An epidemic analysis of hand, foot, and mouth disease in Zunyi, China between 2012 and 2014

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Abstract

Objectives:

To re-evaluate the epidemiology of hand, foot, and mouth disease (HFMD) in a non-vaccinated population in Zunyi, China.

Methods:

We used laboratory-based data from the Third Affiliated Hospital of Zunyi Medical College, Zunyi, China to assess the epidemiology of the HFMD caused by enteroviruses between January 2012 and November 2014. Real-time polymerase chain reaction was used to determine human enteroviruses from a total of 12313 probable cases enrolled in this retrospective study. All analyses were stratified by enterovirus serotype, gender, and age.

Results:

Virological results were available for 12313 cases of probable HFMD. A total of 5750 cases were positive for viral detection, and the positive rates of infection caused by other enteroviruses was 46.7%, EV71 9%, and CVA16 4.7%. During the study period there was a substantial increase in the occurrence of HFMD. Most of the HFMD patients (87.4%) were aged 0-59 months (median 24; range 0-59). Males showed a higher HFMD prevalence rate (62.4%) than females (37.6%).

Conclusion:

Enterovirus infection remains an important public health problem and other entroviruses are emerging as the major causative agent of the HFMD in Zunyi, China.

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Most cited references 12

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An outbreak of hand, foot, and mouth disease associated with subgenotype C4 of human enterovirus 71 in Shandong, China.

Yong Zhang, Xiao-Juan Tan, Hai-Yan Wang … (2009)

An outbreak of hand, foot, and mouth disease (HFMD) included 1149 people in Linyi City, Shandong Province, China, in 2007: three children died. To characterize the pathogens responsible for this outbreak and to analyze their genetic features. A total of 233 clinical specimens were collected from 105 hospitalized patients, including 11 patients with severe HFMD. Virological investigations (direct RT-PCR, viral isolation and molecular identification) and phylogenetic analysis were performed. Human enterovirus 71 (HEV71) was the main pathogen that caused this outbreak, based on clinical manifestations, epidemiological data, and laboratory results. Phylogenetic analysis indicated that the Shandong HEV71 isolates belonged to 3 lineages in subgenotype C4. Subgenotype C4 could be further divided into two clusters (C4a and C4b), which corresponded to two time periods. Cluster C4a HEV71 has been the predominant virus circulating in mainland China in the past 5 years. The 2007 HFMD outbreak was mainly caused by HEV71 subgenotype C4 with 3 transmission chains. This virus has been continuously circulating in China since 1998. The Shandong strains co-evolved with isolates from other provinces in mainland China and neighboring countries.

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Enterovirus 71 in Taiwan.

Luan-Yin Chang (2008)

The enterovirus 71 (EV71) outbreak in Taiwan in 1998 proved fatal in many children. A seroepidemiological study performed prior to the 1998 outbreak showed pre-epidemic (1997) EV71 seroprevalence rates to be about 60-70% in adults and children older than 6 years of age. A retrospective case review carried out from 1980-81 identified 16 cases of hand, foot and mouth disease associated with central nervous system involvement, two of whom died soon after hospitalization. There were 405 severe cases and 78 deaths reported in the 1998 epidemic, and dozens of fatal EV71 cases were still reported from 2000 to 2002. A stage-based management strategy was developed to reduce fatality, but most survivors of brainstem encephalitis with cardiopulmonary failure have neurologic sequelae and impaired cognition. Continuous clinical and laboratory surveillance of EV71 disease is required to enable earlier implementation of control and prevention measures. Development of EV71-specific antiviral therapy, a novel class of imidazolidinones, and development of a vaccine are ongoing.

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Characterization of Full-Length Enterovirus 71 Strains from Severe and Mild Disease Patients in Northeastern China

Xiaomei Wang, Chunfeng Zhu, Wanguo Bao … (2012)

Human enterovirus 71 (EV71)-associated hand, foot, and mouth disease (HFMD) has been a leading cause of childhood infection in China since 2008. Epidemic and molecular characteristics of HFMD have been examined in many areas of China, including the central and southern regions. However, clinical and genetic characterization of EV71 in the northeastern region of China is scarce. In this study, a series of analyses were performed on seven full-length EV71 sequences from HFMD patients who had either severe or mild disease. We have determined that these seven circulating EV71 viruses from Changchun, China are actually complex recombinant viruses involving multiple type A human enterovirus (HEV). Classified as EV71 subtype C4 (EV71 C4), these Changchun EV71 viruses contain genetic recombination events between the CA4, CA5, EV71B4 and EV71C1 strains. Most of the structural protein region (P1) of these viruses resembled that of the prototype EV71 C1 strains. The non-structural protein domains (P2 and P3) showed a high degree of similarity with CA4, CA5 and EV71 B4 in different regions. The 5′UTR had unclassified recombination,while partial 3D region of these viruses showed a high degree of similarity to CA16. Phylogenetic analysis of full-length or partial sequences of isolates from severe or mild disease patients in Changchun always formed a single cluster in various phylogenetic analyses of different genomic regions, suggesting that all seven strains originated from one single common ancestor. There was no correlation between viral genomic sequence and virulence. Thus, we found that circulating recombinant forms of EV71 are prevalent among HFMD patients in Northeastern China. The existence of a unique cluster of EV71 related viruses in Northeast China has important implications for vaccine development that would address the increasing prevalence of HFMD.

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Journal

Journal ID (nlm-ta): Saudi Med J

Journal ID (iso-abbrev): Saudi Med J

Journal ID (publisher-id): SaudiMedJ

Title: Saudi Medical Journal

Publisher: Saudi Medical Journal (Saudi Arabia )

ISSN (Print): 0379-5284

ISSN (Electronic): 1658-3175

Publication date (Print): May 2015

Volume: 36

Issue: 5

Pages: 593-598

Affiliations

[1] From the Departments of Pediatric Health Care (Zhang), Pediatrics (Huang), and Laboratory Medicine (She, Liu, Tong, Wang, Wu), The Third Affiliated Hospital of Zunyi Medical College, Zunyi, China

Author notes

Address correspondence and reprint request to: Dr. Kaifeng Wu, Department of Laboratory Medicine, The Third Affiliated Hospital of Zunyi Medical College, Zunyi 563000, China. E-mail: kiphoonwu@ 123456126.com

Article

Publisher ID: SaudiMedJ-36-593

DOI: 10.15537/smj.2015.5.10859

PMC ID: 4436757

PubMed ID: 25935181

SO-VID: ea4b78bc-946c-41e1-960b-56d14f2521d2

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

An epidemic analysis of hand, foot, and mouth disease in Zunyi, China between 2012 and 2014

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Abstract

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Most cited references 12

An outbreak of hand, foot, and mouth disease associated with subgenotype C4 of human enterovirus 71 in Shandong, China.

Enterovirus 71 in Taiwan.

Characterization of Full-Length Enterovirus 71 Strains from Severe and Mild Disease Patients in Northeastern China

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