Pathogenic characteristics of hand, foot and mouth disease in Shaanxi Province, China, 2010–2016

Abstract

Hand, foot, and mouth disease (HfMD) is a common childhood illness caused by enteroviruses. We analyzed the pathogenic characteristics of HFMD in Shaanxi province, China, during 2010-2016. clinical samples were collected from HfMD cases. Real-time pcR and Rt-pcR were used to identify the enterovirus(EVs) serotypes. Viral RNA sequences were amplified using RT-PCR and compared by phylogenetic analysis. Descriptive epidemiological methods were used to analyze. A total of 16,832 HFMD positive cases were confirmed in the laboratory. EV-A71 and CV-A16 were the main pathogens in 2010. EV-A71 was the dominant pathogen in the periods of 2011 to 2012 and 2014, 2016. In 2013 and 2015, other EVs increased greatly, in which CV-A6 was the predominant pathogen. EV-A71 was more frequently detected in deaths and severe cases. Phylogenetic analysis revealed that EV-A71 belonged to the C4a evolution branch of C4 sub-genotype and CV-A16 belonged to the B1a or B1b evolution branch of B1 sub-genotype, whereas CV-A6 strains were assigned to D2 or D3 sub-genotype. The pathogen spectrum of HFMD has changed in 7 years, and the major serotypes EV-A71, CV-A16 and CV-A6 alternated or co-circulated. Long-term surveillance and research of EVs should be strengthened for the prevention and control of HfMD. Hand foot and mouth disease (HFMD) is a common infectious disease in children caused by human enterovirus (EV) 1-3. The main clinical manifestations of HFMD are fever, rash on the palms, soles, mouth and buttocks. Most HFMD patients have a good prognosis. A few patients may have complications such as aseptic meningitis, encephalitis, acute flaccid paralysis, neurogenic pulmonary edema and myocarditis. Individual severe children may die due to exacerbations 3-5. Since the outbreak of HFMD in Anhui Province in March 2008 6 , there has been a widespread epidemic in mainland of China 7-9. It has become one of the main public health problems which seriously endanger the health of infants and young children. EVs belong to the family of Picornaviridae, enterovirus genus 10. A variety of EVs can cause HFMD. According to its gene and antigen characteristics, EVs can be divided into four species: EV-A, EV-B, EV-C, and EV-D. Human enterovirus 71 (EV-A71) and Coxsackievirus A16 (CV-A16) in EV-A species are generally considered to be the common and major pathogens causing HFMD 11-13. In recent years, however, more and more studies have shown that other EVs also play an important role in the outbreak or epidemic of HFMD 14-18. In particular, CV-A6 has replaced EV-A71 and CV-A16 as the main pathogen for the outbreak or epidemic of HFMD in mainland of China since 2012 19-21. The change of pathogen spectrum put forward a new challenge to the prevention and control of HFMD. In this study, we analyzed the pathogenic characteristics of HFMD in Shaanxi province during 2010-2016, and clarified the epidemiological characteristics and pathogen spectrum changes of HFMD. It could provide scientific basis for prevention and control of HFMD in Shaanxi Province. Results P...

Molecular characterization and epidemiological aspects of non-polio enteroviruses isolated from acute flaccid paralysis in Brazil: a historical series (2005–2017)

“…Although an increasing number of HFMD and aseptic meningitis cases associated with CVA6/CVA16 and E30 infections, respectively, has been reported in Brazil [ 43 , 48 ], an increase isolation rate of these EV-types was not observed among AFP patients. Consistently, even in countries with a high prevalence of these EVs, such as China and Brazil, these viral types seem to be poorly involved in AFP disease [ 43 , 48 , 49 ].…”

Neurological Disease Associated With Enterovirus Infection: Retrospective Analysis of Risk Factors in a Pediatric Population

“…In Asia, due to HFMD outbreaks with neurological involvement, more studies are found from 2010. Between 2010 and 2016, the EV-A71 and coxsackievirus A16 (CV-A16) were the two most common genotypes associated with HFMD in Shanghai, China [22]. Although that study reported a clear association between EV-A71 and worse clinical outcomes, the authors did not specify the type of neurological involvement, which makes it difficult to compare those findings to our results.…”

Oscillatory properties of class C notifiable infectious diseases in China from 2009 to 2021

“…To our knowledge, this is the first work to directly investigate the oscillatory properties of the nine class C infectious diseases together in mainland China. Previous studies mostly targeted one specific disease [Influenza (55), Mumps (56)(57)(58)(59)(60), Rubella (61)(62)(63), AHC (64)(65)(66)(67)(68), Leprosy (69-72), Typhus (73)(74)(75)(76), Leishmaniasis (77,78), Hydatid disease (79-81), HFMD (82)(83)(84)(85)(86)], more in a statistical description sense on the numbers, ratios, or dissecting multiple components to fit the data. These studies seldom investigated these diseases directly from the oscillatory view, but we focused more on the ubiquitous oscillatory property of these class C diseases together to find some common laws as a whole.…”