Epidemic characteristics of hand, foot, and mouth disease in Shanghai from 2009 to 2010: Enterovirus 71 subgenotype C4 as the primary causative agent and a high incidence of mixed infections with coxsackievirus A16

Abstract

EV71 subgenotype C4 was the major causative agent of the HFMD outbreak in Shanghai. A high incidence of mixed infections with EV71 and CA16 was also observed.

VP2 Dominated CD4+ T Cell Responses against Enterovirus 71 and Cross-Reactivity against Coxsackievirus A16 and Polioviruses in a Healthy Population

“…In contrast, no CV-A16-only or CV-A16-superior responses were detected among the study subjects. These findings are in accordance with the EV71-dominated epidemics in China (31,38,39). EV71-dominated neutralizing Ab responses among the study subjects suggested a previous contact of EV71 virus in most of the study subjects and ensured that the investigation of EV71 responsive cellular immunity among these subjects was reasonable and feasible.…”

“…A major concern in the current study might be that whether the T cell responses detected were elicited from nature EV71 exposure, or cross-primed by other enterovirus infection or polioviruses vaccination, especially considering that a proportion of study subjects showed neutralizing titers to both EV71 and CV-A16, and coinfection with EV71 and CV-A16 has been identified in previous studies (39,58). Serial analyses were performed to elucidate this question based on the following findings.…”

Is a multivalent hand, foot, and mouth disease vaccine feasible?

“…Indeed, several mixed EV-A71/CV-A16, EV-A71/ CV-B3, CV-A16/CV-A10, CV-A16/CV-B3, CV-A16/CV-B5, CV-A16/CV-A6, CV-A10/CV-A5, CV-A10/CV-A6, CV-A10/ CV-B1, CV-A10/E-9 infections have been well documented. 29,30,[32][33][34]127,128 The EV-A71 C4 genotype has persisted with progressive drift through time in China. 9,117,126 Intra-genotype EV-A71 B shifts from B3 to B4 (1997)(1998)(1999)(2000) and B4 to B5 (2000)(2001)(2002)(2003) have occurred in Malaysia.…”

Dynamic Constitution of the Pathogens Inducing Encephalitis in Hand, Foot and Mouth Disease in Kunming, 2009–2011

“…Neurological injuries frequently lead to subsequent neurogenic pulmonary edema and abnormal lung function in HFMD patients (10)(11)(12). Pathogenic studies have demonstrated that HFMD is usually caused by infections with enteroviruses such as enterovirus 71 (EV-A71) and coxsakievirus A16 (CV-A16), which constitute 60z-80z of the causative agents of HFMD (13)(14)(15). Viruses such as coxsakievirus A9 (CV-A9), coxsakievirus B4 (CV-B4), and other echoviruses have been reported as other potential causative agents of HFMD (16)(17)(18)(19).…”