Epidemics and aetiology of hand, foot and mouth disease in Xiamen, China, from 2008 to 2015

Abstract

Over the past 8 years, human enteroviruses (HEVs) have caused 27 227 cases of hand, foot and mouth disease (HFMD) in Xiamen, including 99 severe cases and six deaths. We aimed to explore the molecular epidemiology of HFMD in Xiamen to inform the development of diagnostic assays, vaccines and other interventions. From January 2009 to September 2015, 5866 samples from sentinel hospitals were tested using nested reverse transcription PCR that targeted the HEV 5' untranslated region and viral protein 1 region. Of these samples, 4290 were tested positive for HEV and the amplicons were sequenced and genotyped. Twenty-two genotypes were identified. Enterovirus 71 (EV71) and coxsackieviruses A16, A6 and A10 (CA16, CA6 and CA10) were the most common genotypes, and there were no changes in the predominant lineages of these genotypes. EV71 became the most predominant genotype every 2 years. From 2013, CA6 replaced CA16 as one of the two most common genotypes. The results demonstrate the vast diversity of HFMD pathogens, and that minor genotypes are able to replace major genotypes. We recommend carrying-out long-term monitoring of the full spectrum of HFMD pathogens, which could facilitate epidemic prediction and the development of diagnostic assays and vaccines.

Epidemiology of Recurrent Hand, Foot and Mouth Disease, China, 2008–2015

“…Phylogenetic analysis of viral protein 1 gene sequences revealed that the EV-A71 genotype circulating in China since 2008 has been C4 ( 38 – 42 ); hence, the monovalent EV-A71 vaccines licensed in China were designed to target the C4 genotype. B1 has been reported to be the predominant genotype of CV-A16 circulating in China ( 40 – 43 ). Therefore, we reasonably conclude that in our cohort HFMD recurrences involving reinfections with enteroviruses of the same serotype were also highly likely reinfections with the same genotype.…”

miR-1303 regulates BBB permeability and promotes CNS lesions following CA16 infections by directly targeting MMP9

“…However, accumulating evidence in recent years has demonstrated that CA16 might actually be more virulent in children and has induced severe cases of CNS complications and fatal outcomes, which were similar to those of EV71 infections 6 . Furthermore, some severe and fatal HFMD cases with CA6 and CA10 infections have shown a clear increasing trend in recent years 7 . Taken together, these findings demonstrate that it is important to explore the underlying molecular basis of HFMD pathogenesis and progression induced by CA16 infections, which might provide novel approaches for the development of vaccines that cover multiple species of enterovirus.…”

Temperature and humidity affect the incidence of hand, foot, and mouth disease: a systematic review of the literature – a report from the International Society of Dermatology Climate Change Committee

“…Hand, foot, and mouth disease (HFMD) is a condition caused by human enteroviruses (HEVs), which belong to the Picornaviridae family . There are more than 100 types of HEVs, including poliovirus, coxsackie A and B viruses, echoviruses, and enteroviruses .…”

“…In Singapore, where HFMD has been a legally notifiable communicable disease since 2000, the largest outbreak in the history of the country occurred in 2008, when a total of 29,686 cases were seen, including four cases of encephalitis and one fatality . In China, the world's most populous nation and the country with the vast majority of cases, HFMD is responsible for millions of infections and 500–900 reported deaths every year, mainly in young children . Its first large‐scale epidemic with a high number of fatal cases (6,049 cases and 22 fatalities) occurred in Fuyang City, Anhui Province, in the spring of 2008 .…”