Molecular Epidemiological Study of Hand, Foot, and Mouth Disease in a Kindergarten-Based Setting in Bangkok, Thailand

Thammasonthijarern, Nipa; Kosoltanapiwat, Nathamon; Nuprasert, Warisa; Sittikul, Pichamon; Sriburin, Pimolpachr; Pan-ngum, Wirichada; Maneekan, Pannamas; Hataiyusuk, Somboon; Hattasingh, Weerawan; Thaipadungpanit, Janjira; Chatchen, Supawat

doi:10.3390/pathogens10050576

Cited by 12 publications

(16 citation statements)

References 37 publications

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“…Researchers proposed that unique amino acid substitutions of CV-A6 strains might lead to changes in virological characteristics such as antigenicity and had been emerged every 2 years to cause epidemics ( 20 ). As there were no samples tested EV-A71 positive, our result did not conform with some findings, where EV-A71 was with a large proportion ( 21 , 22 ). This may result from territorial differences, revealing the necessity of strengthening disease surveillance.…”

Section: Discussioncontrasting

confidence: 99%

Molecular Epidemiology of Herpangina Children in Tongzhou District, Beijing, China, During 2019-2020

et al. 2022

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BackgroundThe changing pattern of pathogen spectrum causing herpangina in the time of coronavirus disease 2019 (COVID-19) pandemic was unknown. The purpose of this study was to investigate the changes on the molecular epidemiology of herpangina children during 2019-2020 in Tongzhou district, Beijing, China.MethodFrom January 2019 to December 2020, children diagnosed with herpangina were recruited by the staff from Tongzhou Center for Disease Control and Prevention (CDC) in Beijing. Viral RNA extraction from pharyngeal swabs was used for enterovirus (EV) detection and the complete VP1 gene was sequenced. The phylogenetic analysis was performed based on all VP1 sequences for EV genotypes.ResultA total of 1,331 herpangina children were identified during 2019-2020 with 1,121 in 2019 and 210 in 2020, respectively. The predominant epidemic peak of herpangina children was in summer and autumn of 2019, but not observed in 2020. Compared to the number of herpangina children reported in 2019, it decreased sharply in 2020. Among 129 samples tested in 2019, 61 (47.3%) children were detected with EV, while 22.5% (20/89) were positive in 2020. The positive rate for EV increased since June 2019, peaked at August 2019, and decreased continuously until February 2020. No cases were observed from February to July in 2020, and the positive rate of EV rebounded to previous level since August 2020. Four genotypes, including coxsackievirus A6 (CV-A6, 9.3%), CV-A4 (7.8%), CV-A10 (2.3%) and CV-A16 (10.1%), were identified in 2019, and only three genotypes, including CV-A6 (9.0%), CV-A10 (6.7%) and CV-A16 (1.1%), were identified in 2020. The phylogenetic analysis showed that all CV-A6 strains from Tongzhou located in Group C, and the predominant strains mainly located in C2-C4 subgroups during 2016-2018 and changed into C1 subgroup during 2018-2020. CV-A16 strains mainly located in Group B, which consisting of strains widely distributed around the world.ConclusionsThe predominant genotypes gradually shifted from CV-A16, CV-A4 and CV-A6 in 2019 to CV-A6 in 2020 under COVID-19 pandemic. Genotype-based surveillance will provide robust evidence and facilitate the development of public health measures.

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Section: Discussioncontrasting

confidence: 99%

Molecular Epidemiology of Herpangina Children in Tongzhou District, Beijing, China, During 2019-2020

et al. 2022

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“…We also found that children under 5 years are the main morbid population, accounting for 94.17% of all reported cases. The result was consistent with other research’s findings in other countries and China [ 1 , 6 , 46 , 50 ]. The low incidence of children over 5 years old maybe because they have had HFMD before, thereby protecting them and their peers from HFMD [ 61 ].…”

Section: Discussionsupporting

confidence: 93%

“…However, the interrupted time series analysis results indicated that, after the introduction of the vaccine, the incidence of HFMD showed an upward trend, and increased faster than before in mainland China. The incidence of HFMD in Mainland China was 169.41 per 100,000 in 2018, which was only lower than the incidence in 2014 and 2016, higher than Thailand’s incidence rate of 102.51/100,000 [ 46 ] and Malaysia’s incidence rate of 138.6/100,000 [ 47 ]. So, the incidence of HFMD was still at a high level in mainland China in 2018.…”

Section: Discussionmentioning

confidence: 99%

Spatiotemporal cluster patterns of hand, foot, and mouth disease at the province level in mainland China, 2011–2018

Wang

Zhao

et al. 2022

PLoS ONE

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Although three monovalent EV-A71 vaccines have been launched in mainland China since 2016, hand, foot, and mouth disease (HFMD) still causes a considerable disease burden in China. Vaccines’ use may change the epidemiological characters of HFMD. Spatial autocorrelation analysis and space-time scan statistics analysis were used to explore the spatiotemporal distribution pattern of this disease at the provincial level in mainland China. The effects of meteorological factors, socio-economic factors, and health resources on HFMD incidence were analyzed using Geodetector. Interrupted time series (ITS) was used to analyze the impact of the EV-A71 vaccine on the incidence of HFMD. This study found that the median annual incidence of HFMD was 153.78 per 100,000 (ranging from 120.79 to 205.06) in mainland China from 2011 to 2018. Two peaks of infections were observed per year. Children 5 years and under were the main morbid population. The spatial distribution of HFMD was presented a significant clustering pattern in each year (P<0.001). The distribution of HFMD cases was clustered in time and space. The range of cluster time was between April and October. The most likely cluster appeared in the southern coastal provinces (Guangxi, Guangdong, Hainan) from 2011 to 2017 and in the eastern coastal provinces (Shanghai, Jiangsu, Zhejiang) in 2018. The spatial heterogeneity of HFMD incidence could be attributed to meteorological factors, socioeconomic factors, and health resource. After introducing the EV-A71 vaccine, the instantaneous level of HFMD incidence decreased at the national level, and HFMD incidence trended downward in the southern coastal provinces and increased in the eastern coastal provinces. The prevention and control policies of HFMD should be adapted to local conditions in different provinces. It is necessary to advance the EV-A71 vaccination plan, expand the vaccine coverage and develop multivalent HFMD vaccines as soon as possible.

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“…Regression analysis of Dingxi City with a high proportion of EC and SI also shows that there was a linear positive relationship between EC and SI. Other factors, such as gatherings of people [ 52 , 53 ] and levels of vaccine coverage [ 54 , 55 ] may also influence the relationship between EC and SI, which need further investigation in future studies. Furthermore, this may provide scientific evidence for health administrative departments to formulate HFMD prevention, control strategies, and the distribution of health resources when monitoring the patterns of EC.…”

Section: Discussionmentioning

confidence: 99%

Prototypes virus of hand, foot and mouth disease infections and severe cases in Gansu, China: a spatial and temporal analysis

Liu

Zhang

et al. 2022

BMC Infect Dis

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Background Little research has been conducted on the spatio-temporal relationship between the severe cases and the enteroviruses infections of hand, foot and mouth disease (HFMD). This study aimed to investigate epidemic features and spatial clusters of HFMD incidence rates and assess the relationship between Enterovirus 71 (EV71) and Coxsackievirus A16 (CoxA16) and severe cases of HMFD in Gansu province, China. Methods Weekly county-specific data on HFMD between 1st January and 31st December 2018 were collected from the China Infectious Disease Information System (CIDIS), including enterovirus type (EV71 and CoxA16), severe and non-severe cases in Gansu province, China. Temporal risk [frequency index (α), duration index (β) and intensity index (γ)] and spatial cluster analysis were used to assess epidemic features and identify high-risk areas for HFMD. Time-series cross-correlation function and regression model were used to explore the relationship between the ratios of two types of viruses (i.e. EV71/Cox16) (EC) and severe cases index (i.e. severe cases/non-severe cases) (SI) of HFMD. Results Some counties in Dingxi City, Gansu were identified as a hot spot for the temporal risk indices. Time-series cross-correlation analysis showed that SI was significantly associated with EC (r = 0.417, P < 0.05) over a 4-week time lag. The regression analysis showed that SI was positively associated with EC (β = 0.04, 95% confidence interval (CI) 0.02–0.06). Conclusion The spatial patterns of HFMD incidence were associated with enteroviruses in Gansu. The research suggested that the EC could be considered a potential early warning sign for predicting severe cases of HFMD in Gansu province.

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Molecular Epidemiological Study of Hand, Foot, and Mouth Disease in a Kindergarten-Based Setting in Bangkok, Thailand

Cited by 12 publications

References 37 publications

Molecular Epidemiology of Herpangina Children in Tongzhou District, Beijing, China, During 2019-2020

Molecular Epidemiology of Herpangina Children in Tongzhou District, Beijing, China, During 2019-2020

Spatiotemporal cluster patterns of hand, foot, and mouth disease at the province level in mainland China, 2011–2018

Prototypes virus of hand, foot and mouth disease infections and severe cases in Gansu, China: a spatial and temporal analysis

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