Enterovirus 71–associated Hand, Foot, and Mouth Disease, Southern Vietnam, 2011

Khanh, Truong Huu; Sabanathan, Saraswathy; Thanh, Tran Tan; Thoa, Le Phan Kim; Thuong, Tang Chi; Hang, Vu Thi Ty; Farrar, Jeremy; Hien, Tran Tinh; Châu, Nguyễn Văn Vĩnh; Doorn, H. Rogier van

doi:10.3201/eid1812.120929

Cited by 116 publications

(126 citation statements)

References 12 publications

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“…In Taiwan, phylogenetic analyses revealed that different predominant genotypes occurred in 1998 (C2), 2000–2001 (B4), 2004–2005 (C4), and 2008 (B5) [10], [18]. This genotype replacement has also been observed in Malaysia and Vietnam [10], [19], [20]. Therefore, continuous monitoring genetic and antigenic evolution of EV71 are critical to vaccine development and epidemic control.…”

Section: Introductionmentioning

confidence: 97%

Monitoring Antigenic Variations of Enterovirus 71: Implications for Virus Surveillance and Vaccine Development

et al. 2014

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Enterovirus 71 (EV71) causes life-threatening epidemics in Asia and can be phylogenetically classified into three major genogroups (A∼C) including 11 genotypes (A, B1∼B5, and C1∼C5). Recently, EV71 epidemics occurred cyclically in Taiwan with different genotypes. In recent years, human studies using post-infection sera obtained from children have detected antigenic variations among different EV71 strains. Therefore, surveillance of enterovirus 71 should include phylogenetic and antigenic analysis. Due to limitation of sera available from children with EV71 primary infection, suitable animal models should be developed to generate a panel of antisera for monitoring EV71 antigenic variations. Twelve reference strains representing the 11 EV71 genotypes were grown in rhabdomyosarcoma cells. Infectious EV71 particles were purified and collected to immunize rabbits. The rabbit antisera were then employed to measure neutralizing antibody titers against the 12 reference strains and 5 recent strains. Rabbits immunized with genogroup B and C viruses consistently have a lower neutralizing antibody titers against genogroup A (≧8-fold difference) and antigenic variations between genogroup B and C viruses can be detected but did not have a clear pattern, which are consistent with previous human studies. Comparison between human and rabbit neutralizing antibody profiles, the results showed that ≧8-fold difference in rabbit cross-reactive antibody ratios could be used to screen EV71 isolates for identifying potential antigenic variants. In conclusion, a rabbit model was developed to monitor antigenic variations of EV71, which are critical to select vaccine strains and predict epidemics.

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Section: Introductionmentioning

confidence: 97%

Monitoring Antigenic Variations of Enterovirus 71: Implications for Virus Surveillance and Vaccine Development

et al. 2014

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“…Transmission occurs from person to person through direct contact with saliva, feces, vesicular fluid, or respiratory droplets of an infected person, and indirectly by contaminated articles [4]. Over the last decade, many large outbreaks of HFMD have been reported in countries of the Western Pacific Region, including Japan, Malaysia, Taiwan, Singapore, Vietnam, mainland China, and Cambodia [5][6][7][8][9][10][11]. HFMD is a major public health problem in China, resulting in 7.2 million clinical cases and 2,457 deaths from 2008 to 2012 [12].…”

Section: Introductionmentioning

confidence: 99%

Epidemiological characteristics and pathogens attributable to hand, foot, and mouth disease in Shanghai, 2008–2013

Sun

Liu

et al. 2016

J Infect Dev Ctries

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Introduction: Hand, foot, and mouth disease (HFMD) is a common childhood illness caused by enteroviruses. A passive surveillance system has been implemented in Shanghai Pudong since 2008 and etiology surveillance since 2009.We characterized the epidemiology and the etiology of HFMD in Pudong from 2008-2013. Methodology: Health care providers were required to report any clinically diagnosed HFMD to Pudong District Center for Disease Control and Prevention. For all severe cases and randomly selected mild HFMD cases, throat or rectal swabs or feces were collected for enterovirus detection by real time reverse transcription polymerase chain reaction. Results: A total of 50,149 cases were reported, with average 8,508 per year (range: 3,577-13,202) and average incidence of 167.5/100,000 persons (range: 81.4-254.1/100,000 persons). HFMD was more likely to occur in children under five years of age (85.6%), while severe cases were more likely to happen in children under three years of age (63.9%). Every year in May or June, HFMD peaked in the region; two peaks were observed from 2011 to 2013.The most common etiologic agents are EV71 and CA16.Different types of enterovirus circulate in different years. EV71 was the predominant pathogen in severe cases. The proportions of EV71 in severe cases was higher than in mild cases at the children's medical center (p<0.001). Conclusions: HFMD remains an important public health issue in Shanghai. HFMD pathogen surveillance is required for more types of enteroviruses besides EV71 and CA16, which would give a better picture of the etiology of HFMD.

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“…Although HFMD is usually mild and self-limiting, neurological manifestations that are associated with systemic features, such as severe pulmonary edema and shock, can occur and occasionally lead to death. Since 1997, there have been a number of outbreaks of EV71-associated HFMD reported in Malaysia (1997 [1], 2000, and 2005 [2]), Taiwan (1998 [3]), Singapore (2000 [4]), Vietnam (2005 [5] and 2011 [6]), and China (2008 [7]). In China, since HFMD was listed in 2008 as a category C notifiable disease, the numbers of annual cases of HFMD that were reported from the Chinese National Infectious Disease information management system ranged between 1.16 and 1.92 million during 2009 to 2012 (http://www.chinacdc.cn/tjsj/fdcrbbg).…”

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confidence: 99%

Immunogenicity, Safety, and Lot Consistency of a Novel Inactivated Enterovirus 71 Vaccine in Chinese Children Aged 6 to 59 Months

Wang

et al. 2013

Clin Vaccine Immunol

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The determination of lot-to-lot consistency in the manufacturing process is a mandatory step in the clinical development of the novel enterovirus 71 (EV71) vaccine. A phase III, randomized, placebo-controlled, double-blind trial assessed the lot consistency, immunogenicity, and safety of the EV71 vaccine in children aged 6 to 59 months. Healthy children (n ‫؍‬ 1,400) received one of three lots of the EV71 vaccine containing 400 U of EV71 antigen or a placebo at days 0 and 28. Blood samples were collected before dose 1 and at 28 days after dose 2 (day 56) for an anti-EV71 neutralizing antibody (NTAb) assay. The geometric mean titer (GMT) and the seropositivity rates (with titers of >1:8) were compared at day 56. After each dose, the solicited injection site and general adverse events (AEs) were recorded for 7 days, and unsolicited AEs were recorded for 28 days. At day 56, the seropositivity rates ranged from 99.7% to 100% for the vaccine groups. The NTAb GMTs for the vaccine were 140.3 (95% confidence interval [CI], 117.8 to 167.1), 141.5 (95% CI, 118.0 to 169.6), and 146.6 (95% CI, 122.5 to 175.3). The two-sided 95% CI of the log difference in GMTs between the pairs of lots were between ؊0.176 and 0.176, therefore meeting the predefined equivalence criteria. The percentages of subjects reporting any injection site AEs, general AEs, or serious AEs were similar across the four vaccination groups. In conclusion, the demonstration of consistency between the manufacturing lots confirms for the purposes of clinical development the reliability of the EV71 vaccine production process. (This study has been registered at ClinicalTrials.gov under registration no. NCT01636245.)

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Enterovirus 71–associated Hand, Foot, and Mouth Disease, Southern Vietnam, 2011

Cited by 116 publications

References 12 publications

Monitoring Antigenic Variations of Enterovirus 71: Implications for Virus Surveillance and Vaccine Development

Monitoring Antigenic Variations of Enterovirus 71: Implications for Virus Surveillance and Vaccine Development

Epidemiological characteristics and pathogens attributable to hand, foot, and mouth disease in Shanghai, 2008–2013

Immunogenicity, Safety, and Lot Consistency of a Novel Inactivated Enterovirus 71 Vaccine in Chinese Children Aged 6 to 59 Months

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