The epidemiological characteristics of enterovirus infection before and after the use of enterovirus 71 inactivated vaccine in Kunming, China

Jiang, Hongchao; Zhang, Zhen; Rao, Qing; Wang, Xiaodan; Wang, Meifen; Du, Tingyi; Tang, Jiaolian; Long, Shuying; Zhang, Juan; Luo, Jia; Pan, Yue; Chen, Junying; Ma, Jing; Liu, Xiaomei; Mao, Fan; Zhang, Tiesong; Sun, Qiangming

doi:10.1080/22221751.2021.1899772

Cited by 32 publications

(38 citation statements)

References 32 publications

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“…The introduction of the EV-A71 immunisation in 2016 resulted in a significant decrease in both the number of patients with EV-A71-related HFMD and severe cases, demonstrating the favourable effect of the vaccination campaign. A longitudinal surveillance study conducted in Chengdu, a big city in southwest China, revealed the initial evidence for the effectiveness of the programmatic vaccination against EV71, in line with subsequent studies in some other regions [5, 17, 18]. Except for the decline of the EV71 prevalence, the pathogen spectrum associated with HFMD were also altered as reported in these studies.…”

Section: Discussionsupporting

confidence: 71%

Multiple molecular characteristics of circulating enterovirus types among paediatric hand, foot and mouth disease patients after EV71 vaccination campaign in Wuxi, China

et al. 2022

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The molecular properties of the circulating causative agents of hand, foot and mouth disease (HFMD) in Wuxi remain unclear, posing diagnostic and prevention challenges. Additionally, in several regions of mainland China, the EV71 immunisation drastically reduced related cases and altered the HFMD pathogen spectrum, while the precise situation in Wuxi remained unknown. To address these issues, paediatric HFMD cases diagnosed in the clinic were enrolled and anal swabs were acquired in the spring of 2019. The 5′-UTR and VP1 genes were interpreted using RT-nPCR with degenerate primers to confirm their genotypes. Following that, the entire genome sequences of each viral type were recovered, allowing for the interpretation of several molecular properties. A total of 249 clinically confirmed HFMD cases had their anal swabs taken for viral identification, from which the genome sequences of seven genotypes were recovered. Coxsackievirus A16 is the most prevalent type, followed by Coxsackievirus A6, A10, A2, A4, A5 and Echovirus 11, all of which were genetically determined for the first time in Wuxi. Phylogenetic and recombination analyses were used to evaluate their evolutionary relationships with other strains found in other regions. Noticeably, a CVA16 subtype, responsible for a large proportion of the observed cases, phylogenetically clustered within clade B1a along with some strains from other countries, was the first one to be reported in China. Furthermore, some recombination events were inferred from strains detected in sporadic cases, particularly the recombination between CVA2 and CVA5 strains. Our investigation elucidated the multiple molecular characteristics of the HFMD causal enterovirus strains in Wuxi, underlining the potential hazards associated with these circulating viral types in the population and aiding in future surveillance and prevention of this disease.

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Section: Discussionsupporting

confidence: 71%

Multiple molecular characteristics of circulating enterovirus types among paediatric hand, foot and mouth disease patients after EV71 vaccination campaign in Wuxi, China

et al. 2022

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“…Many EVs, including echoviruses, cocirculated in both sporadic and epidemic cases of HFMD 14 – 18 . Since the introduction of an inactivated EV-A71 vaccine, the prevalent etiological agents of HFMD have changed, and CV-A6 has become the main pathogen in mainland China 24 , 25 . EVs, and especially echoviruses, are the major agents of aseptic meningitis 3 – 5 , and EV-B, including echoviruses, can also cause HFMD 18 – 20 .…”

Section: Discussionmentioning

confidence: 99%

Molecular characterization of echovirus 9 strains isolated from hand-foot-and-mouth disease in Kunming, Yunnan Province, China

Zhang

Guo

et al. 2022

Sci Rep

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Echovirus 9 (E9) belongs to the species Enterovirus B. So far, 12 whole genome sequences of E9 are available in GenBank. In this study, we determined the whole genomic sequences of five E9 strains isolated from the stools of patients with hand-foot-and-mouth disease in Kunming, Yunnan Province, China, in 2019. Their nucleotide and amino acid sequences shared 80.8–80.9% and 96.4–96.8% identity with the prototype Hill strain, respectively, and shared 99.3–99.9% and 99.1–99.8% mutual identity, respectively. Recombination analyses revealed that intertype recombination had occurred in the 2C and 3D regions of the five Yunnan E9 strains with coxsackieviruses B5 and B4, respectively. This study augmented the whole genome sequences of E9 in the GenBank database and extended the molecular characterization of this virus in China.

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“… 6 , 8 This finding prompted concerns about whether the epidemiology of HFMD will change due to vaccination and whether there might be a shift in serotypes. A few local studies 9 , 10 , 11 , 12 have been conducted to address EV-A71 vaccination impacts, but the evidence generated has been limited. Among the four studies conducted, only periodicity − without risk factor analysis − has been described.…”

Section: Introductionmentioning

confidence: 99%

Changing epidemiology of hand, foot, and mouth disease in China, 2013−2019: a population-based study

Hong

Liu

et al. 2022

The Lancet Regional Health - Western Pacific

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Background Hand, foot, and mouth disease (HFMD) is an important public health problem. A monovalent EV-A71 vaccine was launched in China in 2016. Previous studies showed that inactivated monovalent EV-A71 vaccines were highly efficient against HFMD associated with EV-A71 but not against HFMD with other etiologies, leading to a hypothesis that the introduction of EV-A71 vaccines might change the pathogen spectrum and epidemiological trend of HFMD. In this study, we described for the first time the changing epidemiological characteristics of HFMD after the launch of the EV-A71 vaccine.Methods We extracted individual-based epidemiological data on HFMD cases reported to the Chinese Center for Disease Control and Prevention between January 2013 and December 2019. We described the changing epidemiological characteristics of HFMD before and after vaccine launch according to the distribution of diseases characteristics (demographic, temporal, and geographical) and evaluated the potential changes in risk factors of severe patients. All analyses were stratified by the phase before and after vaccine launch, and by enterovirus serotype.Findings During 2013À2019, 15,316,710 probable cases of HFMD were reported. Of these, 787,197 (5¢1%) were laboratory confirmed and 76,982 (0¢5%) were severe. After the launch of the EV-A71 vaccine, the median age of HFMD patients infected with EV-A71 increased from 2¢24 years (IQR:1¢43, 3¢56) to 2¢81 years (IQR:1¢58, 4¢01). The proportion of patients less than 3 years of age decreased while the proportion of patients 3À5 years of age increased. There was a large decrease (60¢7%) in the proportion of severe cases as well as a decline (28¢3%) in HFMD patients infected with EV-A71. After the launch of the EV-A71 vaccine, the severe illness rate and mortality rate of HFMD patients in all age groups has decreased sharply, 62¢20% and 83¢78% respectively. The timing of the HFMD epidemic peak was delayed (1-2 months) . After the launch of EV-A71 vaccine, the risk of becoming a severe case for EV-A71 serotype was decreased, whereas that risk was instead increased for CV-A16 (from 0¢17 (95% CI:0¢16, 0¢18) to 0¢23 (95% CI:0¢21, 0¢25)) and other enterovirus compared to EV-A71 (from 0¢38 (95% CI:0¢37, 0¢39) to 0¢58 (95% CI:0¢56, 0¢61)). The longer the time from onset to diagnosis, the higher was the risk of being a severe case, but the effect size was decreased.Interpretation The introduction of the EV-A71 vaccine has effectively reduced the proportion of severe HFMD cases and mortality, but changes to the dominant serotypes should be closely monitored. Development of multivalent vaccines to avoid an increased case burden due to other enteroviruses is greatly needed.

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The epidemiological characteristics of enterovirus infection before and after the use of enterovirus 71 inactivated vaccine in Kunming, China

Cited by 32 publications

References 32 publications

Multiple molecular characteristics of circulating enterovirus types among paediatric hand, foot and mouth disease patients after EV71 vaccination campaign in Wuxi, China

Multiple molecular characteristics of circulating enterovirus types among paediatric hand, foot and mouth disease patients after EV71 vaccination campaign in Wuxi, China

Molecular characterization of echovirus 9 strains isolated from hand-foot-and-mouth disease in Kunming, Yunnan Province, China

Changing epidemiology of hand, foot, and mouth disease in China, 2013−2019: a population-based study

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