Hostname: page-component-76fb5796d-45l2p Total loading time: 0 Render date: 2024-04-25T11:11:04.974Z Has data issue: false hasContentIssue false
  • English
  • Français

Profiles of Human Enteroviruses Associated with Hand, Foot, and Mouth Disease in Nanjing, China

Published online by Cambridge University Press:  01 February 2019

Qian Chen ,
Qihua Zhang  and
Zheng Hu
Qian Chen
Affiliation:
Institute of Pediatrics, Children’s Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
Qihua Zhang
Affiliation:
Institute of Pediatrics, Children’s Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
Zheng Hu*
Affiliation:
Institute of Pediatrics, Children’s Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
*
Correspondence and reprint requests to Zheng Hu, Institute of Pediatrics, Children’s Hospital of Nanjing Medical University, No.72 Guangzhou Road, Nanjing, Jiangsu 210008, China (e-mail: hz18951769051@163.com).
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective

Hand, foot, and mouth disease (HFMD) is a common infectious disease caused by a group of viruses. The causative viruses have changed over time, and there is a need for a more effective protective vaccine. In this study, we investigated the profiles of human enteroviruses that caused HFMD outbreaks in Nanjing in 2015, with the goal of guiding the future prevention and treatment of HFMD.

Methods

Specimens were collected from 1097 patients admitted to our hospital and diagnosed with HFMD. Enteroviruses in the specimens were identified by real-time polymerase chain reaction and epidemiological patterns were analyzed with the clinical data.

Results

Among the 1097 clinically diagnosed HFMD cases, 916 cases were confirmed by laboratory tests. The results showed that the main infectious virus was coxsackievirus A6 (CVA6) (41.75%), followed by enterovirus 71 (EV71) (27.48%), coxsackievirus A16 (7.43%), coxsackievirus A10 (6.84%), and others (16.51%). Further investigation indicated that CVA6 caused mild cases of HFMD, while EV71 caused severe cases. More enterovirus positive cases were reported from rural areas than from urban areas.

Conclusions

CA6 and EV71 were the chief pathogenic viruses of HFMD cases in the present study. Schools, childcare centers, and families from rural areas should be the major targets for prevention and awareness of HFMD. This study will provide information useful in the prevention and management of HFMD and the development of relevant vaccines for HFMD in the future. (Disaster Med Public Health Preparedness. 2019;13:740–744).

Keywords

hand, foot, and mouth diseasecoxsackievirus A6enterovirus 71epidemiological monitoring
Type
Original Research
Information
Disaster Medicine and Public Health Preparedness , Volume 13 , Issue 4 , August 2019 , pp. 740 - 744
Copyright
Copyright © 2019 Society for Disaster Medicine and Public Health, Inc. 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

Repass, GL, Palmer, WC, Stancampiano, FF. Hand, foot, and mouth disease: identifying and managing an acute viral syndrome. Cleve Clin J Med. 2014;81(9):537–543.CrossRefGoogle ScholarPubMed
Nassef, C, Ziemer, C, Morrell, DS. Hand-foot-and-mouth disease: a new look at a classic viral rash. Curr Opin Pediatr. 2015;27(4):486–491.CrossRefGoogle Scholar
Chang, LY, Lin, TY, Huang, YC, et al. Comparison of enterovirus 71 and coxsackie-virus A16 clinical illnesses during the Taiwan enterovirus epidemic, 1998. Pediatr Infect Dis J. 1999;18(12):1092–1096.CrossRefGoogle ScholarPubMed
Blomqvist, S, Klemola, P, Kaijalainen, S, et al. Co-circulation of coxsackieviruses A6 and A10 in hand, foot and mouth disease outbreak in Finland. J Clin Virol. 2010;48(1):49–54.CrossRefGoogle ScholarPubMed
Bracho, MA, Gonzalez-Candelas, F, Valero, A, et al. Enterovirus co-infections and onychomadesis after hand, foot, and mouth disease, Spain, 2008. Emerg Infect Dis. 2011;17(12):2223–2231.CrossRefGoogle Scholar
Wu, Y, Yeo, A, Phoon, MC, et al. The largest outbreak of hand; foot and mouth disease in Singapore in 2008: the role of enterovirus 71 and coxsackievirus A strains. Int J Infect Dis. 2010;14(12):e1076–e1081.CrossRefGoogle ScholarPubMed
Lo, SH, Huang, YC, Huang, CG, et al. Clinical and epidemiologic features of Coxsackievirus A6 infection in children in northern Taiwan between 2004 and 2009. J Microbiol Immunol Infect. 2011;44(4):252–257.CrossRefGoogle ScholarPubMed
Fujimoto, T, Iizuka, S, Enomoto, M, et al. Hand, foot, and mouth disease caused by coxsackievirus A6, Japan, 2011. Emerg Infect Dis. 2012;18(2):337–339.CrossRefGoogle ScholarPubMed
Gopalkrishna, V, Patil, PR, Patil, GP, et al. Circulation of multiple enterovirus serotypes causing hand, foot and mouth disease in India. J Med Microbiol. 2012;61(Pt 3):420–425.CrossRefGoogle ScholarPubMed
Mirand, A, Henquell, C, Archimbaud, C, et al. Outbreak of hand, foot and mouth disease/herpangina associated with coxsackievirus A6 and A10 infections in 2010, France: a large citywide, prospective observational study. Clin Microbiol Infect. 2012;18(5):E110–E118.Google Scholar
He, YQ, Chen, L, Xu, WB, et al. Emergence, circulation, and spatiotemporal phylogenetic analysis of coxsackievirus a6- and coxsackievirus a10-associated hand, foot, and mouth disease infections from 2008 to 2012 in Shenzhen, China. J Clin Microbiol. 2013;51(11):3560–3566.CrossRefGoogle ScholarPubMed
Lu, QB, Zhang, XA, Wo, Y, et al. Circulation of Coxsackievirus A10 and A6 in hand-foot-mouth disease in China, 2009-2011. PLoS One. 2012;7(12):e52073.CrossRefGoogle Scholar
Guan, H, Wang, J, Wang, C, et al. Etiology of multiple non-EV71 and non-CVA16 enteroviruses associated with hand, foot and mouth disease in Jinan, China, 2009-June 2013. PLoS One. 2015;10(11):e142733.CrossRefGoogle Scholar
Hu, YQ, Xie, GC, Li, DD, et al. Prevalence of Coxsackievirus A6 and Enterovirus 71 in hand, foot and mouth disease in Nanjing, China in 2013. Pediatr Infect Dis J. 2015;34(9):951–957.CrossRefGoogle ScholarPubMed
Xing, W, Liao, Q, Viboud, C, et al. Hand, foot, and mouth disease in China, 2008-12: an epidemiological study. Lancet Infect Dis. 2014;14(4):308–318.CrossRefGoogle Scholar
Yang, F, Ren, L, Xiong, Z, et al. Enterovirus 71 outbreak in the People’s Republic of China in 2008. J Clin Microbiol. 2009;47(7):2351–2352.CrossRefGoogle ScholarPubMed
Zhang, Y, Tan, XJ, Wang, HY, et al. An outbreak of hand, foot, and mouth disease associated with subgenotype C4 of human enterovirus 71 in Shandong, China. J Clin Virol. 2009;44(4):262–267.CrossRefGoogle ScholarPubMed
Zhang, Y, Zhu, Z, Yang, W, et al. An emerging recombinant human enterovirus 71 responsible for the 2008 outbreak of hand foot and mouth disease in Fuyang city of China. Virol J. 2010;7:94.CrossRefGoogle ScholarPubMed
Liu, Q, Tong, X, Huang, Z. Towards broadly protective polyvalent vaccines against hand, foot and mouth disease. Microbes Infect. 2015;17(2):155–162.CrossRefGoogle ScholarPubMed
Liu, WD, Wu, Y, Liang, Q, et al. Epidemiological characteristics and temporal-spatial clustering analysis on hand-foot-mouth disease in Jiangsu province, 2009–2011 [in Chinese]. Zhonghua Liu Xing Bing Xue Za Zhi. 2012;33(8):813–817.Google Scholar
Chen, Z, Sun, H, Yan, Y, et al. Epidemiological profiles of hand, foot, and mouth disease, including meteorological factors, in Suzhou, China. Arch Virol. 2015;160(1):315–321.CrossRefGoogle Scholar
Zhang, Q, MacDonald, NE, Smith, JC, et al. Severe enterovirus type 71 nervous system infections in children in the Shanghai region of China: clinical manifestations and implications for prevention and care. Pediatr Infect Dis J. 2014;33(5):482–487.CrossRefGoogle ScholarPubMed
Zou, XN, Zhang, XZ, Wang, B, et al. Etiologic and epidemiologic analysis of hand, foot, and mouth disease in Guangzhou city: a review of 4,753 cases. Braz J Infect Dis. 2012;16(5):457–465.CrossRefGoogle Scholar
Ang, LW, Koh, BK, Chan, KP, et al. Epidemiology and control of hand, foot and mouth disease in Singapore, 2001-2007. Ann Acad Med Singapore. 2009;38(2):106–112.Google Scholar
Chen, KT, Chang, HL, Wang, ST, et al. Epidemiologic features of hand-foot-mouth disease and herpangina caused by enterovirus 71 in Taiwan, 1998-2005. Pediatrics. 2007;120(2):e244–e252.CrossRefGoogle Scholar