 and other EV types such as CV‐A6, CV‐A10, CV‐A4, and E‐9 have been associated with severe HFMD independently of EV‐A71 . Our study samples were collected from patients with serious HFMD.…”

Molecular epidemiology of human enterovirus 71 at the origin of an epidemic of fatal hand, foot and mouth disease cases in Cambodia

“…Our CV-A6 findings are consistent with other reports from the region. 49, 78, 79, 80, 81 CV-A6 progressively became the most common virus detected among mild HFMD cases, apparently replacing other non-EV-A71 viruses, including CV-A16 in China, Thailand, Malaysia and Singapore. 11, 49, 82, 83, 84, 85, 86, 87 CV-A6 seems now to be associated with many outbreaks worldwide.…”

Molecular identification of human enteroviruses associated with aseptic meningitis in Yunnan province, Southwest China

“…Especially after 2008, HFMD has become a pressing issue for public health in China. EV associated HFMD accompanying aseptic meningitis have been reported, such as EV-A71, CV-A16, CV-A6, CV-A10, CV-A4, and E-9, and some of them have become the main causative agents of aseptic meningitis for epidemics of HFMD (Huang et al 1999, 2015). Our previous study has shown that EV-A71, CV-A16, and E-9 were the most common serotypes detected for HFMD and other serotypes such as CV-A1, CV-A8, CV-A9, CV-A10, CV-B2, CV-B4, E-1, and E-3 have been identified from 2009 to 2011 (Ma et al 2015).…”