101
|
Xiao X, Gasparrini A, Huang J, Liao Q, Liu F, Yin F, Yu H, Li X. The exposure-response relationship between temperature and childhood hand, foot and mouth disease: A multicity study from mainland China. ENVIRONMENT INTERNATIONAL 2017; 100:102-109. [PMID: 28069250 DOI: 10.1016/j.envint.2016.11.021] [Citation(s) in RCA: 96] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 11/16/2016] [Accepted: 11/18/2016] [Indexed: 05/04/2023]
Abstract
BACKGROUND Hand, foot and mouth disease (HFMD) is a rising public health issue in the Asia-Pacific region. Numerous studies have tried to quantify the relationship between meteorological variables and HFMD but with inconsistent results, in particular for temperature. We aimed to characterize the relationship between temperature and HFMD in various locations and to investigate the potential heterogeneity. METHODS We retrieved the daily series of childhood HFMD counts (aged 0-12 years) and meteorological variables for each of 143 cities in mainland China in the period 2009-2014. We fitted a common distributed lag nonlinear model allowing for over dispersion to each of the cities to obtain the city-specific estimates of temperature-HFMD relationship. Then we pooled the city-specific estimates through multivariate meta-regression with city-level characteristics as potential effect modifiers. RESULTS We found that the overall pooled temperature-HFMD relationship was shown as an approximately inverted V shape curve, peaking at the 91th percentile of temperature with a risk ratio of 1.30 (95% CI: 1.23-1.37) compared to its 50th percentile. We found that 68.5% of the variations of city-specific estimates was attributable to heterogeneity. We identified rainfall and altitude as the two main effect modifiers. CONCLUSIONS We found a nonlinear relationship between temperature and HFMD. The temperature-HFMD relationship varies depending on geographic and climatic conditions. The findings can help us deepen the understanding of weather-HFMD relationship and provide evidences for related public health decisions.
Collapse
Affiliation(s)
- Xiong Xiao
- Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, No. 17, Section 3, South Renmin Road, Chengdu, Sichuan 610041, PR China; Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
| | - Antonio Gasparrini
- Department of Social and Environmental Health Research, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK.
| | - Jiao Huang
- Division of Infectious Disease & Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing 102206, PR China; Department of Epidemiology and Statistics & the Ministry of Education (MOE) Key Lab of Environment and Health, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Wuhan, Hubei 430030, PR China.
| | - Qiaohong Liao
- Division of Infectious Disease & Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing 102206, PR China.
| | - Fengfeng Liu
- Division of Infectious Disease & Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing 102206, PR China
| | - Fei Yin
- Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, No. 17, Section 3, South Renmin Road, Chengdu, Sichuan 610041, PR China.
| | - Hongjie Yu
- Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, No. 17, Section 3, South Renmin Road, Chengdu, Sichuan 610041, PR China; Division of Infectious Disease & Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, 155 Changbai Road, Changping District, Beijing 102206, PR China.
| | - Xiaosong Li
- Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, No. 17, Section 3, South Renmin Road, Chengdu, Sichuan 610041, PR China.
| |
Collapse
|
102
|
Gou F, Liu X, Ren X, Liu D, Liu H, Wei K, Yang X, Cheng Y, Zheng Y, Jiang X, Li J, Meng L, Hu W. Socio-ecological factors and hand, foot and mouth disease in dry climate regions: a Bayesian spatial approach in Gansu, China. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2017; 61:137-147. [PMID: 27329324 DOI: 10.1007/s00484-016-1197-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 05/04/2016] [Accepted: 06/05/2016] [Indexed: 06/06/2023]
Abstract
The influence of socio-ecological factors on hand, foot and mouth disease (HFMD) were explored in this study using Bayesian spatial modeling and spatial patterns identified in dry regions of Gansu, China. Notified HFMD cases and socio-ecological data were obtained from the China Information System for Disease Control and Prevention, Gansu Yearbook and Gansu Meteorological Bureau. A Bayesian spatial conditional autoregressive model was used to quantify the effects of socio-ecological factors on the HFMD and explore spatial patterns, with the consideration of its socio-ecological effects. Our non-spatial model suggests temperature (relative risk (RR) 1.15, 95 % CI 1.01-1.31), GDP per capita (RR 1.19, 95 % CI 1.01-1.39) and population density (RR 1.98, 95 % CI 1.19-3.17) to have a significant effect on HFMD transmission. However, after controlling for spatial random effects, only temperature (RR 1.25, 95 % CI 1.04-1.53) showed significant association with HFMD. The spatial model demonstrates temperature to play a major role in the transmission of HFMD in dry regions. Estimated residual variation after taking into account the socio-ecological variables indicated that high incidences of HFMD were mainly clustered in the northwest of Gansu. And, spatial structure showed a unique distribution after taking account of socio-ecological effects.
Collapse
Affiliation(s)
- Faxiang Gou
- Institute for communicable disease control and prevention, Gansu Center for Diseases Prevention and Control, Lanzhou, Gansu, China
| | - Xinfeng Liu
- Institute for communicable disease control and prevention, Gansu Center for Diseases Prevention and Control, Lanzhou, Gansu, China
| | - Xiaowei Ren
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Dongpeng Liu
- Institute for communicable disease control and prevention, Gansu Center for Diseases Prevention and Control, Lanzhou, Gansu, China
| | - Haixia Liu
- Institute for communicable disease control and prevention, Gansu Center for Diseases Prevention and Control, Lanzhou, Gansu, China
| | - Kongfu Wei
- Institute for communicable disease control and prevention, Gansu Center for Diseases Prevention and Control, Lanzhou, Gansu, China
| | - Xiaoting Yang
- Institute for communicable disease control and prevention, Gansu Center for Diseases Prevention and Control, Lanzhou, Gansu, China
| | - Yao Cheng
- Institute for communicable disease control and prevention, Gansu Center for Diseases Prevention and Control, Lanzhou, Gansu, China
| | - Yunhe Zheng
- Institute for communicable disease control and prevention, Gansu Center for Diseases Prevention and Control, Lanzhou, Gansu, China
| | - Xiaojuan Jiang
- Institute for communicable disease control and prevention, Gansu Center for Diseases Prevention and Control, Lanzhou, Gansu, China
| | - Juansheng Li
- Institute of Epidemiology and Health Statistics, School of Public Health, Lanzhou University, Lanzhou, Gansu, China
| | - Lei Meng
- Institute for communicable disease control and prevention, Gansu Center for Diseases Prevention and Control, Lanzhou, Gansu, China.
| | - Wenbiao Hu
- Faculty of Health, Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia.
| |
Collapse
|
103
|
Teo FMS, Chu JJH. Diagnosis of human enteroviruses that cause hand, foot and mouth disease. Expert Rev Anti Infect Ther 2016; 14:443-5. [PMID: 27042876 DOI: 10.1586/14787210.2016.1173543] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Fiona Mei Shan Teo
- a Collaborative and Translation Unit for HFMD , Institute of Molecular and Cell Biology, Agency for Science, Technology and Research (A*STAR) , Singapore
| | - Justin Jang Hann Chu
- a Collaborative and Translation Unit for HFMD , Institute of Molecular and Cell Biology, Agency for Science, Technology and Research (A*STAR) , Singapore.,b Laboratory of Molecular RNA Virology and Antiviral Strategies, Department of Microbiology, Yong Loo Lin School of Medicine , National University of Singapore , Singapore
| |
Collapse
|
104
|
Jetsadawisut W, Nutho B, Meeprasert A, Rungrotmongkol T, Kungwan N, Wolschann P, Hannongbua S. Susceptibility of inhibitors against 3C protease of coxsackievirus A16 and enterovirus A71 causing hand, foot and mouth disease: A molecular dynamics study. Biophys Chem 2016; 219:9-16. [PMID: 27668727 DOI: 10.1016/j.bpc.2016.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 09/16/2016] [Accepted: 09/17/2016] [Indexed: 10/21/2022]
Abstract
Hand foot and mouth disease (HFMD) epidemic has occurred in many countries. Coxsackievirus A16 (CV-A16) and Enterovirus A71 (EV-A71) are the main causes of HFMD. Up to now, there are no anti-HFMD drugs available. Rupintrivir, a broad-spectrum inhibitor, is a drug candidate for HFMD treatment, while other HFMD inhibitors designed from several studies have a relatively low efficiency. Therefore, in this work we aim to study the binding mechanisms of rupintrivir and a peptidic α,β-unsaturated ethyl ester (SG85) against both CV-A16 and EV-A71 3C proteases (3Cpro) using all-atoms molecular dynamics simulation. The obtained results indicate that SG85 shows a stronger binding affinity than rupintrivir against CV-A16. Both inhibitors exhibit a comparable affinity against EV-A71 3Cpro. The molecular information of the binding of the two inhibitors to the proteases will be elucidated. Thus, it is implied that these two compounds may be used as leads for further anti-HFMD drug design and development.
Collapse
Affiliation(s)
- W Jetsadawisut
- Computational Chemistry Unit Cell, Department of Chemistry, Faculty of Science, Chulalongkorn University, 254 Phayathai Road, Patumwan, Bangkok 10330, Thailand
| | - B Nutho
- Program in Biotechnology, Faculty of Science, Chulalongkorn University, 254 Phayathai Road, Bangkok 10330, Thailand
| | - A Meeprasert
- Structural and Computational Biology Unit, Department of Biochemistry, Faculty of Science, Chulalongkorn University, 254 Phayathai Road, Bangkok 10330, Thailand
| | - T Rungrotmongkol
- Structural and Computational Biology Unit, Department of Biochemistry, Faculty of Science, Chulalongkorn University, 254 Phayathai Road, Bangkok 10330, Thailand; Ph.D. Program in Bioinformatics and Computational Biology, Faculty of Science, Chulalongkorn University, 254 Phayathai Road, Patumwan, Bangkok 10330, Thailand.
| | - N Kungwan
- Department of Chemistry, Faculty of Science, Chiang Mai University, 239 Huay Kaew Road, Muang District, Chiang Mai 50200, Thailand
| | - P Wolschann
- Computational Chemistry Unit Cell, Department of Chemistry, Faculty of Science, Chulalongkorn University, 254 Phayathai Road, Patumwan, Bangkok 10330, Thailand; Department of Pharmaceutical Technology and Biopharmaceutics, University of Vienna, Vienna 1090, Austria; Institute of Theoretical Chemistry, University of Vienna, Vienna 1090, Austria
| | - S Hannongbua
- Computational Chemistry Unit Cell, Department of Chemistry, Faculty of Science, Chulalongkorn University, 254 Phayathai Road, Patumwan, Bangkok 10330, Thailand.
| |
Collapse
|
105
|
Enterovirus A71 and coxsackievirus A16 show different replication kinetics in human neuronal and non-neuronal cell lines. Arch Virol 2016; 162:727-737. [DOI: 10.1007/s00705-016-3157-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Accepted: 10/19/2016] [Indexed: 01/15/2023]
|
106
|
Aw-Yong KL, Sam IC, Koh MT, Chan YF. Immunodominant IgM and IgG Epitopes Recognized by Antibodies Induced in Enterovirus A71-Associated Hand, Foot and Mouth Disease Patients. PLoS One 2016; 11:e0165659. [PMID: 27806091 PMCID: PMC5091889 DOI: 10.1371/journal.pone.0165659] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 09/26/2016] [Indexed: 01/20/2023] Open
Abstract
Enterovirus A71 (EV-A71) is one of the main causative agents of hand, foot and mouth disease (HFMD). Unlike other enteroviruses that cause HFMD, EV-A71 is more frequently associated with severe neurological complications and fatality. To date, no effective licensed antivirals are available to combat EV-A71 infection. Little is known about the immunogenicity of viral non-structural proteins in humans. Previous studies have mainly focused on characterization of epitopes of EV-A71 structural proteins by using immunized animal antisera. In this study, we have characterized human antibody responses against the structural and non-structural proteins of EV-A71. Each viral protein was cloned and expressed in either bacterial or mammalian systems, and tested with antisera by western blot. Results revealed that all structural proteins (VP1-4), and non-structural proteins 2A, 3C and 3D were targets of EV-A71 IgM, whereas EV-A71 IgG recognized all the structural and non-structural proteins. Sixty three synthetic peptides predicted to be immunogenic in silico were synthesized and used for the characterization of EV-A71 linear B-cell epitopes. In total, we identified 22 IgM and four IgG dominant epitopes. Synthetic peptide PEP27, corresponding to residues 142-156 of VP1, was identified as the EV-A71 IgM-specific immunodominant epitope. PEP23, mapped to VP1 41-55, was recognized as the EV-A71 IgG cross-reactive immunodominant epitope. The structural protein VP1 is the major immunodominant site targeted by anti-EV-A71 IgM and IgG antibodies, but epitopes against non-structural proteins were also detected. These data provide new understanding of the immune response to EV-A71 infection, which benefits the development of diagnostic tools, potential therapeutics and subunit vaccine candidates.
Collapse
Affiliation(s)
- Kam Leng Aw-Yong
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - I-Ching Sam
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Mia Tuang Koh
- Department of Paediatrics, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Yoke Fun Chan
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| |
Collapse
|
107
|
Karrasch M, Fischer E, Scholten M, Sauerbrei A, Henke A, Renz DM, Mentzel HJ, Böer K, Böttcher S, Diedrich S, Krumbholz A, Zell R. A severe pediatric infection with a novel enterovirus A71 strain, Thuringia, Germany. J Clin Virol 2016; 84:90-95. [DOI: 10.1016/j.jcv.2016.09.007] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 09/09/2016] [Accepted: 09/19/2016] [Indexed: 11/27/2022]
|
108
|
Weng Y, Chen W, Huang M, He W, Zheng K, Yan Y. Epidemiology and etiology of hand, foot, and mouth disease in Fujian province, 2008-2014. Arch Virol 2016; 162:535-542. [PMID: 27796546 DOI: 10.1007/s00705-016-3127-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Accepted: 10/24/2016] [Indexed: 01/10/2023]
Abstract
Millions of cases of hand, foot, and mouth disease (HFMD) have been reported annually in mainland China since 2008. In this study, we investigated the epidemiology and etiology of an HFMD epidemic in Fujian province, which is located in subtropical southeastern China. Our study found similar epidemiological features of HFMD in southern areas of China, including seasonality and demographic distribution, as well as correlation between severity of illness and serotype. At least 22 serotypes of other enterovirus co-circulating with enterovirus 71 were found to belong to clade C4a, and those circulating with coxsackievirus A16 were associated with clades B1a and B1b.
Collapse
Affiliation(s)
- Yuwei Weng
- Division of Viral Disease, Fujian Provincial Center for Disease Prevention and Control, Fuzhou, 350001, Fujian, China.,Public Health School of Fujian Medical University, Fuzhou, 350004, Fujian, China
| | - Wei Chen
- Division of Viral Disease, Fujian Provincial Center for Disease Prevention and Control, Fuzhou, 350001, Fujian, China
| | - Meng Huang
- Division of Viral Disease, Fujian Provincial Center for Disease Prevention and Control, Fuzhou, 350001, Fujian, China
| | - Wenxiang He
- Division of Viral Disease, Fujian Provincial Center for Disease Prevention and Control, Fuzhou, 350001, Fujian, China
| | - Kuicheng Zheng
- Division of Viral Disease, Fujian Provincial Center for Disease Prevention and Control, Fuzhou, 350001, Fujian, China
| | - Yansheng Yan
- Division of Viral Disease, Fujian Provincial Center for Disease Prevention and Control, Fuzhou, 350001, Fujian, China. .,Public Health School of Fujian Medical University, Fuzhou, 350004, Fujian, China.
| |
Collapse
|
109
|
Xiao X, Liao Q, Kenward MG, Zheng Y, Huang J, Yin F, Yu H, Li X. Comparisons between mild and severe cases of hand, foot and mouth disease in temporal trends: a comparative time series study from mainland China. BMC Public Health 2016; 16:1109. [PMID: 27769194 PMCID: PMC5073464 DOI: 10.1186/s12889-016-3762-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 10/11/2016] [Indexed: 12/03/2022] Open
Abstract
Background Over recent decades, hand, foot and mouth disease (HFMD) has emerged as a serious public health threat in the Asia-Pacific region because of its high rates of severe complications. Understanding the differences and similarities between mild and severe cases can be helpful in the control of HFMD. In this study, we compared the two types of HFMD cases in their temporal trends. Methods We retrieved the daily series of disease counts of mild and severe HFMD cases reported in mainland China in the period of 2009–2014. We applied a quasi-Poisson regression model to decompose each series into the long-term linear trend, periodic variations, and short-term fluctuations, and then we compared each component between two series separately. Results A total of 11,101,860 clinical HFMD cases together with 115,596 severe cases were included into this analysis. We found a biennial increase of 24.46 % (95 % CI: 22.80–26.14 %) for the baseline of disease incidence of mild cases, whereas a biennial decrease of 8.80 % (95 % CI: 7.26–10.31 %) was seen for that of severe cases. The periodic variations of both two series could be characterized by a mixture of biennial, annual, semi-annual and eight-monthly cycles. However, compared to the mild cases, we found the severe cases vary more widely for the biennial and annual cycle, and started its annual epidemic earlier. We also found the short-term fluctuations between two series were still significantly correlated at the current day with a correlation coefficient of 0.46 (95 % CI: 0.43–0.49). Conclusions We found some noticeable differences and also similarities between the daily series of mild and severe HFMD cases at different time scales. Our findings can help us to deepen the understanding of the transmission of different types of HFMD cases, and also provide evidences for the planning of the associated disease control strategies.
Collapse
Affiliation(s)
- Xiong Xiao
- Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, Chengdu, China.,Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Qiaohong Liao
- Division of Infectious Disease & Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Michael G Kenward
- Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK
| | - Yaming Zheng
- Division of Infectious Disease & Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Jiao Huang
- Division of Infectious Disease & Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Fei Yin
- Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, Chengdu, China
| | - Hongjie Yu
- Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, Chengdu, China. .,Division of Infectious Disease & Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing, China.
| | - Xiaosong Li
- Department of Epidemiology and Biostatistics, West China School of Public Health, Sichuan University, Chengdu, China.
| |
Collapse
|
110
|
Koh WM, Bogich T, Siegel K, Jin J, Chong EY, Tan CY, Chen MIC, Horby P, Cook AR. The Epidemiology of Hand, Foot and Mouth Disease in Asia: A Systematic Review and Analysis. Pediatr Infect Dis J 2016; 35:e285-300. [PMID: 27273688 PMCID: PMC5130063 DOI: 10.1097/inf.0000000000001242] [Citation(s) in RCA: 159] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2016] [Indexed: 12/22/2022]
Abstract
CONTEXT Hand, foot and mouth disease (HFMD) is a widespread pediatric disease caused primarily by human enterovirus 71 (EV-A71) and Coxsackievirus A16 (CV-A16). OBJECTIVE This study reports a systematic review of the epidemiology of HFMD in Asia. DATA SOURCES PubMed, Web of Science and Google Scholar were searched up to December 2014. STUDY SELECTION Two reviewers independently assessed studies for epidemiologic and serologic information about prevalence and incidence of HFMD against predetermined inclusion/exclusion criteria. DATA EXTRACTION Two reviewers extracted answers for 8 specific research questions on HFMD epidemiology. The results are checked by 3 others. RESULTS HFMD is found to be seasonal in temperate Asia with a summer peak and in subtropical Asia with spring and fall peaks, but not in tropical Asia; evidence of a climatic role was identified for temperate Japan. Risk factors for HFMD include hygiene, age, gender and social contacts, but most studies were underpowered to adjust rigorously for confounding variables. Both community-level and school-level transmission have been implicated, but their relative importance for HFMD is inconclusive. Epidemiologic indices are poorly understood: No supporting quantitative evidence was found for the incubation period of EV-A71; the symptomatic rate of EV-A71/Coxsackievirus A16 infection was from 10% to 71% in 4 studies; while the basic reproduction number was between 1.1 and 5.5 in 3 studies. The uncertainty in these estimates inhibits their use for further analysis. LIMITATIONS Diversity of study designs complicates attempts to identify features of HFMD epidemiology. CONCLUSIONS Knowledge on HFMD remains insufficient to guide interventions such as the incorporation of an EV-A71 vaccine in pediatric vaccination schedules. Research is urgently needed to fill these gaps.
Collapse
Affiliation(s)
- Wee Ming Koh
- From the Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Standard Analytics, New York, New York; Rollins School of Public Health, Emory University, Atlanta, Georgia; Duke-NUS Graduate Medical School, Singapore; Communicable Disease Centre, Tan Tock Seng Hospital, Singapore; Nuffield Department of Medicine, University of Oxford, United Kingdom; and Yale-NUS College, National University of Singapore, Singapore
| | - Tiffany Bogich
- From the Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Standard Analytics, New York, New York; Rollins School of Public Health, Emory University, Atlanta, Georgia; Duke-NUS Graduate Medical School, Singapore; Communicable Disease Centre, Tan Tock Seng Hospital, Singapore; Nuffield Department of Medicine, University of Oxford, United Kingdom; and Yale-NUS College, National University of Singapore, Singapore
| | - Karen Siegel
- From the Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Standard Analytics, New York, New York; Rollins School of Public Health, Emory University, Atlanta, Georgia; Duke-NUS Graduate Medical School, Singapore; Communicable Disease Centre, Tan Tock Seng Hospital, Singapore; Nuffield Department of Medicine, University of Oxford, United Kingdom; and Yale-NUS College, National University of Singapore, Singapore
| | - Jing Jin
- From the Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Standard Analytics, New York, New York; Rollins School of Public Health, Emory University, Atlanta, Georgia; Duke-NUS Graduate Medical School, Singapore; Communicable Disease Centre, Tan Tock Seng Hospital, Singapore; Nuffield Department of Medicine, University of Oxford, United Kingdom; and Yale-NUS College, National University of Singapore, Singapore
| | - Elizabeth Y. Chong
- From the Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Standard Analytics, New York, New York; Rollins School of Public Health, Emory University, Atlanta, Georgia; Duke-NUS Graduate Medical School, Singapore; Communicable Disease Centre, Tan Tock Seng Hospital, Singapore; Nuffield Department of Medicine, University of Oxford, United Kingdom; and Yale-NUS College, National University of Singapore, Singapore
| | - Chong Yew Tan
- From the Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Standard Analytics, New York, New York; Rollins School of Public Health, Emory University, Atlanta, Georgia; Duke-NUS Graduate Medical School, Singapore; Communicable Disease Centre, Tan Tock Seng Hospital, Singapore; Nuffield Department of Medicine, University of Oxford, United Kingdom; and Yale-NUS College, National University of Singapore, Singapore
| | - Mark IC Chen
- From the Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Standard Analytics, New York, New York; Rollins School of Public Health, Emory University, Atlanta, Georgia; Duke-NUS Graduate Medical School, Singapore; Communicable Disease Centre, Tan Tock Seng Hospital, Singapore; Nuffield Department of Medicine, University of Oxford, United Kingdom; and Yale-NUS College, National University of Singapore, Singapore
| | - Peter Horby
- From the Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Standard Analytics, New York, New York; Rollins School of Public Health, Emory University, Atlanta, Georgia; Duke-NUS Graduate Medical School, Singapore; Communicable Disease Centre, Tan Tock Seng Hospital, Singapore; Nuffield Department of Medicine, University of Oxford, United Kingdom; and Yale-NUS College, National University of Singapore, Singapore
| | - Alex R. Cook
- From the Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Standard Analytics, New York, New York; Rollins School of Public Health, Emory University, Atlanta, Georgia; Duke-NUS Graduate Medical School, Singapore; Communicable Disease Centre, Tan Tock Seng Hospital, Singapore; Nuffield Department of Medicine, University of Oxford, United Kingdom; and Yale-NUS College, National University of Singapore, Singapore
| |
Collapse
|
111
|
Guo C, Yang J, Guo Y, Ou QQ, Shen SQ, Ou CQ, Liu QY. Short-term effects of meteorological factors on pediatric hand, foot, and mouth disease in Guangdong, China: a multi-city time-series analysis. BMC Infect Dis 2016; 16:524. [PMID: 27682137 PMCID: PMC5041518 DOI: 10.1186/s12879-016-1846-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 09/17/2016] [Indexed: 11/19/2022] Open
Abstract
Background Literature shows inconsistency in meteorological effects on Hand, foot, and mouth disease (HFMD) in different cities. This multi-city study aims to investigate the meteorological effects on pediatric HFMD occurrences and the potential effect modification by geographic factors. Methods Based on daily time-series data in eight major cities in Guangdong, China during 2009–2013, mixed generalized additive models were employed to estimate city-specific meteorological effects on pediatric HFMD. Then, a random-effect multivariate meta-analysis was conducted to obtain the pooled risks and to explore heterogeneity explained by city-level factors. Results There were a total of 400,408 pediatric HFMD cases (children aged 0–14 years old) with an annual incidence rate of 16.6 cases per 1,000 children, clustered in males and children under 3 years old. Daily average temperature was positively associated with pediatric HFMD cases with the highest pooled relative risk (RR) of 1.52 (95 % CI: 1.30–1.77) at the 95th percentile of temperature (30.5 °C) as compared to the median temperature (23.5 °C). Significant non-linear positive effects of high relative humidity were also observed with a 13 % increase (RR = 1.13, 95 % CI: 1.00–1.28) in the risk of HFMD at the 99th percentile of relative humidity (86.9 %) as compared to the median value (78 %). The effect estimates showed geographic variations among the cities which was significantly associated with city’s latitude and longitude with an explained heterogeneity of 32 %. Conclusions Daily average temperature and relative humidity had non-linear and delayed effects on pediatric HFMD and the effects varied across different cities. These findings provide important evidence for comprehensive understanding of the climatic effects on pediatric HFMD and for the authority to take targeted interventions and measures to control the occurrence and transmission of HFMD. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1846-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Cui Guo
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Jun Yang
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, China
| | - Yuming Guo
- Division of Epidemiology and Biostatistics, School of Public Health, The University of Queensland, Brisbane, QLD, 4006, Australia
| | - Qiao-Qun Ou
- Department of Pediatrics, Guangzhou First People's Hospital, Guangzhou Medical University, Guangzhou, Guangdong, 510180, China
| | - Shuang-Quan Shen
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China
| | - Chun-Quan Ou
- State Key Laboratory of Organ Failure Research, Department of Biostatistics, Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, Guangdong, China.
| | - Qi-Yong Liu
- State Key Laboratory of Infectious Disease Prevention and Control, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, China.
| |
Collapse
|
112
|
Chang PC, Chen SC, Chen KT. The Current Status of the Disease Caused by Enterovirus 71 Infections: Epidemiology, Pathogenesis, Molecular Epidemiology, and Vaccine Development. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:E890. [PMID: 27618078 PMCID: PMC5036723 DOI: 10.3390/ijerph13090890] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 08/16/2016] [Accepted: 09/01/2016] [Indexed: 12/22/2022]
Abstract
Enterovirus 71 (EV71) infections have a major public health impact in the Asia-Pacific region. We reviewed the epidemiology, pathogenesis, and molecular epidemiology of EV71 infection as well as EV71 vaccine development. Previous studies were found using the search terms "enterovirus 71" and "epidemiology" or "pathogenesis" or "molecular epidemiology" or "vaccine" in Medline and PubMed. Articles that were not published in the English language, manuscripts without an abstract, and opinion articles were excluded from the review. The reported epidemiology of cases caused by EV71 infection varied from country to country; seasonal variations in incidence were observed. Most cases of EV71 infection that resulted in hospitalization for complications occurred in children less than five years old. The brainstem was the most likely major target of EV71 infection. The emergence of the EV71 epidemic in the Asia-Pacific region has been associated with the circulation of different genetic lineages (genotypes B3, B4, C1, C2, and C4) that appear to be undergoing rapid evolutionary changes. The relationship between the gene structure of the EV71 virus and the factors that ensure its survival, circulation, and evasion of immunity is still unknown. EV71 infection has emerged as an important global public health problem. Vaccine development, including the development of inactivated whole-virus live attenuated, subviral particles, and DNA vaccines, has been progressing.
Collapse
Affiliation(s)
- Ping-Chin Chang
- Division of Infectious Disease, Department of Internal Medicine, Chi-Mei Medical Center, Liouying, Tainan 736, Taiwan.
| | - Shou-Chien Chen
- Department of Family Medicine, Da-Chien General Hospital, Miaoli 237, Taiwan.
- General Education Center, Ta Tung University, Taipei 104, Taiwan.
| | - Kow-Tong Chen
- Department of Occupational Medicine, Tainan Municipal Hospital, Tainan 701, Taiwan.
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan 701, Taiwan.
| |
Collapse
|
113
|
In Vitro Assessment of Combinations of Enterovirus Inhibitors against Enterovirus 71. Antimicrob Agents Chemother 2016; 60:5357-67. [PMID: 27353263 DOI: 10.1128/aac.01073-16] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Accepted: 06/19/2016] [Indexed: 01/19/2023] Open
Abstract
Enterovirus 71 (EV-A71) is a major causative pathogen of hand, foot, and mouth disease (HFMD) epidemics. No antiviral therapies are currently available for treating EV-A71 infections. Here, we selected five reported enterovirus inhibitors (suramin, itraconazole [ITZ], GW5074, rupintrivir, and favipiravir) with different mechanisms of action to test their abilities to inhibit EV-A71 replication alone and in combination. All selected compounds have anti-EV-A71 activities in cell culture. The combination of rupintrivir and ITZ or favipiravir was synergistic, while the combination of rupintrivir and suramin was additive. The combination of suramin and favipiravir exerted a strong synergistic antiviral effect. The observed synergy was not due to cytotoxicity, as there was no significant increase in cytotoxicity when compounds were used in combinations at the tested doses. To investigate the potential inhibitory mechanism of favipiravir against enterovirus, two favipiravir-resistant EV-A71 variants were independently selected, and both of them carried an S121N mutation in the finger subdomain of the 3D polymerase. Reverse engineering of this 3D S121N mutation into an infectious clone of EV-A71 confirmed the resistant phenotype. Moreover, viruses resistant to ITZ or favipiravir remained susceptible to other inhibitors. Most notably, combined with ITZ, rupintrivir prevented the development of ITZ-resistant variants. Taken together, these results provide a rational basis for the design of combination regimens for use in the treatment of EV-A71 infections.
Collapse
|
114
|
Kim HJ, Hyeon JY, Hwang S, Lee YP, Lee SW, Yoo JS, Kang B, Ahn JB, Jeong YS, Lee JW. Epidemiology and virologic investigation of human enterovirus 71 infection in the Republic of Korea from 2007 to 2012: a nationwide cross-sectional study. BMC Infect Dis 2016; 16:425. [PMID: 27538397 PMCID: PMC4989503 DOI: 10.1186/s12879-016-1755-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 08/04/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Enterovirus (EV) 71 is the main pathogen associated with hand, foot and mouth disease (HFMD) or herpangina. Outbreaks of HFMD caused by EV71 infection are associated severe neurological disease and high mortality rates in children. Several sporadic cases of EV71 infection occurred in the Republic of Korea (ROK) in 2000, and EV71 infections were not reported thereafter until 2006. In this prospective study, we report the epidemic and virologic characteristics of the EV71 endemic from 2007 to 2012 in the Republic of Korea. METHODS We analyzed characteristics of the EV71 infection-associated epidemic from collected specimens and clinical information from 9987 patients with suspected EV infection from the National EV Surveillance System in ROK. To identify the EV71 subgenotype, the homology of viral protein 1 sequences obtained using reverse transcription polymerase chain reaction was compared with the sequences on other countries available from GenBank database. RESULTS EV71 was detected in 585 (16.7 %) specimens (cerebrospinal fluid, stool or rectal swabs, throat swabs and blood) during study period and was most frequently observed during epidemic seasons in 2009-2012. Major manifestations due to EV71 infection were HFMD (62.2 %) and HFMD with severe neurological complications (28.4 %). Five deaths (0.9 %) due to EV71 infection occurred, with an increased mortality rate during the period after 2009. Most patients (476; 81.4 %) were less than 5 years of age. Analysis of the monthly distribution showed that there was an obvious seasonal pattern to the epidemics, with infections appearing from June to August. The major subgenotype of EV71 isolates circulating in ROK was the C4a strain, which has also appeared in China, Japan and Vietnam. CONCLUSIONS This surveillance provided valuable data on the epidemic characteristics of EV71 infections in ROK during a 6-year period. Our findings provide data to assist during future outbreaks of EV71 and associated acute neurologic disease.
Collapse
Affiliation(s)
- Hye-Jin Kim
- Division of Vaccine Research, Center for Infectious Diseases, Korea National Institutes of Health, Korea Centers for Disease Control and Prevention, Osong-eup, Cheongju, Chungcheongbuk-do, 363-951, Republic of Korea
| | - Ji-Yeon Hyeon
- Division of Vaccine Research, Center for Infectious Diseases, Korea National Institutes of Health, Korea Centers for Disease Control and Prevention, Osong-eup, Cheongju, Chungcheongbuk-do, 363-951, Republic of Korea
| | - Seoyeon Hwang
- Division of Vaccine Research, Center for Infectious Diseases, Korea National Institutes of Health, Korea Centers for Disease Control and Prevention, Osong-eup, Cheongju, Chungcheongbuk-do, 363-951, Republic of Korea
| | - Yong-Pyo Lee
- Division of Vaccine Research, Center for Infectious Diseases, Korea National Institutes of Health, Korea Centers for Disease Control and Prevention, Osong-eup, Cheongju, Chungcheongbuk-do, 363-951, Republic of Korea
| | - Sang Won Lee
- Division of Vaccine Research, Center for Infectious Diseases, Korea National Institutes of Health, Korea Centers for Disease Control and Prevention, Osong-eup, Cheongju, Chungcheongbuk-do, 363-951, Republic of Korea
| | - Jung Sik Yoo
- Division of Vaccine Research, Center for Infectious Diseases, Korea National Institutes of Health, Korea Centers for Disease Control and Prevention, Osong-eup, Cheongju, Chungcheongbuk-do, 363-951, Republic of Korea
| | - Byunghak Kang
- Division of Vaccine Research, Center for Infectious Diseases, Korea National Institutes of Health, Korea Centers for Disease Control and Prevention, Osong-eup, Cheongju, Chungcheongbuk-do, 363-951, Republic of Korea
| | - Jeong-Bae Ahn
- Division of Vaccine Research, Center for Infectious Diseases, Korea National Institutes of Health, Korea Centers for Disease Control and Prevention, Osong-eup, Cheongju, Chungcheongbuk-do, 363-951, Republic of Korea
| | - Yong-Seok Jeong
- Department of Biology Graduate School, Kyung Hee University, Seoul, Dongdaemun-gu, 130-701, Republic of Korea
| | - June-Woo Lee
- Division of Vaccine Research, Center for Infectious Diseases, Korea National Institutes of Health, Korea Centers for Disease Control and Prevention, Osong-eup, Cheongju, Chungcheongbuk-do, 363-951, Republic of Korea.
| |
Collapse
|
115
|
Neri I, Dondi A, Wollenberg A, Ricci L, Ricci G, Piccirilli G, Lazzarotto T, Patrizi A. Atypical Forms of Hand, Foot, and Mouth Disease: A Prospective Study of 47 Italian Children. Pediatr Dermatol 2016; 33:429-37. [PMID: 27292085 DOI: 10.1111/pde.12871] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Atypical forms of hand, foot, and mouth disease (HFMD) caused by coxsackievirus A6 have been reported in recent years. High fever and severe cutaneous lesions are common, whereas neurologic complications are rare. Eczematous areas of patients with atopic dermatitis show more lesions. The goal of the current study was to describe the clinical characteristics of children with atypical HFMD and to investigate the involvement of the different enterovirus serotypes associated. METHODS All patients referred to our service for atypical HFMD from January 2012 to February 2014 were enrolled and classified as having the diffuse form (lesions extended to the trunk), the acral form (lesions with a mainly acral distribution), or eczema coxsackium (lesions on preexisting eczematous areas). RESULTS Data from 47 patients were analyzed (median age 22 months [range 4-84 mos]); viral genotyping was performed in 11 cases. Sixty-two percent of the subjects developed the acral form, 23% eczema coxsackium, and 15% the diffuse form. Most patients had a nonclassical vesicular eruption and moderate to severe extent of cutaneous involvement. Approximately 80% of patients had palmoplantar purpuric macules. Most children younger than 2 years old had the acral form, most patients with eczema coxsackium were age 2 years and older, and the diffuse form was similarly distributed between the two age groups. Coxsackievirus A6 was detected in 9 of 11 genotyped cases. CONCLUSION Our prospective study allowed the identification of three HFMD phenotypes differing from the classical form. Clinical care of these patients should include symptomatic treatment of extracutaneous features and, if necessary, hospitalization for complications.
Collapse
Affiliation(s)
- Iria Neri
- Dermatology Unit, Department of Specialistic, Diagnostic and Experimental Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Arianna Dondi
- Dermatology Unit, Department of Specialistic, Diagnostic and Experimental Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.,Pediatric Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Andreas Wollenberg
- Department of Dermatology and Allergy, Ludwig-Maximilian University, Munich, Germany
| | - Lorenza Ricci
- Dermatology Unit, Department of Specialistic, Diagnostic and Experimental Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giampaolo Ricci
- Pediatric Unit, Department of Medical and Surgical Sciences, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Giulia Piccirilli
- Department of Specialistic, Diagnostic and Experimental Medicine, Operative Unit of Clinical Microbiology, Laboratory of Virology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Tiziana Lazzarotto
- Department of Specialistic, Diagnostic and Experimental Medicine, Operative Unit of Clinical Microbiology, Laboratory of Virology, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Annalisa Patrizi
- Dermatology Unit, Department of Specialistic, Diagnostic and Experimental Medicine, S. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| |
Collapse
|
116
|
Transmission of Hand, Foot and Mouth Disease and Its Potential Driving Factors in Hong Kong. Sci Rep 2016; 6:27500. [PMID: 27271966 PMCID: PMC4895171 DOI: 10.1038/srep27500] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Accepted: 05/19/2016] [Indexed: 01/20/2023] Open
Abstract
Hand-foot-and-mouth disease (HFMD) is a common childhood disease with substantial disease burden in Asia. Mixed results were reported on the associations between HFMD incidence and meteorological factors or school holidays, while limited studies focused on their association on transmissibility. We aimed to measure the transmissibility of HFMD and to examine its potential driving factors in Hong Kong. A likelihood-based procedure was used to estimate time-dependent effective reproduction number (Rt) based on weekly number of HFMD-associated hospitalizations from 2010 to 2014. The associations of between-year effects, depletion of susceptibles, absolute humidity and school holidays with Rt were examined using linear regression. Rt usually started increasing between early spring and summer and peaked in April to May at around 1.1-1.2, followed by a slight rebound in autumn. Depletion of susceptibles and between-years effects explained most of the variances (19 and 13% respectively) in Rt. We found a negative association between depletion of susceptibles and Rt (coefficients ranged from -0.14 to -0.03 for different years), but the estimated effects of absolute humidity and school holidays were insignificant. Overall, HFMD transmission was moderate in Hong Kong and was mainly associated with depletion of susceptibles. Limited impact was suggested from meteorological factors and school holidays.
Collapse
|
117
|
Thong WY, Han A, Wang SJF, Lin J, Isa MS, Koay ESC, Tay SKH. Enterovirus infections in Singaporean children: an assessment of neurological manifestations and clinical outcomes. Singapore Med J 2016; 58:189-195. [PMID: 27245861 DOI: 10.11622/smedj.2016099] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Enterovirus infections in childhood can be associated with significant neurological morbidity. This study aimed to describe the prevalence and range of neurological manifestations, determine the clinical characteristics and assess differences in clinical outcomes for Singaporean children diagnosed with enterovirus infections. METHODS In this single-centre, case-control study, clinical data was collected retrospectively from patients admitted to National University Hospital, Singapore, from August 2007 to October 2011 and diagnosed with enterovirus infection, based on the enterovirus polymerase chain reaction test, or cultures from throat and rectal swabs or cerebrospinal fluid samples. The occurrence of neurological manifestations was reviewed and clinical outcomes were assessed. RESULTS A total of 48 patients (age range: six days-17.8 years) were included in the study. Neurological manifestations were seen in 75.0% of patients, 63.9% of whom presented with aseptic meningitis. Other neurological manifestations included encephalitis, acute cerebellitis, transverse myelitis and autonomic dysfunction. The incidence of neurological manifestations was significantly higher in patients aged > 1 year as compared to younger patients (p = 0.043). In patients without neurological manifestations, a significantly higher proportion presented with hand, foot and mouth disease and poor feeding. Long-term neurological sequelae were seen in 16.7% of patients with neurological manifestations. CONCLUSION A wide spectrum of neurological manifestations resulting in a relatively low incidence of long-term neurological sequelae was observed in our study of Singaporean children with enterovirus infections. As some of these neurological morbidities were severe, careful evaluation of children with neurological involvement is therefore necessary.
Collapse
Affiliation(s)
- Wen Yi Thong
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore
| | - Audrey Han
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - S J Furene Wang
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore
| | - Jeremy Lin
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore
| | - Mas Suhaila Isa
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore
| | - Evelyn Siew Chuan Koay
- Laboratory Medicine, Molecular Diagnosis Centre, National University Health System, Singapore
| | - Stacey Kiat-Hong Tay
- Khoo Teck Puat-National University Children's Medical Institute, National University Health System, Singapore.,Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| |
Collapse
|
118
|
Long L, Gao LD, Hu SX, Luo KW, Chen ZH, Ronsmans C, Zhou DL, Lan YJ. Risk factors for death in children with severe hand, foot, and mouth disease in Hunan, China. Infect Dis (Lond) 2016; 48:744-8. [PMID: 27195893 DOI: 10.1080/23744235.2016.1185801] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND In recent years, outbreaks of hand, foot, and mouth disease (HFMD) have increased throughout East and Southeast Asia, especially in mainland China. The disease now presents as an increasingly serious public health threat in China. METHODS A case-control study was designed to examine risk factors associated with death from severe HFMD. A total of 553 severe HFMD cases were collected from the National Surveillance System. RESULTS Multifactorial logistic regression was used to analyse independent associations between potential influence factors and death from severe HFMD. We found that the migrants were more likely to die from severe HFMD than the resident population (OR = 3.07, 95%CI: 1.39-8.32). Additionally, the children whose first visit was to a village-level clinic had a high risk of death from severe HFMD. Patients with EV71 infection or symptoms of convulsion, dyspnoea, cyanosis, coolness of extremities, and vomiting had an increased risk of death from severe HFMD. While breastfeeding children, having a confirmed diagnosis at the first visit to the hospital and with symptom of hyperarousal were identified as protective factors for death from severe HFMD. CONCLUSIONS To reduce the mortality from severe HFMD, doctors and health care providers need to pay attention to the patients with EV71 infection or with symptoms of convulsion, dyspnoea, cyanosis, coolness of extremities, and vomiting. Health administration departments should pay more attention to the rational allocation of health resources. Furthermore, they should increase financial support and manpower in village-level health institutions.
Collapse
Affiliation(s)
- Lu Long
- a Department of Environmental and Occupational Health , West China School of Public Health, Sichuan University , Sichuan , China
| | - Li-Dong Gao
- b Department of Infectious Disease Prevention and Control , Hunan Provincial Center for Disease Control and Prevention , Hunan , China
| | - Shi-Xiong Hu
- b Department of Infectious Disease Prevention and Control , Hunan Provincial Center for Disease Control and Prevention , Hunan , China
| | - Kai-Wei Luo
- b Department of Infectious Disease Prevention and Control , Hunan Provincial Center for Disease Control and Prevention , Hunan , China
| | - Zhen-Hua Chen
- c Department of Microbiology Laboratory , Chengdu Municipal Center for Disease Control and Prevention , Sichuan , China
| | - Carine Ronsmans
- d Department of Infectious Disease Epidemiology , London School of Hygiene and Tropical Medicine , London , United Kingdom ;,e Department of Epidemiology and Biostatistics, West China School of Public Health , Sichuan University , Sichuan , China
| | - Ding-Lun Zhou
- a Department of Environmental and Occupational Health , West China School of Public Health, Sichuan University , Sichuan , China
| | - Ya-Jia Lan
- a Department of Environmental and Occupational Health , West China School of Public Health, Sichuan University , Sichuan , China
| |
Collapse
|
119
|
Li ZH, Yue YY, Li P, Song NN, Li B, Zhang Y, Meng H, Jiang GS, Qin L. MA104 Cell line presents characteristics suitable for enterovirus A71 isolation and proliferation. Microbiol Immunol 2016; 59:477-82. [PMID: 26138857 DOI: 10.1111/1348-0421.12281] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 06/09/2015] [Accepted: 06/28/2015] [Indexed: 11/27/2022]
Abstract
Enterovirus A71 (EV-A71), one of the most important causative agents of hand, foot and mouth disease (HFMD) in children, can lead to severe clinical outcomes, even death. However, the infection spectrum of EV-A71 in different cell lines remains unknown. Therefore, in this study, the biological characteristics of EV-A71 Subgroup C4 in different cell lines were investigated. To this end, the infectivity of EV-A71Jinan1002 isolated from children with severe HFMD was assessed in 18 different host cell lines. It was found that the MA104 cell line displayed biological characteristics suitable for EV-A71 Subgroup C4 strain isolation and proliferation; indeed, it was found that a broad spectrum of cell lines can be infected by EV-A71Jinan1002. Among the screened cells, four cell lines (HEK293, RD, MA104 and Marc145) produced high 50% tissue culture infective dose (TCID50 ) values calculated in viral proliferations (ranged from 10(7.6) to 10(7.8) ); the TCID50 being negatively associated with the time to appearance of CPE. Proliferation curves demonstrated that EV-A71Jinan1002 amplifies more efficiently in MA104, Hep-2 and RD cells. Remarkably, the virus isolation rate was much higher in MA104 cells than in RD cells. Thus this study, to our knowledge, is for the first to explore the infection spectrum of EV-A71 subgroup C4 in such a large number of different cell lines. Our data provide useful reference data for facilitating further study of EV-A71.
Collapse
Affiliation(s)
- Zhi-Hui Li
- Department of Microbiology, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Key Laboratory of Rare and Uncommon Diseases, 18877 Jingshi Road, Jinan 250062
| | - Ying-Ying Yue
- Department of Microbiology, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Key Laboratory of Rare and Uncommon Diseases, 18877 Jingshi Road, Jinan 250062
| | - Peng Li
- Department of Microbiology, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Key Laboratory of Rare and Uncommon Diseases, 18877 Jingshi Road, Jinan 250062
| | - Nan-Nan Song
- Department of Microbiology, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Key Laboratory of Rare and Uncommon Diseases, 18877 Jingshi Road, Jinan 250062
| | - Bingqing Li
- Department of Microbiology, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Key Laboratory of Rare and Uncommon Diseases, 18877 Jingshi Road, Jinan 250062
| | - Ying Zhang
- Jinan Infectious Disease Hospital, 22029 Jingshi Road, Jinan 250021, China
| | - Hong Meng
- Department of Microbiology, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Key Laboratory of Rare and Uncommon Diseases, 18877 Jingshi Road, Jinan 250062
| | - Guo-Sheng Jiang
- Department of Microbiology, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Key Laboratory of Rare and Uncommon Diseases, 18877 Jingshi Road, Jinan 250062
| | - Lizeng Qin
- Department of Microbiology, Institute of Basic Medicine, Shandong Academy of Medical Sciences, Key Laboratory of Rare and Uncommon Diseases, 18877 Jingshi Road, Jinan 250062
| |
Collapse
|
120
|
Ong KC, Wong KT. Understanding Enterovirus 71 Neuropathogenesis and Its Impact on Other Neurotropic Enteroviruses. Brain Pathol 2016; 25:614-24. [PMID: 26276025 DOI: 10.1111/bpa.12279] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 06/19/2015] [Indexed: 01/27/2023] Open
Abstract
Enterovirus A71 (EV-A71) belongs to the species group A in the Enterovirus genus within the Picornaviridae family. EV-A71 usually causes self-limiting hand, foot and mouth disease or herpangina but rarely causes severe neurological complications such as acute flaccid paralysis and encephalomyelitis. The pathology and neuropathogenesis of these neurological syndromes is beginning to be understood. EV-A71 neurotropism for motor neurons in the spinal cord and brainstem, and other neurons, is mainly responsible for central nervous system damage. This review on the general aspects, recent developments and advances of EV-A71 infection will focus on neuropathogenesis and its implications on other neurotropic enteroviruses, such as poliovirus and the newly emergent Enterovirus D68. With the imminent eradication of poliovirus, EV-A71 is likely to replace it as an important neurotropic enterovirus of worldwide importance.
Collapse
Affiliation(s)
- Kien Chai Ong
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kum Thong Wong
- Department of Pathology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| |
Collapse
|
121
|
Hand, Foot, and Mouth Disease in China: Critical Community Size and Spatial Vaccination Strategies. Sci Rep 2016; 6:25248. [PMID: 27125917 PMCID: PMC4850478 DOI: 10.1038/srep25248] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 04/13/2016] [Indexed: 11/08/2022] Open
Abstract
Hand Foot and Mouth Disease (HFMD) constitutes a considerable burden for health care systems across China. Yet this burden displays important geographic heterogeneity that directly affects the local persistence and the dynamics of the disease, and thus the ability to control it through vaccination campaigns. Here, we use detailed geographic surveillance data and epidemic models to estimate the critical community size (CCS) of HFMD associated enterovirus serotypes CV-A16 and EV-A71 and we explore what spatial vaccination strategies may best reduce the burden of HFMD. We found CCS ranging from 336,979 (±225,866) to 722,372 (±150,562) with the lowest estimates associated with EV-A71 in the southern region of China where multiple transmission seasons have previously been identified. Our results suggest the existence of a regional immigration-recolonization dynamic driven by urban centers. If EV-A71 vaccines doses are limited, these would be optimally deployed in highly populated urban centers and in high-prevalence areas. If HFMD vaccines are included in China's National Immunization Program in order to achieve high coverage rates (>85%), routine vaccination of newborns largely outperforms strategies in which the equivalent number of doses is equally divided between routine vaccination of newborns and pulse vaccination of the community at large.
Collapse
|
122
|
Li J, Sun Y, Du Y, Yan Y, Huo D, Liu Y, Peng X, Yang Y, Liu F, Lin C, Liang Z, Jia L, Chen L, Wang Q, He Y. Characterization of Coxsackievirus A6- and Enterovirus 71-Associated Hand Foot and Mouth Disease in Beijing, China, from 2013 to 2015. Front Microbiol 2016; 7:391. [PMID: 27065963 PMCID: PMC4812011 DOI: 10.3389/fmicb.2016.00391] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 03/11/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Etiology surveillance of Hand Foot and Mouth disease (HFMD) in Beijing showed that Coxsackievirus A6 (CVA6) became the major pathogen of HFMD in 2013 and 2015. In order to understand the epidemiological characteristics and clinical manifestations of CVA6-associated HFMD, a comparison study among CVA6-, EV71- (Enterovirus 71), and CVA16- (Coxsackievirus A16) associated HFMD was performed. METHODS Epidemiological characteristics and clinical manifestations among CVA6-, EV71- and CVA16-associated mild or severe cases were compared from 2013 to 2015. VP1 gene of CVA6 and EV71 from mild cases, severe cases were sequenced, aligned, and compared with strains from 2009 to 2015 in Beijing and strains available in GenBank. Phylogenetic tree was constructed by neighbor-joining method. RESULTS CVA6 became the predominant causative agent of HFMD and accounted for 35.4 and 36.9% of total positive cases in 2013 and 2015, respectively. From 2013 to 2015, a total of 305 severe cases and 7 fatal cases were reported. CVA6 and EV71 were responsible for 57.5% of the severe cases. Five out six samples from fatal cases were identified as EV71. High fever, onychomadesis, and decrustation were the typical symptoms of CVA6-associated mild HFMD. CVA6-associated severe cases were characterized by high fever with shorter duration and twitch compared with EV71-associated severe cases which were characterized by poor mental condition, abnormal pupil, and vomiting. Poor mental condition, lung wet rales, abnormal pupil, and tachycardia were the most common clinical features of fatal cases. The percentage of lymphocyte in CVA6-associated cases was significantly lower than that of EV71. High percentage of lymphocyte and low percentage of neutrophils were the typical characteristics of fatal cases. VP1 sequences between CVA6- or EV71-associated mild and severe cases were highly homologous. CONCLUSION CVA6 became one of the major pathogens of HFMD in 2013 and 2015 in Beijing. Epidemiological characteristics, clinical manifestations of CVA6-, EV71- and CVA16-associated cases in this study enriched the definition of HFMD caused by different pathogens and shed light to accurate diagnosis, appropriate treatment and effective prevention of HFMD.
Collapse
Affiliation(s)
- Jie Li
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical UniversityBeijing, China; Beijing Center for Disease Prevention and Control, Institute for Infectious Disease and Endemic Disease ControlBeijing, China
| | - Ying Sun
- Beijing Center for Disease Prevention and Control, Institute for Infectious Disease and Endemic Disease Control Beijing, China
| | - Yiwei Du
- Beijing Center for Disease Prevention and Control, Institute for Infectious Disease and Endemic Disease Control Beijing, China
| | - Yuxiang Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University Beijing, China
| | - Da Huo
- Beijing Center for Disease Prevention and Control, Institute for Infectious Disease and Endemic Disease Control Beijing, China
| | - Yuan Liu
- Beijing Center for Disease Prevention and Control, Institute for Infectious Disease and Endemic Disease Control Beijing, China
| | - Xiaoxia Peng
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University Beijing, China
| | - Yang Yang
- Beijing Center for Disease Prevention and Control, Institute for Infectious Disease and Endemic Disease Control Beijing, China
| | - Fen Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University Beijing, China
| | - Changying Lin
- Beijing Center for Disease Prevention and Control, Institute for Infectious Disease and Endemic Disease Control Beijing, China
| | - Zhichao Liang
- Beijing Center for Disease Prevention and Control, Institute for Infectious Disease and Endemic Disease Control Beijing, China
| | - Lei Jia
- Beijing Center for Disease Prevention and Control, Institute for Infectious Disease and Endemic Disease Control Beijing, China
| | - Lijuan Chen
- Beijing Center for Disease Prevention and Control, Institute for Infectious Disease and Endemic Disease Control Beijing, China
| | - Quanyi Wang
- Beijing Center for Disease Prevention and Control, Institute for Infectious Disease and Endemic Disease Control Beijing, China
| | - Yan He
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University Beijing, China
| |
Collapse
|
123
|
Long L, Xu L, Xiao Z, Hu S, Luo R, Wang H, Lu X, Xu Z, Yao X, Zhou L, Long H, Gong J, Song Y, Zhao L, Luo K, Zhang M, Feng L, Yang L, Sheng X, Fan X, Xiao B. Neurological complications and risk factors of cardiopulmonary failure of EV-A71-related hand, foot and mouth disease. Sci Rep 2016; 6:23444. [PMID: 27001010 PMCID: PMC4802311 DOI: 10.1038/srep23444] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 03/07/2016] [Indexed: 12/04/2022] Open
Abstract
From 2010 to 2012, large outbreaks of EV-A71-related- hand foot and mouth disease (HFMD) occurred annually in China. Some cases had neurological complications and were closely associated with fatal cardiopulmonary collapse, but not all children with central nervous system (CNS) involvement demonstrated a poor prognosis. To identify which patients and which neurological complications are more likely to progress to cardiopulmonary failure, we retrospectively studied 1,125 paediatric inpatients diagnosed with EV-A71-related HFMD in Hunan province, including 1,017 cases with CNS involvement. These patients were divided into cardiopulmonary failure (976 people) group and group without cardiopulmonary failure (149 people). A logistic regression analysis was used to compare the clinical symptoms, laboratory test results, and neurological complications between these two groups. The most significant risk factors included young age, fever duration ≥3 days, coma, limb weakness, drowsiness and ANS involvement. Patients with brainstem encephalitis and more CNS-involved regions were more likely to progress to cardiopulmonary failure. These findings can help front-line clinicians rapidly and accurately determine patient prognosis, thus rationally distributing the limited medical resources and implementing interventions as early as possible.
Collapse
Affiliation(s)
- Lili Long
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Lin Xu
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, China.,Department of Neurology, General Hospital, Tianjin Medical University, Tianjin, 300052, China
| | - Zhenghui Xiao
- Emergency center, Hunan Children's Hospital, Changsha, 410007, China
| | - Shixiong Hu
- Hunan Provincial Center for Disease Control and Prevention, Changsha, 410005, China
| | - Ruping Luo
- Department of Infectious disease, Hunan Children's Hospital, Changsha, 410007, China
| | - Hua Wang
- Department of Genetics, The Maternity and Child Health Hospital of Hunan Province, Changsha, 410008, China
| | - Xiulan Lu
- Department of Intensive Care Unit, Hunan Children's Hospital, Changsha, 410007, China
| | - Zhiyue Xu
- Department of Intensive Care Unit, Hunan Children's Hospital, Changsha, 410007, China
| | - Xu Yao
- Hunan Children's Hospital, Changsha, 410007, China
| | - Luo Zhou
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Hongyu Long
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Jiaoe Gong
- Department of Neurology, Hunan Children's Hospital, Changsha, 410007, China
| | - Yanmin Song
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Li Zhao
- Medical Records Management and Information Statistics Office, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Kaiwei Luo
- Hunan Provincial Center for Disease Control and Prevention, Changsha, 410005, China
| | - Mengqi Zhang
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Li Feng
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Liming Yang
- Department of Neurology, Hunan Children's Hospital, Changsha, 410007, China
| | - Xiaoqi Sheng
- The Maternity and Child Health Hospital of Hunan Province, 410008, China
| | - Xuegong Fan
- Department of Infectious disease, Xiangya Hospital, Central South University, Changsha, 410008, China
| | - Bo Xiao
- Department of Neurology, Xiangya Hospital, Central South University, Changsha, 410008, China
| |
Collapse
|
124
|
Hand, Foot, and Mouth Disease in China: Modeling Epidemic Dynamics of Enterovirus Serotypes and Implications for Vaccination. PLoS Med 2016; 13:e1001958. [PMID: 26882540 PMCID: PMC4755668 DOI: 10.1371/journal.pmed.1001958] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 01/05/2016] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Hand, foot, and mouth disease (HFMD) is a common childhood illness caused by serotypes of the Enterovirus A species in the genus Enterovirus of the Picornaviridae family. The disease has had a substantial burden throughout East and Southeast Asia over the past 15 y. China reported 9 million cases of HFMD between 2008 and 2013, with the two serotypes Enterovirus A71 (EV-A71) and Coxsackievirus A16 (CV-A16) being responsible for the majority of these cases. Three recent phase 3 clinical trials showed that inactivated monovalent EV-A71 vaccines manufactured in China were highly efficacious against HFMD associated with EV-A71, but offered no protection against HFMD caused by CV-A16. To better inform vaccination policy, we used mathematical models to evaluate the effect of prospective vaccination against EV-A71-associated HFMD and the potential risk of serotype replacement by CV-A16. We also extended the model to address the co-circulation, and implications for vaccination, of additional non-EV-A71, non-CV-A16 serotypes of enterovirus. METHODS AND FINDINGS Weekly reports of HFMD incidence from 31 provinces in Mainland China from 1 January 2009 to 31 December 2013 were used to fit multi-serotype time series susceptible-infected-recovered (TSIR) epidemic models. We obtained good model fit for the two-serotype TSIR with cross-protection, capturing the seasonality and geographic heterogeneity of province-level transmission, with strong correlation between the observed and simulated epidemic series. The national estimate of the basic reproduction number, R0, weighted by provincial population size, was 26.63 for EV-A71 (interquartile range [IQR]: 23.14, 30.40) and 27.13 for CV-A16 (IQR: 23.15, 31.34), with considerable variation between provinces (however, predictions about the overall impact of vaccination were robust to this variation). EV-A71 incidence was projected to decrease monotonically with higher coverage rates of EV-A71 vaccination. Across provinces, CV-A16 incidence in the post-EV-A71-vaccination period remained either comparable to or only slightly increased from levels prior to vaccination. The duration and strength of cross-protection following infection with EV-A71 or CV-A16 was estimated to be 9.95 wk (95% confidence interval [CI]: 3.31, 23.40) in 68% of the population (95% CI: 37%, 96%). Our predictions are limited by the necessarily short and under-sampled time series and the possible circulation of unidentified serotypes, but, nonetheless, sensitivity analyses indicate that our results are robust in predicting that the vaccine should drastically reduce incidence of EV-A71 without a substantial competitive release of CV-A16. CONCLUSIONS The ability of our models to capture the observed epidemic cycles suggests that herd immunity is driving the epidemic dynamics caused by the multiple serotypes of enterovirus. Our results predict that the EV-A71 and CV-A16 serotypes provide a temporary immunizing effect against each other. Achieving high coverage rates of EV-A71 vaccination would be necessary to eliminate the ongoing transmission of EV-A71, but serotype replacement by CV-A16 following EV-A71 vaccination is likely to be transient and minor compared to the corresponding reduction in the burden of EV-A71-associated HFMD. Therefore, a mass EV-A71 vaccination program of infants and young children should provide significant benefits in terms of a reduction in overall HFMD burden.
Collapse
|
125
|
Wang M, Tao L, Xu H. Chinese herbal medicines as a source of molecules with anti-enterovirus 71 activity. Chin Med 2016; 11:2. [PMID: 26834824 PMCID: PMC4731985 DOI: 10.1186/s13020-016-0074-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Accepted: 01/08/2016] [Indexed: 02/06/2023] Open
Abstract
Enterovirus 71 (EV71) is one of the causative agents of hand, foot, and mouth disease (HFMD), which sometimes leads to severe neurological disease and death in the Asia-Pacific region. In Chinese medicine, HFMD is caused mainly by an accumulation of damp-heat and toxicity in the body. No effective drugs are currently available for the treatment and prevention of EV71 infection. This review summarizes the potential Chinese herbal extracts and isolated compounds with antiviral activity against EV71 and their clinical applications, especially those categorized as heat-clearing and detoxifying.
Collapse
Affiliation(s)
- Mengjie Wang
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203 China ; Engineering Research Center of Shanghai Colleges for TCM New Drug Discovery, Shanghai, 201203 China
| | - Ling Tao
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203 China ; Engineering Research Center of Shanghai Colleges for TCM New Drug Discovery, Shanghai, 201203 China ; Xinxiang Medical University, Jinsui Road 601, Xinxiang, Henan 453003 China
| | - Hongxi Xu
- School of Pharmacy, Shanghai University of Traditional Chinese Medicine, Shanghai, 201203 China ; Engineering Research Center of Shanghai Colleges for TCM New Drug Discovery, Shanghai, 201203 China
| |
Collapse
|
126
|
Liao J, Yu S, Yang F, Yang M, Hu Y, Zhang J. Short-Term Effects of Climatic Variables on Hand, Foot, and Mouth Disease in Mainland China, 2008-2013: A Multilevel Spatial Poisson Regression Model Accounting for Overdispersion. PLoS One 2016; 11:e0147054. [PMID: 26808311 PMCID: PMC4726563 DOI: 10.1371/journal.pone.0147054] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 12/28/2015] [Indexed: 11/19/2022] Open
Abstract
Background Hand, Foot, and Mouth Disease (HFMD) is a worldwide infectious disease. In China, many provinces have reported HFMD cases, especially the south and southwest provinces. Many studies have found a strong association between the incidence of HFMD and climatic factors such as temperature, rainfall, and relative humidity. However, few studies have analyzed cluster effects between various geographical units. Methods The nonlinear relationships and lag effects between weekly HFMD cases and climatic variables were estimated for the period of 2008–2013 using a polynomial distributed lag model. The extra-Poisson multilevel spatial polynomial model was used to model the exact relationship between weekly HFMD incidence and climatic variables after considering cluster effects, provincial correlated structure of HFMD incidence and overdispersion. The smoothing spline methods were used to detect threshold effects between climatic factors and HFMD incidence. Results The HFMD incidence spatial heterogeneity distributed among provinces, and the scale measurement of overdispersion was 548.077. After controlling for long-term trends, spatial heterogeneity and overdispersion, temperature was highly associated with HFMD incidence. Weekly average temperature and weekly temperature difference approximate inverse “V” shape and “V” shape relationships associated with HFMD incidence. The lag effects for weekly average temperature and weekly temperature difference were 3 weeks and 2 weeks. High spatial correlated HFMD incidence were detected in northern, central and southern province. Temperature can be used to explain most of variation of HFMD incidence in southern and northeastern provinces. After adjustment for temperature, eastern and Northern provinces still had high variation HFMD incidence. Conclusion We found a relatively strong association between weekly HFMD incidence and weekly average temperature. The association between the HFMD incidence and climatic variables spatial heterogeneity distributed across provinces. Future research should explore the risk factors that cause spatial correlated structure or high variation of HFMD incidence which can be explained by temperature. When analyzing association between HFMD incidence and climatic variables, spatial heterogeneity among provinces should be evaluated. Moreover, the extra-Poisson multilevel model was capable of modeling the association between overdispersion of HFMD incidence and climatic variables.
Collapse
Affiliation(s)
- Jiaqiang Liao
- West China School of Public Health, Sichuan University, Chengdu, Sichuan Province, China
| | - Shicheng Yu
- Office of Epidemiology, Chinese Center for Disease Prevention and Control, Beijing, China
| | - Fang Yang
- West China School of Public Health, Sichuan University, Chengdu, Sichuan Province, China
| | - Min Yang
- West China School of Public Health, Sichuan University, Chengdu, Sichuan Province, China
| | - Yuehua Hu
- Office of Epidemiology, Chinese Center for Disease Prevention and Control, Beijing, China
| | - Juying Zhang
- West China School of Public Health, Sichuan University, Chengdu, Sichuan Province, China
- * E-mail:
| |
Collapse
|
127
|
Lei X, Xiao X, Wang J. Innate Immunity Evasion by Enteroviruses: Insights into Virus-Host Interaction. Viruses 2016; 8:v8010022. [PMID: 26784219 PMCID: PMC4728582 DOI: 10.3390/v8010022] [Citation(s) in RCA: 74] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Revised: 12/16/2015] [Accepted: 12/25/2015] [Indexed: 12/18/2022] Open
Abstract
Enterovirus genus includes multiple important human pathogens, such as poliovirus, coxsackievirus, enterovirus (EV) A71, EV-D68 and rhinovirus. Infection with EVs can cause numerous clinical conditions including poliomyelitis, meningitis and encephalitis, hand-foot-and-mouth disease, acute flaccid paralysis, diarrhea, myocarditis and respiratory illness. EVs, which are positive-sense single-stranded RNA viruses, trigger activation of the host antiviral innate immune responses through pathogen recognition receptors such as retinoic acid-inducible gene (RIG-I)-likeand Toll-like receptors. In turn, EVs have developed sophisticated strategies to evade host antiviral responses. In this review, we discuss the interplay between the host innate immune responses and EV infection, with a primary focus on host immune detection and protection against EV infection and viral strategies to evade these antiviral immune responses.
Collapse
Affiliation(s)
- Xiaobo Lei
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology (IPB), Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College, Beijing 100730, China.
| | - Xia Xiao
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology (IPB), Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College, Beijing 100730, China.
| | - Jianwei Wang
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology (IPB), Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College, Beijing 100730, China.
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou 310003, China.
| |
Collapse
|
128
|
Liu DP, Wang TA, Huang WT, Chang LY, Wang ET, Cheng SH, Yang MC. Disease burden of enterovirus infection in Taiwan: Implications for vaccination policy. Vaccine 2016; 34:974-80. [PMID: 26768128 DOI: 10.1016/j.vaccine.2015.12.026] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 11/13/2015] [Accepted: 12/10/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES This study aimed to assess the disease burden and economic impacts of human nonpolio enteroviruses (NPEV) and enterovirus A71 (EV-A71) infection in Taiwan. MATERIALS AND METHODS We included children under five years old (n=983,127-1,118,649) with ICD-9-CM codes 0740 (herpangina) or 0743 (hand-foot-and-mouth disease) from the 2006 to 2010 National Health Insurance Database. Severity of enterovirus infection was assessed from outpatient/emergency visits, hospitalization (with/without intensive care unit [ICU] admission), infection with severe complications, and death. We estimated medical costs and indirect costs from the societal perspective. RESULTS The annual rates of NPEV events for children under five years old ranged from 13.9% to 38.4%, of which 5.1-8.8% were hospitalized. EV-A71 accounted for 7.8% of all NPEV medical costs, but 79.1% of NPEV ICU costs. Travel costs and productivity loss of caregivers were $37.1 (range: $24.5-$64.7) million per year. These costs were not higher in the EV-A71 dominant year ($34.4 million) compared with those in the other years. Productivity losses resulting from premature mortality by NPEV infection were $0.8 (range: $0.0-$2.9) million per year, of which 96.3% were caused by EV-A71. CONCLUSIONS Diseases associated with NPEV other than EV-A71 were responsible for most of the medical expenses. In addition, caregiver productivity loss by high rates of NPEV infection impacted the society much more than medical costs. A multi-valent vaccine that includes EV-A71 and other serotypes, for example coxsackievirus A16, may be beneficial to the health of children in Taiwan.
Collapse
Affiliation(s)
- Ding-Ping Liu
- Epidemic Intelligence Center, Centers for Disease Control, Taipei, Taiwan; Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan.
| | - Ting-Ann Wang
- Division of Acute Infectious Diseases, Centers for Disease Control, Taipei, Taiwan.
| | - Wan-Ting Huang
- Office of Preventive Medicine, Centers for Disease Control, Taipei, Taiwan; Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Luan-Yin Chang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - En-Tzu Wang
- Division of Acute Infectious Diseases, Centers for Disease Control, Taipei, Taiwan.
| | - Shou-Hsia Cheng
- Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan.
| | - Ming-Chin Yang
- Institute of Health Policy and Management, National Taiwan University, Taipei, Taiwan.
| |
Collapse
|
129
|
Krishnamoorthy V, Mackensen GB, Gibbons EF, Vavilala MS. Cardiac Dysfunction After Neurologic Injury: What Do We Know and Where Are We Going? Chest 2015; 149:1325-31. [PMID: 26836901 DOI: 10.1016/j.chest.2015.12.014] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 12/11/2015] [Accepted: 12/13/2015] [Indexed: 01/06/2023] Open
Abstract
Recent literature has implicated severe neurologic injuries, such as aneurysmal subarachnoid hemorrhage, as a cause of cardiac dysfunction, impaired hemodynamic function, and poor outcomes. Mechanistic links between the brain and the heart have been explored in detail over the past several decades, and catecholamine excess, neuroendocrine dysfunction, and unchecked inflammation all likely contribute to the pathophysiologic process. Although cardiac dysfunction has also been described in other disease paradigms, including septic shock and thermal injury, there is likely a common underlying pathophysiology. In this review, we will examine the pathophysiology of cardiac dysfunction after neurologic injury, discuss the evidence surrounding cardiac dysfunction after different neurologic injuries, and suggest future research goals to gain knowledge and improve outcomes in this patient population.
Collapse
Affiliation(s)
- Vijay Krishnamoorthy
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA; Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA.
| | - G Burkhard Mackensen
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA
| | - Edward F Gibbons
- Department of Medicine, University of Washington, Seattle, WA; Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA
| | - Monica S Vavilala
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA; Harborview Injury Prevention and Research Center, University of Washington, Seattle, WA
| |
Collapse
|
130
|
Zhuang ZC, Kou ZQ, Bai YJ, Cong X, Wang LH, Li C, Zhao L, Yu XJ, Wang ZY, Wen HL. Epidemiological Research on Hand, Foot, and Mouth Disease in Mainland China. Viruses 2015; 7:6400-11. [PMID: 26690202 PMCID: PMC4690870 DOI: 10.3390/v7122947] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 11/27/2015] [Accepted: 12/01/2015] [Indexed: 01/23/2023] Open
Abstract
Hand, foot, and mouth disease (HFMD), which has led to millions of attacks and several outbreaks across the world and become more predominant in Asia-Pacific Region, especially in Mainland China, is caused by several Human Enteroviruses including new enterovirus, coxsakievirus and echovirus. In recent years, much research has focused on the epidemiological characteristics of HFMD. In this article, multiple characteristics of HFMD such as basic epidemiology, etiology and molecular epidemiology; influencing factors; detection; and surveillance are reviewed, as these can be help protect high risks groups, prevalence prediction and policy making for disease prevention.
Collapse
Affiliation(s)
- Zhi-Chao Zhuang
- Department of Virology, School of Public Health, Shandong University, Jinan 250012, China.
| | - Zeng-Qiang Kou
- Shandong Center for Disease Control and Prevention, Jinan 250014, China.
| | - Yong-Juan Bai
- Department of Virology, School of Public Health, Shandong University, Jinan 250012, China.
| | - Xiang Cong
- Qilu Hospital of Shandong University, Jinan 250012, China.
| | - Li-Hong Wang
- Department of Virology, School of Public Health, Shandong University, Jinan 250012, China.
| | - Chun Li
- Department of Virology, School of Public Health, Shandong University, Jinan 250012, China.
| | - Li Zhao
- Department of Virology, School of Public Health, Shandong University, Jinan 250012, China.
| | - Xue-Jie Yu
- Department of Virology, School of Public Health, Shandong University, Jinan 250012, China.
- Center for Biodefense and Emerging Infectious Diseases, Departments of Pathology and Microbiology, Institute for Human Infections and Immunity, University of Texas Medical Branch, Galveston, TX 77555-0609, USA.
| | - Zhi-Yu Wang
- Department of Virology, School of Public Health, Shandong University, Jinan 250012, China.
| | - Hong-Ling Wen
- Department of Virology, School of Public Health, Shandong University, Jinan 250012, China.
| |
Collapse
|
131
|
Yu J, Zhang L, Ren P, Zhong T, Li Z, Wang Z, Li J, Liu X, Zhao K, Zhang W, Yu XF. Enterovirus 71 mediates cell cycle arrest in S phase through non-structural protein 3D. Cell Cycle 2015; 14:425-36. [PMID: 25659038 DOI: 10.4161/15384101.2014.980631] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Many viruses disrupt the host cell cycle to facilitate their own growth. We assessed the mechanism and function of enterovirus 71 (EV71), a primary causative agent for recent hand, foot, and mouth disease outbreaks, in manipulating cell cycle progression. Our results suggest that EV71 infection induces S-phase arrest in diverse cell types by preventing the cell cycle transition from the S phase into the G2/M phase. Similar results were observed for an alternate picornavirus, Coxsackievirus A16. Synchronization in S phase, but not G0/G1 phase or G2/M phase, promotes viral replication. Consistent with its ability to arrest cells in S phase, the expression of cyclin A2, CDK 2, cyclin E1, and cyclin B1 was regulated by EV71 through increasing transcription of cyclin E1, promoting proteasome-mediated degradation of cyclin A2 and regulating the phosphorylation of CDK 2. Finally, a non-structural protein of EV71, the RNA-dependent RNA polymerase 3D, was demonstrated to mediate S-phase cell cycle arrest. These findings suggest that EV71 induces S-phase cell cycle arrest in infected cells via non-structural protein 3D, which may provide favorable conditions for virus production.
Collapse
Affiliation(s)
- Jinghua Yu
- a Institute of Virology and AIDS Research ; The First Hospital of Jilin University; Jilin University ; Changchun , Jilin , China
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
132
|
Gou E, Li Q, Li X, Gu S, Han Y, Tang Z, Li Y, Huang B. Analysis on the sequence of the whole genome of an isolated enterovirus 71 strain. Int J Clin Exp Med 2015; 8:20652-20657. [PMID: 26884986 PMCID: PMC4723831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 09/02/2015] [Indexed: 06/05/2023]
Abstract
An enterovirus 71 (EV71) strain Query was isolated from a patient specimen in 2015. In order to known about its genetic evolution, this study amplified gene fragment of the isolated stain by RT-PCT and carried out sequencing of the total genome. The homology and genetic evolution of the gene sequence of the virus strain in the study were analyzed. The results showed that the isolated EV71 strain in this study had higher homology of nucleotide sequence and amino acid sequence with other virus strains, which was 80%-97% and 88% to 92%, respectively, but it had lower homology with Cox.A16 (homology of nucleotide sequence and amino acid sequence of Cox.A16 was 81% and 79%, respectively). Compare of homologous sequence at the encoding region VP1 demonstrated that the experimental isolated strain EV71 had higher homology of amino acid sequence at VP1 region with other virus strains. Genetic evolution of nucleotide sequence at VP1 region of the identified strain and other EV71 strains was analyzed, and the results demonstrated gene sequence at VP1 region and 5'UTR region of the isolated strain and SDLY017 strain was at the same branch, both of which belonged to C4a, a subtype of type C4.
Collapse
Affiliation(s)
- Enjin Gou
- Graduate School of Zunyi Medical UniversityZunyi 563000, Guizhou, China
| | - Qing Li
- The Third Affiliated Hospital of Zunyi Medical UniversityZunyi 563000, Guizhou, China
| | - Xiangxue Li
- Graduate School of Zunyi Medical UniversityZunyi 563000, Guizhou, China
| | - Shengli Gu
- The Third Affiliated Hospital of Zunyi Medical UniversityZunyi 563000, Guizhou, China
| | - Yun Han
- The Third Affiliated Hospital of Zunyi Medical UniversityZunyi 563000, Guizhou, China
| | - Zhengzhen Tang
- The Third Affiliated Hospital of Zunyi Medical UniversityZunyi 563000, Guizhou, China
| | - Ying Li
- The Third Affiliated Hospital of Zunyi Medical UniversityZunyi 563000, Guizhou, China
| | - Bo Huang
- The Third Affiliated Hospital of Zunyi Medical UniversityZunyi 563000, Guizhou, China
| |
Collapse
|
133
|
Identification of Positively Charged Residues in Enterovirus 71 Capsid Protein VP1 Essential for Production of Infectious Particles. J Virol 2015; 90:741-52. [PMID: 26512078 DOI: 10.1128/jvi.02482-15] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 10/17/2015] [Indexed: 01/24/2023] Open
Abstract
UNLABELLED Enterovirus 71 (EV71), a positive-stranded RNA virus, is the major cause of hand, foot, and mouth disease (HFMD) in children, which can cause severe central nervous system disease and death. The capsids of EV71 consist of 60 copies of each of four viral structural proteins (VP1 to VP4), with VP1, VP2, and VP3 exposed on the surface and VP4 arranged internally. VP1 plays a central role in particle assembly and cell entry. To gain insight into the role of positively charged residues in VP1 function in these processes, a charged-to-alanine scanning analysis was performed using an infectious cDNA clone of EV71. Twenty-seven mutants containing single charged-to-alanine changes were tested. Sixteen of them were not viable, seven mutants were replication defective, and the remaining four mutants were replication competent. By selecting revertants, second-site mutations which could at least partially restore viral infectivity were identified within VP1 for four defective mutations and two lethal mutations. The resulting residue pairs represent a network of intra- and intermolecular interactions of the VP1 protein which could serve as a potential novel drug target. Interestingly, mutation K215A in the VP1 GH loop led to a significant increase in thermal stability, demonstrating that conditional thermostable mutants can be generated by altering the charge characteristics of VP1. Moreover, all mutants were sensitive to the EV71 entry inhibitor suramin, which binds to the virus particle via the negatively charged naphthalenetrisulfonic acid group, suggesting that single charged-to-alanine mutation is not sufficient for suramin resistance. Taken together, these data highlight the importance of positively charged residues in VP1 for production of infectious particles. IMPORTANCE Infection with EV71 is more often associated with neurological complications in children and is responsible for the majority of fatalities. No licensed vaccines or antiviral therapies are currently available for the prevention or treatment of EV71 infection. Understanding the determinants of virion assembly and entry will facilitate vaccine development and drug discovery. Here, we identified 23 out of 27 positively charged residues in VP1 which impaired or blocked the production of infectious particles. The defect could be rescued by second-site mutations within the VP1 protein. Our findings highlight the importance of positively charged residues in VP1 during infectious particle production and reveal a potential strategy for blocking EV71 infections by inhibiting intra- or intermolecular interactions of the VP1 protein.
Collapse
|
134
|
Basic reproduction number of coxsackievirus type A6 and A16 and enterovirus 71: estimates from outbreaks of hand, foot and mouth disease in Singapore, a tropical city-state. Epidemiol Infect 2015; 144:1028-34. [DOI: 10.1017/s0950268815002137] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
SUMMARYCoxsackievirus A6 (CV-A6), coxsackievirus A16 (CV-A16) and enterovirus 71 (EV-A71) were the major enteroviruses causing nationwide hand, foot and mouth disease (HFMD) epidemics in Singapore in the last decade. We estimated the basic reproduction number (R0) of these enteroviruses to obtain a better understanding of their transmission dynamics. We merged records of cases from HFMD outbreaks reported between 2007 and 2012 with laboratory results from virological surveillance. R0 was estimated based on the cumulative number of reported cases in the initial growth phase of each outbreak associated with the particular enterovirus type. A total of 33 HFMD outbreaks were selected based on the inclusion criteria specified for our study, of which five were associated with CV-A6, 13 with CV-A16, and 15 with EV-A71. The median R0 was estimated to be 5·04 [interquartile range (IQR) 3·57–5·16] for CV-A6, 2·42 (IQR 1·85–3·36) for CV-A16, and 3·50 (IQR 2·36–4·53) for EV-A71. R0 was not significantly associated with number of infected children (P = 0·86), number of exposed children (P = 0·94), and duration of the outbreak (P = 0·05). These enterovirus-specific R0 estimates will be helpful in providing insights into the potential growth of future HFMD epidemics and outbreaks for timely implementation of disease control measures, together with disease dynamics such as severity of the cases.
Collapse
|
135
|
Mauleekoonphairoj J, Vongpunsawad S, Puenpa J, Korkong S, Poovorawan Y. Complete genome sequence analysis of enterovirus 71 isolated from children with hand, foot, and mouth disease in Thailand, 2012-2014. Virus Genes 2015; 51:290-3. [PMID: 26303899 DOI: 10.1007/s11262-015-1239-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 08/17/2015] [Indexed: 10/23/2022]
Abstract
The complete genomic sequences of 14 enterovirus 71 (EV71) strains isolated from children with hand, foot, and mouth disease in Thailand from 2012 to 2014 were determined and compared to enterovirus group A prototypes. Phylogenetic analysis revealed that 13 strains resembled the B5 subgroup, while one strain from a fatal case designated THA_1219 belonged to the C4 subgroup. Similarity plot and bootscan analyses suggested that THA_1219 underwent recombination in the P2 and P3 regions. Full-genome data from this work will contribute to the study of evolution dynamics of EV71.
Collapse
Affiliation(s)
- John Mauleekoonphairoj
- Department of Pediatrics, Center of Excellence in Clinical Virology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Sompong Vongpunsawad
- Department of Pediatrics, Center of Excellence in Clinical Virology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Jiratchaya Puenpa
- Department of Pediatrics, Center of Excellence in Clinical Virology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Sumeth Korkong
- Department of Pediatrics, Center of Excellence in Clinical Virology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Yong Poovorawan
- Department of Pediatrics, Center of Excellence in Clinical Virology, Faculty of Medicine, Chulalongkorn University, Bangkok, 10330, Thailand.
| |
Collapse
|
136
|
Li MZ, Pang LL, Bai AY, Yu SC, Gong X, Liu N, Cai K, Xie GC, Gao WJ, Jin Y, Duan ZJ. Association of Chemotactic Chemokine Ligand 5 Polymorphisms with the Risk of Developing Severe Enterovirus 71 Infection. Am J Trop Med Hyg 2015; 93:709-13. [PMID: 26304916 DOI: 10.4269/ajtmh.14-0745] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 06/26/2015] [Indexed: 02/01/2023] Open
Abstract
Respiratory damage is a main manifestation of severe Enterovirus 71 (EV71) infection. Polymorphisms of -403G/A (rs2107538), -28C/G (rs2280788), and In1.1T/C (rs2280789) in chemotactic chemokine ligand 5 (CCL5) have linked with many respiratory diseases. In this study, we explored the possible correlation of CCL5 polymorphisms with severe EV71 infection. Blood samples were obtained from 87 children hospitalized for EV71 infection. Fifty-seven healthy children were enrolled as asymptomatic controls. Genotype and allele frequencies were analyzed by logistic regression analysis. There were statistically significant differences in polymorphisms of CCL5 -403G/A and In1.1T/C for dominant model (P = 0.016; P = 0.027) and additive model (P = 0.010; P = 0.019) between patients with severe EV71 infection and asymptomatic controls. With ordinal logistic regression model analysis, statistically significant differences were found between polymorphisms of CCL5 (-403G/A) (P = 0.034) with the severity of EV71 infection after adjusting for age. The frequency of A-C-C haplotype was significantly higher in EV71 infection patients than controls (P = 0.032). These results suggest that CCL5 -403G/A and In1.1T/C polymorphisms may contribute to severe EV71 infection and individuals with haplotype of A-C-C may exhibit higher risk of developing severe EV71 infection. These findings may provide insights into pathogenic and protective mechanisms of severe EV71 infection.
Collapse
Affiliation(s)
- Mao-Zhong Li
- National Institute for Viral Disease Control and Prevention, China CDC, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, China; Ji'nan Municipal Center for Disease Control and Prevention, Ji'nan, China; National Center for Public Health Surveillance and Information Services, Chinese Center for Disease Control and Prevention, Beijing, China; Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China; Nanjing Children's Hospital, Medical School of Nanjing University, Nanjing, China
| | - Li-Li Pang
- National Institute for Viral Disease Control and Prevention, China CDC, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, China; Ji'nan Municipal Center for Disease Control and Prevention, Ji'nan, China; National Center for Public Health Surveillance and Information Services, Chinese Center for Disease Control and Prevention, Beijing, China; Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China; Nanjing Children's Hospital, Medical School of Nanjing University, Nanjing, China
| | - Ai-Ying Bai
- National Institute for Viral Disease Control and Prevention, China CDC, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, China; Ji'nan Municipal Center for Disease Control and Prevention, Ji'nan, China; National Center for Public Health Surveillance and Information Services, Chinese Center for Disease Control and Prevention, Beijing, China; Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China; Nanjing Children's Hospital, Medical School of Nanjing University, Nanjing, China
| | - Shi-Cheng Yu
- National Institute for Viral Disease Control and Prevention, China CDC, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, China; Ji'nan Municipal Center for Disease Control and Prevention, Ji'nan, China; National Center for Public Health Surveillance and Information Services, Chinese Center for Disease Control and Prevention, Beijing, China; Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China; Nanjing Children's Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xun Gong
- National Institute for Viral Disease Control and Prevention, China CDC, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, China; Ji'nan Municipal Center for Disease Control and Prevention, Ji'nan, China; National Center for Public Health Surveillance and Information Services, Chinese Center for Disease Control and Prevention, Beijing, China; Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China; Nanjing Children's Hospital, Medical School of Nanjing University, Nanjing, China
| | - Na Liu
- National Institute for Viral Disease Control and Prevention, China CDC, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, China; Ji'nan Municipal Center for Disease Control and Prevention, Ji'nan, China; National Center for Public Health Surveillance and Information Services, Chinese Center for Disease Control and Prevention, Beijing, China; Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China; Nanjing Children's Hospital, Medical School of Nanjing University, Nanjing, China
| | - Kun Cai
- National Institute for Viral Disease Control and Prevention, China CDC, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, China; Ji'nan Municipal Center for Disease Control and Prevention, Ji'nan, China; National Center for Public Health Surveillance and Information Services, Chinese Center for Disease Control and Prevention, Beijing, China; Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China; Nanjing Children's Hospital, Medical School of Nanjing University, Nanjing, China
| | - Guang-Cheng Xie
- National Institute for Viral Disease Control and Prevention, China CDC, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, China; Ji'nan Municipal Center for Disease Control and Prevention, Ji'nan, China; National Center for Public Health Surveillance and Information Services, Chinese Center for Disease Control and Prevention, Beijing, China; Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China; Nanjing Children's Hospital, Medical School of Nanjing University, Nanjing, China
| | - Wen-Juan Gao
- National Institute for Viral Disease Control and Prevention, China CDC, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, China; Ji'nan Municipal Center for Disease Control and Prevention, Ji'nan, China; National Center for Public Health Surveillance and Information Services, Chinese Center for Disease Control and Prevention, Beijing, China; Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China; Nanjing Children's Hospital, Medical School of Nanjing University, Nanjing, China
| | - Yu Jin
- National Institute for Viral Disease Control and Prevention, China CDC, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, China; Ji'nan Municipal Center for Disease Control and Prevention, Ji'nan, China; National Center for Public Health Surveillance and Information Services, Chinese Center for Disease Control and Prevention, Beijing, China; Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China; Nanjing Children's Hospital, Medical School of Nanjing University, Nanjing, China
| | - Zhao-Jun Duan
- National Institute for Viral Disease Control and Prevention, China CDC, Key Laboratory for Medical Virology, National Health and Family Planning Commission, Beijing, China; Ji'nan Municipal Center for Disease Control and Prevention, Ji'nan, China; National Center for Public Health Surveillance and Information Services, Chinese Center for Disease Control and Prevention, Beijing, China; Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China; Nanjing Children's Hospital, Medical School of Nanjing University, Nanjing, China
| |
Collapse
|
137
|
Clinical Features for Mild Hand, Foot and Mouth Disease in China. PLoS One 2015; 10:e0135503. [PMID: 26302092 PMCID: PMC4547800 DOI: 10.1371/journal.pone.0135503] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Accepted: 07/22/2015] [Indexed: 12/12/2022] Open
Abstract
Background Mild hand, foot and mouth disease (HFMD) is at a critical stage owing to its ease of communicability and a higher risk of developing severe complications and death. Clinical diagnosis of mild HFMD was made by the presenting symptoms and signs (symptoms in brief) alone. We aim to evaluate the frequencies of symptoms in a retrospective case series study. Methods We collected epidemiological, demographic, clinical, and laboratory data from outpatient and inpatient settings on the clinical data warehouse system. We principally described the frequencies of symptoms of mild HFMD. Correlations between symptoms with laboratory-confirmed cases were then analyzed. Results The clinical data warehouse system included 3649 probable cases, between 2010 and 2012, of which 956 (26.20%) were laboratory confirmed. The peak incidence was identified in children 2 years of age. A total of 370 of the 956 laboratory confirmed cases (38.70%) were associated with enterovirus 71 (EV71). Logistic regression analysis adjusted for geographical variables, age, sex, month of onset, and time from onset to diagnosis showed that the clinical features constipation (P<0.0001; adjusted OR, 95%CI (2.99, 2.28–3.91)), and blisters (P<0.0001; adjusted OR, 95%CI (2.16, 1.82–2.56)) were positively correlated with the confirmed cases. Conclusions This is the largest case series study, including all the guideline-mentioned symptoms of mild HFMD. Our findings suggest that blisters and constipation should be considered as potential warning signs while front-line clinicians manage surges of children diagnosed with mild HFMD during a pandemic.
Collapse
|
138
|
Han X, Ying XL, Zhou SL, Han T, Huang H, Jin Q, Yang F, Sun QY, Sun XX. Characterization of the enterovirus 71 P1 polyprotein expressed in Pichia pastor as a candidate vaccine. Hum Vaccin Immunother 2015; 10:2220-6. [PMID: 25424925 DOI: 10.4161/hv.29123] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Human enterovirus 71 (EV71) plays an important role in hand, foot, and mouth disease (HFMD), which recently caused the death of hundreds of children in the Asia-Pacific region. However, there are no specific treatments available for EV71 infections; thus, a safe and effective vaccine is needed urgently. In this study, we developed an effective and economical method for producing EV71 polyprotein (P1 protein) in Pichia pastoris. Furthermore, we evaluated the potential of P1 protein as a candidate vaccine against EV71 virus. The data revealed that P1 protein induced persistent high cross-neutralization antibodies for different EV71 subtypes, and elicited significant splenocyte proliferation. The high levels of interleukin-10(IL-10) and interferon-gamma (IFN-γ) showed that P1 protein induced Th1 and Th2 immune responses. Interestingly, vaccinating female mice with the P1 protein conferred cross-protection against different EV71 subtypes to their neonatal offspring.Compared with heat-inactivated EV71, the P1 protein elicited improved humoral and cellular immune responses and showed good cross-protection with different EV71 subtypes. Therefore, the EV71-P1 protein produced by P. pastoris is a promising candidate vaccine against EV71.
Collapse
Affiliation(s)
- Xue Han
- a College of life science; Jianghan University; Wuhan, Hubei, PR China
| | | | | | | | | | | | | | | | | |
Collapse
|
139
|
Lei X, Cui S, Zhao Z, Wang J. Etiology, pathogenesis, antivirals and vaccines of hand, foot, and mouth disease. Natl Sci Rev 2015. [DOI: 10.1093/nsr/nwv038] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Abstract
Hand, foot, and mouth disease (HFMD), caused by enteroviruses, is a syndrome characterized by fever with vesicular eruptions mainly on the skin of the hands, feet, and oral cavity. HFMD primarily affects infants and young children. Although infection is usually self-limited, severe neurological complications in the central nervous system can present in some cases, which can lead to death. Widespread infection of HFMD across the Asia-Pacific region over the past two decades has made HFMD a major public health challenge, ranking first among the category C notifiable communicable diseases in China every year since 2008. This review summarizes our understanding of HFMD, focusing on the etiology and pathogenesis of the disease, as well as on progress toward antivirals and vaccines. The review also discusses the implications of these studies as they relate to the control and prevention of the disease.
Collapse
Affiliation(s)
- Xiaobo Lei
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Sheng Cui
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Zhendong Zhao
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jianwei Wang
- MOH Key Laboratory of Systems Biology of Pathogens, Institute of Pathogen Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
- Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou 310003, China
| |
Collapse
|
140
|
Zhang SY, Xu MY, Xu HM, Li XJ, Ding SJ, Wang XJ, Li TY, Lu QB. Immunologic Characterization of Cytokine Responses to Enterovirus 71 and Coxsackievirus A16 Infection in Children. Medicine (Baltimore) 2015; 94:e1137. [PMID: 26166120 PMCID: PMC4504596 DOI: 10.1097/md.0000000000001137] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Viral encephalitis is a serious complication of hand, foot, and mouth disease (HFMD), but characteristics of cytokines response in enterovirus 71 (EV-71) and/or coxsackievirus A16 (CV-A16) associated HFMD with or without viral encephalitis remained unclear.We performed a multigroup retrospective study and compared the serum cytokines concentrations among 16 encephalitis patients infected with EV-71 and CV-A16, 24 encephalitis patients with single EV-71 infection, 34 mild HFMD patients with EV-71 infection, 18 mild HFMD patients with CV-A16 infection, and 39 healthy control subjects.Serum levels of interleukin (IL)-4, IL-5, IL-22, and IL-23 were significantly higher in encephalitis patients than in HFMD-alone patients when adjusting for age and sex; IL-2, tumor necrosis factor (TNF)-α, IL-4, IL-22, and IL-1β were significantly higher in HFMD-alone patients of EV-71 infection than in CV-A16 infected HFMD patients; cerebrospinal fluid level of IL-6 was lower in the EV-71/CV-A16 associated encephalitis than that in the EV-71 alone associated encephalitis patients.Over or low expression of the cytokines cascade in HFMD patients appears to play an important role in the elicitation of the immune response to EV-71 and CV-A16. These data will be used to define a cytokine profile, which might help to recognize HFMD patients with the high risk of developing encephalitis.
Collapse
Affiliation(s)
- Shu-Yan Zhang
- From the Department of Clinical Laboratory, General Hospital of Beijing Military Region (S-YZ); Department of Nutrition, Aerospace Center Hospital, Beijing (M-YX); Chongqing Children's hospital, Chongqing (H-MX, T-YL); School of Public health College, Shandong University (X-JL); Department of Viral Infectious Diseases Control and Prevention, Shandong Center for Disease Control and Prevention, Shandong Provincial Key Laboratory of Communicable Disease Control and Prevention, Jinan (S-JD, X-JW); and School of Public Health, Peking University, Beijing, P. R. China (Q-BL)
| | | | | | | | | | | | | | | |
Collapse
|
141
|
Liu W, Ji H, Shan J, Bao J, Sun Y, Li J, Bao C, Tang F, Yang K, Bergquist R, Peng Z, Zhu Y. Spatiotemporal Dynamics of Hand-Foot-Mouth Disease and Its Relationship with Meteorological Factors in Jiangsu Province, China. PLoS One 2015; 10:e0131311. [PMID: 26121573 PMCID: PMC4488144 DOI: 10.1371/journal.pone.0131311] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Accepted: 06/01/2015] [Indexed: 11/18/2022] Open
Abstract
Hand, foot and mouth disease (HFMD) is an important public health issue in mainland China, including Jiangsu Province. The main purpose of this study was to depict the epidemiological characteristics of HFMD and evaluate the effects of meteorological variables on its dynamics via spatiotemporal analytic methods, which is essential for formulating scientific and effective prevention and control strategies and measures. In total, 497,910 cases of HFMD occurred in the 2009-2013 period, with an average annual incidence of 126.3 per 100,000 in Jiangsu. Out of these, 87.7% were under 5 years old with a male-to-female incidence ratio of 1.4. The dominant pathogens of the laboratory-confirmed cases were EV71 and CoxA16, accounting for 44.8% and 30.6% of all cases, respectively. Two incidence peaks were observed in each year, the higher occurring between April and June, the lower between November and December. The incidence ranged between 16.8 and 233.5 per 100,000 at the county level. The incidence in the South of the province was generally higher than that in the northern regions. The most likely spatiotemporal cluster detected by space–time scan analysis occurred in May-June of 2012 in the southern region. Average temperature and rainfall were positively correlated with HFMD incidence, while the number of days with rainfall ≥ 0.1mm, low temperature, high temperature and hours of sunshine were negatively related. Particularly, relative humidity had no relationship. In conclusion, the prevalence of HFMD in Jiangsu Province has an obvious feature of seasonality. The etiological composition changed dynamically and might be a latent driving force for the temporal variation of the incidence of HFMD. A moderately warm environment promotes the transmission of the HFMD viruses, while particularly cold and hot climate conditions restrain their transmission.
Collapse
Affiliation(s)
- Wendong Liu
- Key Lab of Enteric Pathogenic Microbiology, Ministry of Health, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Hong Ji
- Key Lab of Enteric Pathogenic Microbiology, Ministry of Health, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Jun Shan
- Key Lab of Enteric Pathogenic Microbiology, Ministry of Health, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Jin Bao
- Jiangsu Meteorological Service Center, Nanjing, China
| | - Yan Sun
- Jiangsu Meteorological Observatory, Nanjing, China
| | - Juan Li
- Jiangsu Meteorological Service Center, Nanjing, China
| | - Changjun Bao
- Key Lab of Enteric Pathogenic Microbiology, Ministry of Health, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Fenyang Tang
- Key Lab of Enteric Pathogenic Microbiology, Ministry of Health, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
| | - Kun Yang
- Department of Schistosomiasis Control, Jiangsu Institute of Parasitic Diseases, Wuxi, China
| | | | - Zhihang Peng
- Department of Epidemiology & Biostatistics, School of Public Health, Nanjing Medical University, Nanjing, China
| | - Yefei Zhu
- Key Lab of Enteric Pathogenic Microbiology, Ministry of Health, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, China
- * E-mail:
| |
Collapse
|
142
|
Zhou X, Zhu Q, Xia W, He F, Hu M, Ni X, Gao M, Chen H, Chen S. Molecular epidemiology of an outbreak of hand, foot, and mouth disease associated with subgenotype C4a of enterovirus A71 in Nanchang, China in 2014. J Med Virol 2015; 87:2154-8. [PMID: 26058813 DOI: 10.1002/jmv.24288] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2015] [Indexed: 11/10/2022]
Abstract
An outbreak of hand, foot, and mouth disease was reported through hospital-based surveillance in Nanchang, China in 2014. A total of 244 cases were reported, 176 (72.1%) cases were tested positive for enteroviruses by direct reverse transcription-polymerase chain reaction, in which enterovirus A71 (EV-A71), coxsackievirus A16 (CV-A16), and untyped enteroviruses (UEV) accounted for 84.1%, 3.4%, and 12.5%, respectively. In this outbreak, children under 5 years old constituted more than 98% of the positive cases, and the ratio of male to female cases was 2.6 to 1 (P < 0.01). Phylogenetic analysis indicated that the Nanchang EV-A71 strains belonged to subgenotype C4a undergoing continuously evolutionary changes.
Collapse
Affiliation(s)
- Xianfeng Zhou
- Nanchang Center for Disease Control and Prevention, Nanchang, China
| | - Qingxiong Zhu
- Department of Infectious Diseases, Children's Hospital of Jiangxi Province, Nanchang, China
| | - Wen Xia
- Nanchang Center for Disease Control and Prevention, Nanchang, China
| | - Fenglan He
- Nanchang Center for Disease Control and Prevention, Nanchang, China
| | - Maohong Hu
- Nanchang Center for Disease Control and Prevention, Nanchang, China
| | - Xiansheng Ni
- Nanchang Center for Disease Control and Prevention, Nanchang, China
| | - Meiling Gao
- Nanchang University Medical College, Nanchang, China
| | - Haiying Chen
- Nanchang Center for Disease Control and Prevention, Nanchang, China
| | - Shengen Chen
- Nanchang Center for Disease Control and Prevention, Nanchang, China
| |
Collapse
|
143
|
Ang LW, Tay J, Phoon MC, Hsu JP, Cutter J, James L, Goh KT, Chow VTK. Seroepidemiology of Coxsackievirus A6, Coxsackievirus A16, and Enterovirus 71 Infections among Children and Adolescents in Singapore, 2008-2010. PLoS One 2015; 10:e0127999. [PMID: 26011735 PMCID: PMC4444285 DOI: 10.1371/journal.pone.0127999] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 04/21/2015] [Indexed: 01/21/2023] Open
Abstract
Coxsackieviruses A6 (CV-A6) and A16 (CV-A16) and Enterovirus 71 (EV-A71) have caused periodic epidemics of hand, foot and mouth disease (HFMD) among children in Singapore. We conducted a cross-sectional study to estimate the seroprevalence of these enteroviruses among Singapore children and adolescents. The study was conducted between August 2008 and July 2010. It involved 700 Singapore residents aged 1-17 years whose residual sera were obtained following the completion of routine biochemical investigations in two public acute-care hospitals. The levels of neutralizing antibodies (NtAb) against CV-A6, CV-A16 and EV-A71 were analyzed by the microneutralization test. The age-specific geometric mean titer (GMT) of antibodies against each of the three enteroviruses and the 95% confidence intervals (CI) were calculated. The seroprevalence of CV-A6 and CV-A16 was high at 62.7% (95% CI: 59.1-66.2%) and 60.6% (95% CI: 56.9-64.1%), respectively. However, the seroprevalence of EV-A71 was significantly lower at 29.3% (95% CI: 26.0-32.8%). About 89.7% of the children and adolescents had been infected by at least one of the three enteroviruses by 13-17 years of age. About half (52.3%) were seropositive for two or all three enteroviruses, while only 16.1% had no NtAb against any of the three enteroviruses. High NtAb levels were observed in the younger age groups. CV-A6 and CV-A16 infections are very common among Singapore children and adolescents, while EV-A71 infections are less common. Infection is continually acquired from early childhood to adolescent age.
Collapse
Affiliation(s)
- Li Wei Ang
- Epidemiology and Disease Control Division, Ministry of Health, Singapore, College of Medicine Building, 16 College Road, Singapore 169854, Singapore
| | - Joanne Tay
- Communicable Diseases Division, Ministry of Health, Singapore, College of Medicine Building, 16 College Road, Singapore 169854, Singapore
| | - Meng Chee Phoon
- Department of Microbiology, Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, MD4, 5 Science Drive 2, Singapore 117545, Singapore
| | - Jung Pu Hsu
- Department of Microbiology, Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, MD4, 5 Science Drive 2, Singapore 117545, Singapore
| | - Jeffery Cutter
- Communicable Diseases Division, Ministry of Health, Singapore, College of Medicine Building, 16 College Road, Singapore 169854, Singapore
| | - Lyn James
- Epidemiology and Disease Control Division, Ministry of Health, Singapore, College of Medicine Building, 16 College Road, Singapore 169854, Singapore
| | - Kee Tai Goh
- Communicable Diseases Division, Ministry of Health, Singapore, College of Medicine Building, 16 College Road, Singapore 169854, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, MD3, 16 Medical Drive, Singapore 117597, Singapore
| | - Vincent Tak-Kwong Chow
- Department of Microbiology, Yong Loo Lin School of Medicine, National University Health System, National University of Singapore, MD4, 5 Science Drive 2, Singapore 117545, Singapore
| |
Collapse
|
144
|
Huang Y, Zhou Y, Lu H, Yang H, Feng Q, Dai Y, Chen L, Yu S, Yao X, Zhang H, Jiang M, Wang Y, Han N, Hu G, He Y. Characterization of severe hand, foot, and mouth disease in Shenzhen, China, 2009-2013. J Med Virol 2015; 87:1471-9. [PMID: 25951788 DOI: 10.1002/jmv.24200] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/19/2015] [Indexed: 11/07/2022]
Abstract
Hand, foot, and mouth disease (HFMD) is caused by human enteroviruses, especially by enterovirus 71 (EV71) and coxsackievirus A16 (CA16). Patients infected with different enteroviruses show varied clinical symptoms. The aim of this study was to determine whether the etiological spectrum of mild and severe HFMD changed, and the association between pathogens and clinical features. From 2009 to 2013, a total of 2,299 stool or rectal specimens were collected with corresponding patient data. A dynamic view of the etiological spectrum of mild and severe HFMD in Shenzhen city of China was provided. EV71 accounted for the majority proportion of severe HFMD cases and fatalities during 2009-2013. CA16 and EV71 were gradually replaced by coxsackievirus A6 (CA6) as the most common serotype for mild HFMD since 2010. Myoclonic jerk and vomiting were the most frequent severe symptoms. Nervous system complications, including aseptic encephalitis and aseptic meningitis were observed mainly in patients infected by EV71. Among EV71, CA16, CA6, and CA10 infection, fever and pharyngalgia were more likely to develop, vesicles on the hand, foot, elbow, knee and buttock were less likely to develop in patients infected with CA10. Vesicles on the mouth more frequently occurred in the patients with CA6, but less in the patient with EV71. Associations between diverse enterovirus serotypes and various clinical features were discovered in the present study, which may offer further insight into early detection, diagnosis and treatment of HFMD.
Collapse
Affiliation(s)
- Yun Huang
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China
| | - Yuanping Zhou
- First School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Hong Lu
- Scientific Research Department of Nanfang Hospital Affiliated to Southern Medical University, Guangzhou, China
| | - Hong Yang
- Major Infectious Disease Control Key Laboratory, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Qianjin Feng
- Department of Health Statistics and Epidemiology, College of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Yingchun Dai
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China
| | - Long Chen
- Major Infectious Disease Control Key Laboratory, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Shouyi Yu
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China
| | - Xiangjie Yao
- Major Infectious Disease Control Key Laboratory, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Hailong Zhang
- Major Infectious Disease Control Key Laboratory, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Ming Jiang
- Major Infectious Disease Control Key Laboratory, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Yujie Wang
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China
| | - Ning Han
- Department of Occupational and Environmental Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Guifang Hu
- Department of Epidemiology, School of Public Health and Tropical Medicine, Southern Medical University, Guangzhou, China
| | - Yaqing He
- First School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Major Infectious Disease Control Key Laboratory, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| |
Collapse
|
145
|
Cao L, Mao F, Pang Z, Yi Y, Qiu F, Tian R, Meng Q, Jia Z, Bi S. Protective effect of enterovirus‑71 (EV71) virus‑like particle vaccine against lethal EV71 infection in a neonatal mouse model. Mol Med Rep 2015; 12:2473-80. [PMID: 25936344 PMCID: PMC4464482 DOI: 10.3892/mmr.2015.3680] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2014] [Accepted: 03/16/2015] [Indexed: 01/01/2023] Open
Abstract
Enterovirus-71 (EV71) is a viral pathogen that causes severe cases of hand, foot and mouth disease (HFMD) among young children, with significant mortality. Effective vaccines against HFMD are urgently required. Several EV71 virus-like particle (VLP) vaccine candidates were found to be protective in the neonatal mouse EV71 challenge model. However, to what extent the VLP vaccine protects susceptible organs against EV71 infection in vivo has remained elusive. In the present study, the comprehensive immunogenicity of a potential EV71 vaccine candidate based on VLPs was evaluated in a neonatal mouse model. Despite lower levels of neutralizing antibodies to EV71 in the sera of VLP-immunized mice compared with those in mice vaccinated with inactivated EV71, the VLP-based vaccine was shown to be able to induce immunoglobulin (Ig)G and IgA memory-associated cellular immune responses to EV71. Of note, the EV71 VLP vaccine candidate was capable of inhibiting viral proliferation in cardiac muscle, skeletal muscle, lung and intestine of immunized mice and provided effective protection against the pathological damage caused by viral attack. In particular, the VLP vaccine was able to inhibit the transportation of EV71 from the central nervous system to the muscle tissue and greatly protected muscle tissue from infection, along with recovery from the viral infection. This led to nearly 100% immunoprotective efficacy, enabling neonatal mice delivered by VLP-immunized female adult mice to survive and grow with good health. The present study provided valuable additional knowledge of the specific protective efficacy of the EV71 VLP vaccine in vivo, which also indicated that it is a promising potential candidate for being developed into an EV71 vaccine.
Collapse
Affiliation(s)
- Lei Cao
- Department of Viral Hepatitis, National Institute for Viral Disease Control and Prevention, China Center for Disease Control and Prevention, Beijing 102206, P.R. China
| | - Fengfeng Mao
- Laboratory Animal Center, The Fourth Military Medical University, Xi'an, Shaanxi 710032, P.R. China
| | - Zheng Pang
- Department of Viral Hepatitis, National Institute for Viral Disease Control and Prevention, China Center for Disease Control and Prevention, Beijing 102206, P.R. China
| | - Yao Yi
- Department of Viral Hepatitis, National Institute for Viral Disease Control and Prevention, China Center for Disease Control and Prevention, Beijing 102206, P.R. China
| | - Feng Qiu
- Department of Viral Hepatitis, National Institute for Viral Disease Control and Prevention, China Center for Disease Control and Prevention, Beijing 102206, P.R. China
| | - Ruiguang Tian
- Department of Viral Hepatitis, National Institute for Viral Disease Control and Prevention, China Center for Disease Control and Prevention, Beijing 102206, P.R. China
| | - Qingling Meng
- Department of Viral Hepatitis, National Institute for Viral Disease Control and Prevention, China Center for Disease Control and Prevention, Beijing 102206, P.R. China
| | - Zhiyuan Jia
- Department of Viral Hepatitis, National Institute for Viral Disease Control and Prevention, China Center for Disease Control and Prevention, Beijing 102206, P.R. China
| | - Shengli Bi
- Department of Viral Hepatitis, National Institute for Viral Disease Control and Prevention, China Center for Disease Control and Prevention, Beijing 102206, P.R. China
| |
Collapse
|
146
|
Kotani O, Iwata‐Yoshikawa N, Suzuki T, Sato Y, Nakajima N, Koike S, Iwasaki T, Sata T, Yamashita T, Minagawa H, Taguchi F, Hasegawa H, Shimizu H, Nagata N. Establishment of a panel of in-house polyclonal antibodies for the diagnosis of enterovirus infections. Neuropathology 2015; 35:107-21. [PMID: 25263613 PMCID: PMC7168124 DOI: 10.1111/neup.12171] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2014] [Accepted: 09/02/2014] [Indexed: 11/30/2022]
Abstract
The aim of this study was to establish a reliable method of virus detection for the diagnosis of critical enterovirus infections such as acute infective encephalitis, encephalomyelitis and myocarditis. Because histopathological and immunohistochemical analyses of paraffin-embedded tissues play an important role in recognizing infectious agents in tissue samples, six in-house polyclonal antibodies raised against three representative enteroviruses using an indirect immunofluorescence assay and immunohistochemistry were examined. This panel of polyclonal antibodies recognized three serotypes of enterovirus. Two of the polyclonal antibodies were raised against denatured virus particles from enterovirus A71, one was raised against the recombinant VP1 protein of coxsackievirus B3, and the other for poliovirus type 1 were raised against denatured virus particles, the recombinant VP1 protein and peptide 2C. Western blot analysis revealed that each of these antibodies recognized the corresponding viral antigen and none cross-reacted with non-enteroviruses within the family Picornaviridae. However, all cross-reacted to some extent with the antigens derived from other serotypes of enterovirus. Indirect immunofluorescence assay and immunohistochemistry revealed that the virus capsid and non-structural proteins were localized in the cytoplasm of affected culture cells, and skeletal muscles and neurons in neonatal mice experimentally-infected with human enterovirus. The antibodies also recognized antigens derived from recent clinical isolates of enterovirus A71, coxsackievirus B3 and poliovirus. In addition, immunohistochemistry revealed that representative antibodies tested showed the same recognition pattern according to each serotype. Thus, the panel of in-house anti-enterovirus polyclonal antibodies described herein will be an important tool for the screening and pathological diagnosis for enterovirus infections, and may be useful for the classification of different enterovirus serotypes, including coxsackieviruses A and B, echoviruses, enterovirus A71 and poliovirus.
Collapse
Affiliation(s)
- Osamu Kotani
- Department of PathologyNational Institute of Infectious DiseasesAichiJapan
- Department of Virology and Viral InfectionsFaculty of Veterinary MedicineNippon Veterinary and Life Science UniversityAichiJapan
| | | | - Tadaki Suzuki
- Department of PathologyNational Institute of Infectious DiseasesAichiJapan
| | - Yuko Sato
- Department of PathologyNational Institute of Infectious DiseasesAichiJapan
| | - Noriko Nakajima
- Department of PathologyNational Institute of Infectious DiseasesAichiJapan
| | - Satoshi Koike
- Neurovirology ProjectTokyo Metropolitan Institute of Medical ScienceAichiJapan
| | - Takuya Iwasaki
- Department of PathologyNational Institute of Infectious DiseasesAichiJapan
| | - Tetsutaro Sata
- Department of PathologyNational Institute of Infectious DiseasesAichiJapan
| | - Teruo Yamashita
- Department of Microbiology and Medical ZoologyAichi Prefectural Institute of Public HealthAichiJapan
| | - Hiroko Minagawa
- Department of Microbiology and Medical ZoologyAichi Prefectural Institute of Public HealthAichiJapan
| | - Fumihiro Taguchi
- Department of Virology and Viral InfectionsFaculty of Veterinary MedicineNippon Veterinary and Life Science UniversityAichiJapan
| | - Hideki Hasegawa
- Department of PathologyNational Institute of Infectious DiseasesAichiJapan
| | - Hiroyuki Shimizu
- Department of Virology IINational Institute of Infectious DiseasesAichiJapan
| | - Noriyo Nagata
- Department of PathologyNational Institute of Infectious DiseasesAichiJapan
| |
Collapse
|
147
|
Shang L, Zhang S, Yang X, Sun J, Li L, Cui Z, He Q, Guo Y, Sun Y, Yin Z. Biochemical characterization of recombinant Enterovirus 71 3C protease with fluorogenic model peptide substrates and development of a biochemical assay. Antimicrob Agents Chemother 2015; 59:1827-36. [PMID: 25421478 PMCID: PMC4356770 DOI: 10.1128/aac.04698-14] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Accepted: 11/17/2014] [Indexed: 02/08/2023] Open
Abstract
Enterovirus 71 (EV71), a primary pathogen of hand, foot, and mouth disease (HFMD), affects primarily infants and children. Currently, there are no effective drugs against HFMD. EV71 3C protease performs multiple tasks in the viral replication, which makes it an ideal antiviral target. We synthesized a small set of fluorogenic model peptides derived from cleavage sites of EV71 polyprotein and examined their efficiencies of cleavage by EV71 3C protease. The novel peptide P08 [(2-(N-methylamino)benzoyl) (NMA)-IEALFQGPPK(DNP)FR] was determined to be the most efficiently cleaved by EV71 3C protease, with a kinetic constant kcat/Km of 11.8 ± 0.82 mM(-1) min(-1). Compared with literature reports, P08 gave significant improvement in the signal/background ratio, which makes it an attractive substrate for assay development. A Molecular dynamics simulation study elaborated the interactions between substrate P08 and EV71 3C protease. Arg39, which is located at the bottom of the S2 pocket of EV71 3C protease, may participate in the proteolysis process of substrates. With an aim to evaluate EV71 3C protease inhibitors, a reliable and robust biochemical assay with a Z' factor of 0.87 ± 0.05 was developed. A novel compound (compound 3) (50% inhibitory concentration [IC50] = 1.89 ± 0.25 μM) was discovered using this assay, which effectively suppressed the proliferation of EV 71 (strain Fuyang) in rhabdomyosarcoma (RD) cells with a highly selective index (50% effective concentration [EC50] = 4.54 ± 0.51 μM; 50% cytotoxic concentration [CC50] > 100 μM). This fast and efficient assay for lead discovery and optimization provides an ideal platform for anti-EV71 drug development targeting 3C protease.
Collapse
Affiliation(s)
- Luqing Shang
- College of Pharmacy & State Key Laboratory of Elemento-Organic Chemistry, Nankai University, Tianjin, People's Republic of China Collaborative Innovation Center of Chemical Science and Engineering (Tianjin), Tianjin, People's Republic of China
| | - Shumei Zhang
- College of Pharmacy & State Key Laboratory of Elemento-Organic Chemistry, Nankai University, Tianjin, People's Republic of China Collaborative Innovation Center of Chemical Science and Engineering (Tianjin), Tianjin, People's Republic of China
| | - Xi Yang
- College of Pharmacy & State Key Laboratory of Elemento-Organic Chemistry, Nankai University, Tianjin, People's Republic of China Collaborative Innovation Center of Chemical Science and Engineering (Tianjin), Tianjin, People's Republic of China
| | - Jixue Sun
- College of Pharmacy & State Key Laboratory of Elemento-Organic Chemistry, Nankai University, Tianjin, People's Republic of China
| | - Linfeng Li
- College of Pharmacy & State Key Laboratory of Elemento-Organic Chemistry, Nankai University, Tianjin, People's Republic of China Collaborative Innovation Center of Chemical Science and Engineering (Tianjin), Tianjin, People's Republic of China
| | - Zhengjie Cui
- College of Pharmacy & State Key Laboratory of Elemento-Organic Chemistry, Nankai University, Tianjin, People's Republic of China Collaborative Innovation Center of Chemical Science and Engineering (Tianjin), Tianjin, People's Republic of China
| | - Qiuhong He
- High-Throughput Molecular Drug Discovery Center, Tianjin International Joint Academy of Biotechnology & Medicine, Tianjin, People's Republic of China
| | - Yu Guo
- College of Pharmacy & State Key Laboratory of Elemento-Organic Chemistry, Nankai University, Tianjin, People's Republic of China
| | - Yuna Sun
- National Laboratory of Macromolecules, Institute of Biophysics, Chinese Academy of Science, Beijing, People's Republic of China
| | - Zheng Yin
- College of Pharmacy & State Key Laboratory of Elemento-Organic Chemistry, Nankai University, Tianjin, People's Republic of China Collaborative Innovation Center of Chemical Science and Engineering (Tianjin), Tianjin, People's Republic of China
| |
Collapse
|
148
|
Enterovirus 71 infection causes severe pulmonary lesions in gerbils, meriones unguiculatus, which can be prevented by passive immunization with specific antisera. PLoS One 2015; 10:e0119173. [PMID: 25767882 PMCID: PMC4359154 DOI: 10.1371/journal.pone.0119173] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 01/10/2015] [Indexed: 01/28/2023] Open
Abstract
Neurogenic pulmonary edema caused by severe brainstem encephalitis is the leading cause of death in young children infected by Enterovirus 71 (EV71). However, no pulmonary lesions have been found in EV71-infected transgenic or non-transgenic mouse models. Development of a suitable animal model is important for studying EV71 pathogenesis and assessing effect of therapeutic approaches. We had found neurological disorders in EV71-induced young gerbils previously. Here, we report severe pulmonary lesions characterized with pulmonary congestion and hemorrhage in a gerbil model for EV71 infection. In the EV71-infected gerbils, six 21-day-old or younger gerbils presented with a sudden onset of symptoms and rapid illness progression after inoculation with 1×105.5 TCID50 of EV71 via intraperitoneal (IP) or intramuscular (IM) route. Respiratory symptoms were observed along with interstitial pneumonia, pulmonary congestion and extensive lung hemorrhage could be detected in the lung tissues by histopathological examination. EV71 viral titer was found to be peak at late stages of infection. EV71-induced pulmonary lesions, together with severe neurological disorders were also observed in gerbils, accurately mimicking the disease process in EV71-infected patients. Passive transfer with immune sera from EV71 infected adult gerbils with a neutralizing antibody (GMT=89) prevented severe pulmonary lesion formation after lethal EV71 challenge. These results establish this gerbil model as a useful platform for studying the pathogenesis of EV71-induced pulmonary lesions, immunotherapy and antiviral drugs.
Collapse
|
149
|
Yang Q, Ding J, Cao J, Huang Q, Hong C, Yang B. Epidemiological and etiological characteristics of hand, foot, and mouth disease in Wuhan, China from 2012 to 2013: outbreaks of coxsackieviruses A10. J Med Virol 2015; 87:954-60. [PMID: 25754274 DOI: 10.1002/jmv.24151] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2015] [Indexed: 11/06/2022]
Abstract
Hand-foot-mouth disease (HFMD) is a common infectious disease which often occurs in young children. It is caused by enteroviruses, most commonly enterovirus71 (EV71) and Coxsackievirus A16 (CVA16). The present study focuses on the molecular epidemiology of the pathogen of HFMD in the Wuhan region of China during the period 2012 to 2013. A total of 463 viruses were isolated from throat swab of 3,208 HFMD patients and analyzed by quantitative RT-PCR with all sets of specific primers for EV71, CVA16, and pan-enterovirus. Of the 463 viruses, 111 (21.2%) were EV71, 52 (9.6%) were CVA16, and 300 (69.2%) were pan-enterovirus. In pan-enterovirus isolations 190 (52.8%) were CVA10, 50 (13.9%) were CVA4, 30 were CB2, 17 were CB3, 13 were CB5 identified by VP4 gene sequencing. Eleven EV71 isolates were complete genome sequenced and phylogenetic analysis revealed that the EV71 strains that circulated in Wuhan belonged to the C4 subgenotype. Among the 190 CVA10 isolations, 187 CVA10 strains have the same nucleotide sequence, the other three CVA10 strains belongs to another type of nucleotide sequence. Phylogenetic analysis based on 19 CVA10 isolations suggested that they belonged to the clade of Chinese strains, but form different clusters isolated from Japan, Europe. This study showed that EVA71 and CVA16 were detected as the predominant viruses (>60%) in 2012 and the total reported HFMD cases attained a peak in June and July. In contrast, CVA10 was also detected during April 2012 and replaced EVA71 and CVA16 as the major HFMD-associated pathogen from May 2013.
Collapse
Affiliation(s)
- Qin Yang
- Department of Medical Laboratory, Wuhan General Hospital of Guangzhou Command, Wuhan, China
| | | | | | | | | | | |
Collapse
|
150
|
Wei J, Hansen A, Liu Q, Sun Y, Weinstein P, Bi P. The effect of meteorological variables on the transmission of hand, foot and mouth disease in four major cities of shanxi province, China: a time series data analysis (2009-2013). PLoS Negl Trop Dis 2015; 9:e0003572. [PMID: 25742504 PMCID: PMC4351101 DOI: 10.1371/journal.pntd.0003572] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Accepted: 01/27/2015] [Indexed: 11/18/2022] Open
Abstract
Increased incidence of hand, foot and mouth disease (HFMD) has been recognized as a critical challenge to communicable disease control and public health response. This study aimed to quantify the association between climate variation and notified cases of HFMD in selected cities of Shanxi Province, and to provide evidence for disease control and prevention. Meteorological variables and HFMD cases data in 4 major cities (Datong, Taiyuan, Changzhi and Yuncheng) of Shanxi province, China, were obtained from the China Meteorology Administration and China CDC respectively over the period 1 January 2009 to 31 December 2013. Correlations analyses and Seasonal Autoregressive Integrated Moving Average (SARIMA) models were used to identify and quantify the relationship between the meteorological variables and HFMD. HFMD incidence varied seasonally with the majority of cases in the 4 cities occurring from May to July. Temperatures could play important roles in the incidence of HFMD in these regions. The SARIMA models indicate that a 1° C rise in average, maximum and minimum temperatures may lead to a similar relative increase in the number of cases in the 4 cities. The lag times for the effects of temperatures were identified in Taiyuan, Changzhi and Yuncheng. The numbers of cases were positively associated with average and minimum temperatures at a lag of 1 week in Taiyuan, Changzhi and Yuncheng, and with maximum temperature at a lag of 2 weeks in Yuncheng. Positive association between the temperature and HFMD has been identified from the 4 cities in Shanxi Province, although the role of weather variables on the transmission of HFMD varied in the 4 cities. Relevant prevention measures and public health action are required to reduce future risks of climate change with consideration of local climatic conditions. Understanding of the impact of weather variables on HFMD transmission remains limited due to various local climatic conditions, socioeconomic status and demographic characteristics in different regions. This study provides quantitative evidence that the incidence of HFMD cases was significantly associated with temperature in Shanxi Province, North China. The delayed effects of weather variables on HFMD dictate different public health responses in 4 major cities in Shanxi Province. The results may provide a direction for local community and health authorities to perform public health actions, and the SARIMA models are helpful in the prediction of epidemics, determination of high-risk areas and susceptible populations, allocation of health resources, and the formulation of relevant prevention strategies. In order to reduce future risks of climatic variations on HFMD epidemics, similar studies in other geographical areas are needed, together with a longer study period to enable trend analysis which takes into consideration local weather conditions and demographic characteristics.
Collapse
Affiliation(s)
- Junni Wei
- Department of Epidemiology, School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
- * E-mail: (JW); (PB)
| | - Alana Hansen
- Discipline of Public Health, School of Population Health, The University of Adelaide, Adelaide, Australia
| | - Qiyong Liu
- State Key Laboratory for Infectious Diseases Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- Shandong University Climate Change and Health Center, Jinan, Shandong, China
| | - Yehuan Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Phil Weinstein
- Division of Health Sciences, School of Pharmacy and Medical Sciences, The University of South Australia, Adelaide, Australia
| | - Peng Bi
- Discipline of Public Health, School of Population Health, The University of Adelaide, Adelaide, Australia
- * E-mail: (JW); (PB)
| |
Collapse
|