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Chen J, You P, Chen X, Li H, Zhang N, Zhang G, Xu C, Ma C, Zhang Y, Lv T. Genetic characteristics and phylogenetic analysis of coxsackievirus A6 isolated in Linyi, China, 2022-2023. Jpn J Infect Dis 2024:JJID.2024.072. [PMID: 38945859 DOI: 10.7883/yoken.jjid.2024.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Hand, foot and mouth disease (HFMD) was one of the most common infectious disease in the past few decades. After 2013, coxsackievirus A6 (CVA6) has replaced enterovirus 71 (EV-A71) and coxsackievirus A16 (CVA16), becoming the predominant pathogen responsible for HFMD in many areas in China. The objective of this study is to investigate the genetic characteristics and molecular epidemiology of CVA6 in Linyi from 2022 to 2023. A total of 965 HFMD cases were enrolled in this study and analyses based on VP1 nucleotide sequences were performed to determine the evolutionary trajectory of CVA6. In 2022, 281 (281/386, 72.8%) were positive for enterovirus (EVs), and 217 (217/281, 77.2%) were CVA6 positive. In 2023, 398 (398/579, 68.7%) samples were positive for EVs, and 243 (243/398, 61.1%) were CVA6 positive. Six sequences were selected from each year for the homology analysis. The results showed that 12 strains isolated in Linyi were far from the prototype strain (AY421764) and the first CVA6 strain reported in China (JQ364886). Phylogenetic analysis showed that the CVA6 strains isolated in Linyi all belonged to D3 subgenotype. CVA6 is emerging as a common pathogen causing HFMD in Linyi, and continuous surveillance of HFMD etiological agents is necessary.
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Affiliation(s)
- Jie Chen
- Linyi Key Laboratory of Birth Defects Prevention and Control, Linyi Maternal and Child Healthcare Hospital, China
| | - Pengfei You
- Children's Emergency Department, Linyi Maternal and Child Healthcare Hospital, China
| | - Xiaoyan Chen
- Linyi Key Laboratory of Birth Defects Prevention and Control, Linyi Maternal and Child Healthcare Hospital, China
| | - Huafeng Li
- Linyi Key Laboratory of Birth Defects Prevention and Control, Linyi Maternal and Child Healthcare Hospital, China
| | - Na Zhang
- Children's Emergency Department, Linyi Maternal and Child Healthcare Hospital, China
| | - Guangyun Zhang
- Linyi Key Laboratory of Birth Defects Prevention and Control, Linyi Maternal and Child Healthcare Hospital, China
| | - Conghong Xu
- Linyi Key Laboratory of Birth Defects Prevention and Control, Linyi Maternal and Child Healthcare Hospital, China
| | - Chunling Ma
- Linyi Key Laboratory of Birth Defects Prevention and Control, Linyi Maternal and Child Healthcare Hospital, China
- Department of Immunology Teaching and Research, Shandong Medical College, China
| | - Yanli Zhang
- Linyi Key Laboratory of Birth Defects Prevention and Control, Linyi Maternal and Child Healthcare Hospital, China
| | - Tiegang Lv
- Linyi Key Laboratory of Birth Defects Prevention and Control, Linyi Maternal and Child Healthcare Hospital, China
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Sun Y, Cai J, Mao H, Gong L, Chen Y, Yan H, Shi W, Lou X, Su L, Wang X, Zhou B, Pei Z, Cao Y, Ge Q, Zhang Y. Epidemiology of hand, foot and mouth disease and genomic surveillance of coxsackievirus A10 circulating in Zhejiang Province, China during 2017 to 2022. J Clin Virol 2023; 166:105552. [PMID: 37523938 DOI: 10.1016/j.jcv.2023.105552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 07/19/2023] [Accepted: 07/21/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Coxsackievirus A10 (CA10) is one of the etiological agents associated with hand, foot and mouth disease (HFMD). OBJECTIVES We aimed to perform a retrospective analysis of the molecular epidemiological characteristics and genetic features of HFMD associated with CA10 infections in Zhejiang Province from 2017 to 2022. STUDY DESIGN Epidemiologic features were summarized. Throat swab specimens were collected and tested. The VP1 regions were sequenced for genotyping. CA10 positive samples were isolated. Whole genomes of CA10 isolations were sequenced. Nucleotide and amino acid changes were characterized. Phylogenetic trees were constructed. RESULTS The number of HFMD cases fluctuated from 2017 to 2022. Children aged below 3 years accounted for the majority (66.29%) and boys were more frequently affected than girls. Cases peaked in June. The positivity rate of HEV was 62.69%. A total of 90 strains of CA10 were isolated and 53 genomes were obtained. All CA10 in this study could be assigned to two genogroups, C (C2) and F (F1 and F3). CONCLUSION The clinical manifestations of HFMD associated with HEV are complex and diverse. CA10 infection may be emerging as a new and major cause of HFMD because an upward trend was observed in the proportion of CA10 cases after the use of EV71 vaccines. Different genogroups of CA10 had different geographic distribution patterns. Surveillance should be strengthened and further comprehensive studies should be continued to provide a scientific basis for HFMD prevention and control.
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Affiliation(s)
- Yi Sun
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, Zhejiang 310051, China
| | - Jian Cai
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, Zhejiang 310051, China
| | - Haiyan Mao
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, Zhejiang 310051, China
| | - Liming Gong
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, Zhejiang 310051, China
| | - Yin Chen
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, Zhejiang 310051, China
| | - Hao Yan
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, Zhejiang 310051, China
| | - Wen Shi
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, Zhejiang 310051, China
| | - Xiuyu Lou
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, Zhejiang 310051, China
| | - Lingxuan Su
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, Zhejiang 310051, China
| | - Xingxing Wang
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, Zhejiang 310051, China
| | - Biaofeng Zhou
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, Zhejiang 310051, China
| | - Zhichao Pei
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, Zhejiang 310051, China
| | - Yanli Cao
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, Zhejiang 310051, China
| | - Qiong Ge
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, Zhejiang 310051, China.
| | - Yanjun Zhang
- Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, Zhejiang 310051, China.
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Zhao D, Zhang H, Zhang R, He S. Research on hand, foot and mouth disease incidence forecasting using hybrid model in mainland China. BMC Public Health 2023; 23:619. [PMID: 37003988 PMCID: PMC10064964 DOI: 10.1186/s12889-023-15543-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 03/28/2023] [Indexed: 04/03/2023] Open
Abstract
BACKGROUND This study aimed to construct a more accurate model to forecast the incidence of hand, foot, and mouth disease (HFMD) in mainland China from January 2008 to December 2019 and to provide a reference for the surveillance and early warning of HFMD. METHODS We collected data on the incidence of HFMD in mainland China between January 2008 and December 2019. The SARIMA, SARIMA-BPNN, and SARIMA-PSO-BPNN hybrid models were used to predict the incidence of HFMD. The prediction performance was compared using the mean absolute error(MAE), mean squared error(MSE), root mean square error (RMSE), mean absolute percentage error (MAPE), and correlation analysis. RESULTS The incidence of HFMD in mainland China from January 2008 to December 2019 showed fluctuating downward trends with clear seasonality and periodicity. The optimal SARIMA model was SARIMA(1,0,1)(2,1,2)[12], with Akaike information criterion (AIC) and Bayesian Schwarz information criterion (BIC) values of this model were 638.72, 661.02, respectively. The optimal SARIMA-BPNN hybrid model was a 3-layer BPNN neural network with nodes of 1, 10, and 1 in the input, hidden, and output layers, and the R-squared, MAE, and RMSE values were 0.78, 3.30, and 4.15, respectively. For the optimal SARIMA-PSO-BPNN hybrid model, the number of particles is 10, the acceleration coefficients c1 and c2 are both 1, the inertia weight is 1, the probability of change is 0.95, and the values of R-squared, MAE, and RMSE are 0.86, 2.89, and 3.57, respectively. CONCLUSIONS Compared with the SARIMA and SARIMA-BPNN hybrid models, the SARIMA-PSO-BPNN model can effectively forecast the change in observed HFMD incidence, which can serve as a reference for the prevention and control of HFMD.
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Affiliation(s)
- Daren Zhao
- Department of Medical Administration, Sichuan Provincial Orthopedics Hospital, Chengdu, Sichuan, People's Republic of China
| | - Huiwu Zhang
- Department of Medical Administration, Sichuan Provincial Orthopedics Hospital, Chengdu, Sichuan, People's Republic of China.
| | - Ruihua Zhang
- School of Management, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, People's Republic of China.
- General Practitioners Training Center of Sichuan Province, Chengdu, Sichuan, People's Republic of China.
| | - Sizhang He
- Department of Information and Statistics, The Affiliated Hospital of Southwest Medical University, Luzhou, 64600, Sichuan, China
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Gopalkrishna V, Ganorkar N. Epidemiological and molecular characteristics of circulating CVA16, CVA6 strains and genotype distribution in hand, foot and mouth disease cases in 2017 to 2018 from Western India. J Med Virol 2021; 93:3572-3580. [PMID: 32833231 DOI: 10.1002/jmv.26454] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 08/16/2020] [Indexed: 12/22/2022]
Abstract
Hand, Foot, and Mouth disease (HFMD) is a mild exanthematous and febrile disease occurs in children aged ≤10 years old. The present study highlights clinical, epidemiological characteristics, distribution of enterovirus (EV) types, and sub genotypes in HFMD cases reported during 2017 to 2018 in Western India. A total of 93 clinical samples collected from 68 HFMD cases were included. The presence of EV-RNA was determined by 5'UTR based nested reverse transcription polymerase chain reaction followed by molecular typing, sub genotyping by VP1/2A junction or VP1, full VP1 gene amplification, and phylogenetic analysis. The study reports 80.64% (75/93) EV positivity and 94.66% (71/75) typing rate, with a predominant circulation of CVA16 and CVA6 strains. Sequence analysis revealed the presence of coxsackievirus (CV)A16 (57.7%), CVA6 (40.8%), and Echo1 (1.4%) strains. EV infections were predominantly observed in children aged 1 to 3 years old (43.9%). Although cases were reported throughout the year, peaked in July (15.8%) and August (24.6%) months and persisted till September (19.3%). All the CVA16 and CVA6 positive strains were genotyped using full VP1 gene amplification. All CVA16 Indian strains (n = 41) were clustered with rarely reported B1c sub genotype and CVA6 strains (n = 29) with E2 sub-lineage. The study highlights the genetic characteristics of circulating CVA16, CVA6, and Echo1 strains in HFMD cases from Western India. The emergence of CVA16 B1c genotype and sub-lineage E2 of CVA6 strains and their constant circulation further demands systemic surveillance studies on HFMD from different parts of India to facilitate the rapid diagnosis of CVA16 and CVA6 strains using the molecular and serological based approach and for intervention strategies.
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Affiliation(s)
- Varanasi Gopalkrishna
- Enteric Viruses Group, Indian Council of Medical Research (ICMR), National Institute of Virology, Pune, India
| | - Nital Ganorkar
- Enteric Viruses Group, Indian Council of Medical Research (ICMR), National Institute of Virology, Pune, India
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Xu J, Yang M, Zhao Z, Wang M, Guo Z, Zhu Y, Rui J, Wang Y, Liu X, Lin S, Luo L, Su Y, Zhao B, Zhou Y, Frutos R, Chen T. Meteorological Factors and the Transmissibility of Hand, Foot, and Mouth Disease in Xiamen City, China. Front Med (Lausanne) 2021; 7:597375. [PMID: 33553200 PMCID: PMC7862718 DOI: 10.3389/fmed.2020.597375] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 12/30/2020] [Indexed: 11/18/2022] Open
Abstract
Background: As an emerging infectious disease, the prevention and control of hand, foot, and mouth disease (HFMD) poses a significant challenge to the development of public health in China. In this study, we aimed to explore the mechanism of the seasonal transmission characteristics of HFMD and to reveal the correlation and potential path between key meteorological factors and the transmissibility of HFMD. Methods: Combined with daily meteorological data such as average temperature, average relative humidity, average wind velocity, amount of precipitation, average air pressure, evaporation capacity, and sunshine duration, a database of HFMD incidence and meteorological factors was established. Spearman rank correlation was used to calculate the correlation between the various meteorological factors and the incidence of HFMD. The effective reproduction number (R eff ) of HFMD was used as an intermediate variable to further quantify the dynamic relationship between the average temperature and R eff . Results: A total of 43,659 cases of HFMD were reported in Xiamen from 2014 to 2018. There was a significantly positive correlation between the average temperature and the incidence of HFMD (r = 0.596, p < 0.001), and a significantly negative correlation between the average air pressure and the incidence of HFMD (r = -0.511, p < 0.001). There was no correlation between the average wind velocity (r = 0.045, p > 0.05) or amount of precipitation (r = 0.043, p > 0.05) and incidence. There was a temperature threshold for HFMD's transmissibility. Owing to the seasonal transmission characteristics of HFMD in Xiamen, the temperature threshold of HFMD's transmissibility was 13.4-18.4°C and 14.5-29.3°C in spring and summer and in autumn and winter, respectively. Conclusions: HFMD's transmissibility may be affected by the average temperature; the temperature threshold range of transmissibility in autumn and winter is slightly wider than that in spring and summer. Based on our findings, we suggest that the relevant epidemic prevention departments should pay close attention to temperature changes in Xiamen to formulate timely prevention strategies before the arrival of the high-risk period.
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Affiliation(s)
- Jingwen Xu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, China
| | - Meng Yang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, China
| | - Zeyu Zhao
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, China
| | - Mingzhai Wang
- Xiamen Center for Disease Control and Prevention, Xiamen City, China
| | - Zhinan Guo
- Xiamen Center for Disease Control and Prevention, Xiamen City, China
| | - Yuanzhao Zhu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, China
| | - Jia Rui
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, China
| | - Yao Wang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, China
| | - Xingchun Liu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, China
| | - Shengnan Lin
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, China
| | - Li Luo
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, China
| | - Yanhua Su
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, China
| | - Benhua Zhao
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, China
| | - Yulin Zhou
- United Diagnostic and Research Center for Clinical Genetics, Women and Children's Hospital, School of Medicine & School of Public Health, Xiamen University, Xiamen City, China
| | - Roger Frutos
- Agricultural Research Centre for International Development, Intertryp, Montpellier, France
- Institut d'Electronique et des Systèmes, Université de Montpellier-Centre National de la Recherche Scientifique, Montpellier, France
| | - Tianmu Chen
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, China
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Abstract
To examine the effects of temperature on the daily cases of hand, foot, and mouth disease (HFMD).Data on the daily cases of HFMD in Lanzhou from 2008 to 2015 were obtained, and meteorological data from the same period were collected. A distributed lag nonlinear model was fitted to reveal the relationship between the daily mean temperature and the daily cases of HFMD.From 2008 to 2015, 25,644 cases were reported, of which children under 5 years of age accounted for 78.68% of cases. The highest peak of HFMD cases was usually reported between April to July each year. An inverse V-shaped relationship was observed between daily mean temperature and HFMD cases; a temperature of 18°C was associated with a maximum risk of HFMD. The relative risk (RR) was 1.57 (95% confidence interval: 1.23-1.23), and boys and children aged 3 to 5 years were populations with the highest risk. The cumulative risks of high temperature (20.2°C and 25.2°C) in the total, age-specific, and gender-specific groups peaked on lag 14 days; RR was higher in girls than in boys and in children aged 1 to 2 years than in other age groups. However, the effects of low temperature (-5.3°C, 2.0°C, and 12.8°C) were not significant for both gender-specific and age-specific patients.High temperature may increase the risk of HFMD, and boys and children aged 3 to 5 years were at higher risks on lag 0 day; however, the cumulative risks in girls and children aged 1 to 2 years increased with the increasing number of lag days.
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Affiliation(s)
- Jinyu Wang
- School of Basic Medical Science, Lanzhou University
| | - Sheng Li
- The First People's Hospital of Lanzhou City, Lanzhou, PR China
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Miao L, Liu Y, Luo P, Mao S, Liu J, Lu S. Association between platelet count and the risk and progression of hand, foot, and mouth disease among children. Clinics (Sao Paulo) 2020; 75:e1619. [PMID: 32428116 PMCID: PMC7213664 DOI: 10.6061/clinics/2020/e1619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 02/05/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE We aimed to evaluate the association between platelet (PLT) count and the risk and progression of hand, foot, and mouth disease (HFMD). METHODS In total, 122 HFMD patients and 40 healthy controls were enrolled in the study. The differences between variables among the different subgroups were compared. Logistic regression analyses were performed to assess the relationship between various parameters and HFMD risk/progression. Sensitivity analysis was conducted by detecting the trend of the association between PLT count quartiles and HFMD risk/progression. A generalized additive model was used to identify the nonlinear relationship between PLT count and HFMD risk/progression. The relationship between gender and PLT count as well as the risk/progression of HFMD was detected using a stratified logistic regression model. RESULTS Significant differences were observed in terms of age, male/female ratio, white blood cell (WBC) count, and PLT count between patients with stage I-II, III-IV HFMD and healthy controls. Moreover, the alanine aminotransferase and magnesium levels between patients with stage I-II and III-IV HFMD significantly differed. Moreover, a significant difference was noted in the male/female ratio among the different PLT groups. The group with a low PLT count had a lower risk of HFMD progression than the group with a high PLT count (Q4) (p=0.039). Lower age, male gender, and WBC count were found to be associated with HFMD risk. Meanwhile, PLT count was correlated to HFMD progression. The sensitivity analysis yielded a similar result using the minimally adjusted model (p for trend=0.037), and minimal changes were observed using the crude and fully adjusted model (p for trend=0.054; 0.090). A significant nonlinear relationship was observed between PLT count and HFMD progression after adjusting for age, gender, and WBC (p=0.039). CONCLUSIONS PLT was independently associated with HFMD progression in a nonlinear manner.
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Affiliation(s)
- Li Miao
- Department of Pediatrics, The First Affiliated Hospital of Kangda College of Nanjing Medical University /, The First People's Hospital of Lianyungang, Lianyungang, China
- Department of Pediatric Nephrology, Lianyungang Children's Hospital, Lianyungang, China
| | - Yongjuan Liu
- Department of Central Laboratory, The First Affiliated Hospital of Kangda College of Nanjing Medical University /, The First People's Hospital of Lianyungang, Lianyungang, China
| | - Peiliang Luo
- Department of Pediatrics, The First Affiliated Hospital of Kangda College of Nanjing Medical University /, The First People's Hospital of Lianyungang, Lianyungang, China
| | - Song Mao
- Department of Pediatrics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jiansheng Liu
- Department of Pediatrics, The First Affiliated Hospital of Kangda College of Nanjing Medical University /, The First People's Hospital of Lianyungang, Lianyungang, China
- Department of Pediatric Nephrology, Lianyungang Children's Hospital, Lianyungang, China
- Corresponding author. E-mail:
| | - Siguang Lu
- Department of Pediatrics, The First Affiliated Hospital of Kangda College of Nanjing Medical University /, The First People's Hospital of Lianyungang, Lianyungang, China
- Department of Pediatric Nephrology, Lianyungang Children's Hospital, Lianyungang, China
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An emerging and expanding clade accounts for the persistent outbreak of Coxsackievirus A6-associated hand, foot, and mouth disease in China since 2013. Virology 2018; 518:328-334. [PMID: 29587191 DOI: 10.1016/j.virol.2018.03.012] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 03/12/2018] [Accepted: 03/15/2018] [Indexed: 11/23/2022]
Abstract
Enterovirus (EV)-A71 and Coxsackievirus (CV)-A16 have historically been the major pathogens of hand, foot, and mouth disease (HMFD) in China; however, CV-A6, which had previously received little attention, became the predominant pathogen in 2013, and has remained one of the common pathogens since then. In this work, we conducted a molecular epidemiology study of CV-A6-associated HFMD in Xiamen from 2009 to 2015. The data showed CV-A6 pandemics had a certain periodicity rather than occurring randomly. Evolution analysis based on near-complete VP1 nucleotide sequences showed subgenotype D5 lineage 4 strains account for the persistent outbreak of CV-A6-associated HFMD in China since 2013. Alignment analysis revealed eight candidate amino acid substitutions in VP1, which may provide useful information for the research of CV-A6 virulence enhancement. This study contributed to elucidating the circulation patterns and genetic characteristics of CV-A6 in China; however, further surveillance and intervention in CV-A6 epidemics is recommended.
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Epidemiological Characteristics and Spatial-Temporal Distribution of Hand, Foot, and Mouth Disease in Chongqing, China, 2009-2016. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15020270. [PMID: 29401726 PMCID: PMC5858339 DOI: 10.3390/ijerph15020270] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 01/22/2018] [Accepted: 01/24/2018] [Indexed: 12/19/2022]
Abstract
(1) Objective: Even with licensed vaccine for enterovirus 71 (EV71) put into market in 2016 in China, hand, foot, and mouth disease (HFMD) is still a threat for children’s health in Chongqing. We described the epidemiological characteristics and spatial–temporal patterns of HFMD in Chongqing from 2009 to 2016, in order to provide information and evidence for guiding public health response and intervention. (2) Methods: We retrieved the HFMD surveillance data from January 2009 to December 2016 from “National Disease Reporting Information System”, and then analyzed demographic and geographical information integrally. Descriptive analysis was conducted to evaluate the epidemic features of HFMD in Chongqing. The spatial–temporal methods were performed to explore the clusters at district/county level. (3) Results: A total of 276,207 HFMD cases were reported during the study period (total population incidence: 114.8 per 100,000 per year), including 641 severe cases (129 deaths). The annual incidence of HFMD sharply increased in even-numbered years, but remained stable or decreased in odd-numbered years. A semiannual seasonality was observed during April to July, and October to December in each year. The male-to-female ratios of the mild and severe cases were 1.4:1 and 1.5:1, with the median age of 2.3 years and 1.9 years, respectively. More than 90% of the cases were children equal to and less than 5 years old. High-incidence clustered regions included the main urban districts and northeast regions according to incidence rates comparison or space–time cluster analysis. A total of 19,482 specimen were collected from the reported cases and 13,277 (68.2%) were positive for enterovirus. EV71 was the major causative agent for severe cases, while other enteroviruses were the predominant serotype for mild cases. (4) Conclusions: The characteristics of HFMD in Chongqing exhibited a phenomenon of increasing incidence in two-year cycles and semiannual seasonality in time distribution. Children ≤5 years old, especially boys, were more affected by HFMD. EV71 was the major causative agent for severe cases. We suggest initiating mass EV71 vaccination campaigns among children aged 6 months to 5 years in Chongqing, especially in the main urban districts and northern regions, in order to reduce case fatality, and take integrated measurements for controlling and preventing HFMD attributed to other enteroviruses.
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Wang P, Zhao H, You F, Zhou H, Goggins WB. Seasonal modeling of hand, foot, and mouth disease as a function of meteorological variations in Chongqing, China. INTERNATIONAL JOURNAL OF BIOMETEOROLOGY 2017; 61:1411-1419. [PMID: 28188360 DOI: 10.1007/s00484-017-1318-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 01/11/2017] [Accepted: 01/27/2017] [Indexed: 06/06/2023]
Abstract
Hand, foot, and mouth disease (HFMD) is an enterovirus-induced infectious disease, mainly affecting children under 5 years old. Outbreaks of HFMD in recent years indicate the disease interacts with both the weather and season. This study aimed to investigate the seasonal association between HFMD and weather variation in Chongqing, China. Generalized additive models and distributed lag non-linear models based on a maximum lag of 14 days, with negative binomial distribution assumed to account for overdispersion, were constructed to model the association between reporting HFMD cases from 2009 to 2014 and daily mean temperature, relative humidity, total rainfall and sun duration, adjusting for trend, season, and day of the week. The year-round temperature and relative humidity, rainfall in summer, and sun duration in winter were all significantly associated with HFMD. An inverted-U relationship was found between mean temperature and HFMD above 19 °C in summer, with a maximum morbidity at 27 °C, while the risk increased linearly with the temperature in winter. A hockey-stick association was found for relative humidity in summer with increasing risks over 60%. Heavy rainfall, relative to no rain, was found to be associated with reduced HFMD risk in summer and 2 h of sunshine could decrease the risk by 21% in winter. The present study showed meteorological variables were differentially associated with HFMD incidence in two seasons. Short-term weather variation surveillance and forecasting could be employed as an early indicator for potential HFMD outbreaks.
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Affiliation(s)
- Pin Wang
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Han Zhao
- Chongqing Center for Disease Control and Prevention, Chongqing, China
| | - Fangxin You
- Chongqing Jiangbei District Center for Disease Control and Prevention, Chongqing, China
| | - Hailong Zhou
- Chongqing Jiangbei District Center for Disease Control and Prevention, Chongqing, China
| | - William B Goggins
- School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong SAR, China.
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Ganorkar NN, Patil PR, Tikute SS, Gopalkrishna V. Genetic characterization of enterovirus strains identified in Hand, Foot and Mouth Disease (HFMD): Emergence of B1c, C1 subgenotypes, E2 sublineage of CVA16, EV71 and CVA6 strains in India. INFECTION GENETICS AND EVOLUTION 2017; 54:192-199. [PMID: 28577914 DOI: 10.1016/j.meegid.2017.05.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 05/22/2017] [Accepted: 05/28/2017] [Indexed: 10/19/2022]
Abstract
Hand, Foot and Mouth disease (HFMD) is a common childhood disease and caused due to Enterovirus-A (EV-A), EV-B and EV-C species worldwide. Cases of HFMD were reported from, Ahmedabad (Gujarat, 2012) and Pune (Maharashtra, 2013-2014) in India. The present study highlights the identification of EV strains (CVA16, CVA6, CVA4 and Echo12), characterization of subgenotypes of CVA16, CVA6 strains during 2012-14 and CVA16, CVA6, EV71 strains reported from the earlier study (2009-10) in HFMD cases from India. A total 158 clinical specimens collected from 64 HFMD cases (2012-2014) were included in the study. EV detection was carried out by 5'NCR based RT-PCR, molecular typing and subgenotyping was by VP1/2A junction or VP1, full VP1 gene amplification respectively followed by phylogenetic analysis. The present study reports 63.92% (101/158) EV positivity by RT-PCR. Ninety four of the 101 (93.06%) EV positive strains were amplified by VP1/2A junction or VP1 regions. Sequence analysis revealed the presence of CVA16 (61.7%), CVA6 (34.04%), CVA4 and Echo12 (4.3%). A total of 114 EV positive strains were genotyped using full and partial VP1 region. All CVA16 Indian strains (n=70) clustered with rarely reported B1c subgenotype, CVA6 (n=43) and EV71 (n=1) strains clustered with sub-lineage E2 and C1 subgenotypes respectively. In summary, the study reports genetic characterization of CVA16, CVA6, CVA4 and Echo12 strains in HFMD cases from India. Circulation of B1c subgenotype of CVA16, E2 sub-lineage of CVA6 and C1 subgenotype of EV 71 strains in HFMD cases were reported for the first time from India. This study helps to understand the genotype distribution, genetic diversity of EV strains associated with HFMD from Eastern, Western and Southern regions in India.
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Affiliation(s)
- Nital N Ganorkar
- Enteric Viruses Group, National Institute of Virology, 20-A, Dr. Ambedkar Road, Pune 411 001, India
| | - Pooja R Patil
- Enteric Viruses Group, National Institute of Virology, 20-A, Dr. Ambedkar Road, Pune 411 001, India
| | - Sanjay S Tikute
- Enteric Viruses Group, National Institute of Virology, 20-A, Dr. Ambedkar Road, Pune 411 001, India
| | - Varanasi Gopalkrishna
- Enteric Viruses Group, National Institute of Virology, 20-A, Dr. Ambedkar Road, Pune 411 001, India.
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Chen M, He S, Yan Q, Xu X, Wu W, Ge S, Zhang S, Chen M, Xia N. Severe hand, foot and mouth disease associated with Coxsackievirus A10 infections in Xiamen, China in 2015. J Clin Virol 2017; 93:20-24. [PMID: 28577423 DOI: 10.1016/j.jcv.2017.05.011] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 05/06/2017] [Accepted: 05/10/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Coxsackievirus A10 (CV-A10) is one of the etiological agents associated with hand, foot and mouth disease (HFMD) and usually causes mild cases. During 2009-2014, no severe cases caused by CV-A10 was reported in Xiamen, China, however, an increase in cases was seen in 2015. OBJECTIVES We aimed to perform a retrospective molecular epidemiological analysis of HFMD associated with CV-A10 infections in Xiamen. STUDY DESIGN CV-A10 VP1 (n=41) capsid and full-length or near full-length genomes (n=14) were sequenced. Phylogenetic trees were constructed based on these sequences and other reference sequences and nucleotide and amino acid changes were characterized. RESULTS From 2009-2014, no laboratory-confirmed CV-A10 infections associated with severe cases were identified, however, in 2015, 39% (7/18) of severe HFMD cases were CV-A10 infections. Sequence analysis of severe and non-severe CV-A10 HFMD cases determined that severe cases predominantly clustered with an emerging clade E lineage A strain which contained 4 nucleotide changes in 5' UTR and 5 amino acid substitutions in structural and non-structural proteins. CONCLUSIONS The results indicate CV-A10 infection may be emerging as a new and major cause of severe HFMD and CV-A10 surveillance should be increased and considered in HFMD prevention and control strategies.
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Affiliation(s)
- Mengyuan Chen
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Xiamen University, Xiang'an Campus of Xiamen University, South Xiang'an Rd., Xiamen, China; State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Xiamen University, Xiang'an Campus of Xiamen University, South Xiang'an Rd., Xiamen, China; School of Public Health, Xiamen University, Xiang'an Campus of Xiamen University, South Xiang'an Rd., Xiamen, China.
| | - Shuizhen He
- Xiamen Center for Disease Control and Prevention, Shengguang Rd., Jimei District, Xiamen, China.
| | - Qiang Yan
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Xiamen University, Xiang'an Campus of Xiamen University, South Xiang'an Rd., Xiamen, China.
| | - Xuerong Xu
- Xiamen Center for Disease Control and Prevention, Shengguang Rd., Jimei District, Xiamen, China.
| | - Wenhui Wu
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Xiamen University, Xiang'an Campus of Xiamen University, South Xiang'an Rd., Xiamen, China; State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Xiamen University, Xiang'an Campus of Xiamen University, South Xiang'an Rd., Xiamen, China; School of Public Health, Xiamen University, Xiang'an Campus of Xiamen University, South Xiang'an Rd., Xiamen, China.
| | - Shengxiang Ge
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Xiamen University, Xiang'an Campus of Xiamen University, South Xiang'an Rd., Xiamen, China; State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Xiamen University, Xiang'an Campus of Xiamen University, South Xiang'an Rd., Xiamen, China; School of Public Health, Xiamen University, Xiang'an Campus of Xiamen University, South Xiang'an Rd., Xiamen, China.
| | - Shiyin Zhang
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Xiamen University, Xiang'an Campus of Xiamen University, South Xiang'an Rd., Xiamen, China; State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Xiamen University, Xiang'an Campus of Xiamen University, South Xiang'an Rd., Xiamen, China; School of Public Health, Xiamen University, Xiang'an Campus of Xiamen University, South Xiang'an Rd., Xiamen, China.
| | - Min Chen
- Xiamen Center for Disease Control and Prevention, Shengguang Rd., Jimei District, Xiamen, China.
| | - Ningshao Xia
- National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Xiamen University, Xiang'an Campus of Xiamen University, South Xiang'an Rd., Xiamen, China; State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Xiamen University, Xiang'an Campus of Xiamen University, South Xiang'an Rd., Xiamen, China; School of Public Health, Xiamen University, Xiang'an Campus of Xiamen University, South Xiang'an Rd., Xiamen, China.
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Epidemiology of 45,616 suspect cases of Hand, Foot and Mouth Disease in Chongqing, China, 2011-2015. Sci Rep 2017; 7:45630. [PMID: 28422128 PMCID: PMC5395817 DOI: 10.1038/srep45630] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 03/01/2017] [Indexed: 12/19/2022] Open
Abstract
Epidemiology and etiology of hand, foot, and mouth disease (HFMD) based on large sample size or evaluation of detection for more enterovirus serotypes are not well investigated in Chongqing of China. 45,616 suspect HFMD patients were prospectively enrolled among whom 21,615 were laboratory confirmed HFMD cases over a 5-year period (January 2011 to December 2015). Their epidemiological, clinical, and laboratory data were extracted and stratified by month, age, sex, disease severity, and enterovirus serotype. Subsequently 292 non-EV-A71/CV-A16 HFMD confirmed cases were randomly selected in three consecutive outbreaks to detect CV-A6 and CV-A10, using RT-PCR. Results showed that the HFMD epidemic peaked in early summer and autumn. The median age of onset was 2.45 years with a male-to-female ratio of 1.54:1, and with children under 5 years of age accounting for 92.54% of all confirmed cases. EV-A71 and CV-A16 infection accounted for only 36.05% (7793/21615) of total confirmed cases while EV-A71 accounted for 59.64% (232/389) of severe cases. Importantly, the proportion of EV-A71 infection generally increased with age which showed rapid growth in severe cases. CV-A6 and CV-A10 were tested positive in Chongqing, but CV-A6 had greater positive rates of 62.33% while CV-A10 had 4.79% in non-EV-A71/CV-A16 HFMD confirmed cases.
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Effects of Meteorological Parameters and PM10 on the Incidence of Hand, Foot, and Mouth Disease in Children in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13050481. [PMID: 27171104 PMCID: PMC4881106 DOI: 10.3390/ijerph13050481] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 04/29/2016] [Accepted: 05/05/2016] [Indexed: 12/13/2022]
Abstract
Hand, foot, and mouth disease (HFMD) is a globally-prevalent infectious disease. However, few data are available on prevention measures for HFMD. The purpose of this investigation was to evaluate the impacts of temperature, humidity, and air pollution, particularly levels of particulate matter with an aerodynamic diameter 10 micrometers (PM10), on the incidence of HFMD in a city in Eastern China. Daily morbidity, meteorological, and air pollution data for Ningbo City were collected for the period from January 2012 to December 2014. A total of 86,695 HFMD cases were enrolled in this study. We used a distributed lag nonlinear model (DLNM) with Poisson distribution to analyze the nonlinear lag effects of daily mean temperature, daily humidity, and found significant relationships with the incidence of HFMD; in contrast, PM10 level showed no relationship to the incidence of HFMD. Our findings will facilitate the development of effective preventive measures and early forecasting of HFMD outbreaks.
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