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Zhu P, Ji W, Li D, Li Z, Chen Y, Dai B, Han S, Chen S, Jin Y, Duan G. Current status of hand-foot-and-mouth disease. J Biomed Sci 2023; 30:15. [PMID: 36829162 PMCID: PMC9951172 DOI: 10.1186/s12929-023-00908-4] [Citation(s) in RCA: 41] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 02/16/2023] [Indexed: 02/26/2023] Open
Abstract
Hand-foot-and-mouth disease (HFMD) is a viral illness commonly seen in young children under 5 years of age, characterized by typical manifestations such as oral herpes and rashes on the hands and feet. These symptoms typically resolve spontaneously within a few days without complications. Over the past two decades, our understanding of HFMD has greatly improved and it has received significant attention. A variety of research studies, including epidemiological, animal, and in vitro studies, suggest that the disease may be associated with potentially fatal neurological complications. These findings reveal clinical, epidemiological, pathological, and etiological characteristics that are quite different from initial understandings of the illness. It is important to note that HFMD has been linked to severe cardiopulmonary complications, as well as severe neurological sequelae that can be observed during follow-up. At present, there is no specific pharmaceutical intervention for HFMD. An inactivated Enterovirus A71 (EV-A71) vaccine that has been approved by the China Food and Drug Administration (CFDA) has been shown to provide a high level of protection against EV-A71-related HFMD. However, the simultaneous circulation of multiple pathogens and the evolution of the molecular epidemiology of infectious agents make interventions based solely on a single agent comparatively inadequate. Enteroviruses are highly contagious and have a predilection for the nervous system, particularly in child populations, which contributes to the ongoing outbreak. Given the substantial impact of HFMD around the world, this Review synthesizes the current knowledge of the virology, epidemiology, pathogenesis, therapy, sequelae, and vaccine development of HFMD to improve clinical practices and public health efforts.
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Affiliation(s)
- Peiyu Zhu
- grid.207374.50000 0001 2189 3846Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, 450001 China
| | - Wangquan Ji
- grid.207374.50000 0001 2189 3846Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, 450001 China
| | - Dong Li
- grid.207374.50000 0001 2189 3846Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, 450001 China
| | - Zijie Li
- grid.207374.50000 0001 2189 3846Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, 450001 China
| | - Yu Chen
- grid.207374.50000 0001 2189 3846Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, 450001 China
| | - Bowen Dai
- grid.207374.50000 0001 2189 3846Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, 450001 China
| | - Shujie Han
- grid.207374.50000 0001 2189 3846Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, 450001 China
| | - Shuaiyin Chen
- grid.207374.50000 0001 2189 3846Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, 450001 China
| | - Yuefei Jin
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, 450001, China.
| | - Guangcai Duan
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, 450001, China. .,Academy of Medical Science, Zhengzhou University, Zhengzhou, 450001, Henan, China.
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He X, Dong S, Li L, Liu X, Wu Y, Zhang Z, Mei S. Using a Bayesian spatiotemporal model to identify the influencing factors and high-risk areas of hand, foot and mouth disease (HFMD) in Shenzhen. PLoS Negl Trop Dis 2020; 14:e0008085. [PMID: 32196496 PMCID: PMC7112242 DOI: 10.1371/journal.pntd.0008085] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 04/01/2020] [Accepted: 01/23/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The epidemic of hand, foot, and mouth disease (HFMD) has become a severe public health problem in the world and has also brought a high economic and health burden. Furthermore, the prevalence of HFMD varies significantly among different locations. However, there have been few investigations of the effects of socioeconomic factors and air pollution factors on the incidence of HFMD. METHODS This study collected data on HFMD in Shenzhen, China, from 2012 to 2015. We selected eleven factors as potential risk factors for HFMD. A Bayesian spatiotemporal model was used to quantify the influence of the factors on HFMD and to identify the relative risks in different districts. RESULTS The risk factors of HFMD were the population, population density, concentration of SO2, and concentration of NO2. The relative risks (RRs) were 1.00473 (95% CI: 1.00059-1.00761), 1.00010 (95% CI: 1.00002-1.00016), 1.00215 (95% CI: 1.00170-1.00232) and 1.00058 (95% CI: 1.00028-1.00078), respectively. The protective factors against HFMD were the per capita GDP, the number of public kindergartens, the concentration of PM10, and the concentration of O3. The RRs were 0.98840 (95% CI: 0.98660-0.99026), 0.97686 (95% CI: 0.96946-0.98403), 0.99108 (95% CI: 0.98551-0.99840) and 0.99587 (95% CI: 0.99534-0.99610), respectively. The risk of incidence in Longgang district and Pingshan district decreased, while the risk of incidence in Baoan district increased. CONCLUSIONS Studies have confirmed that socioeconomic factors and air pollution factors have an impact on the incidence of HFMD in Shenzhen, China. The results will be of great practical significance to local authorities, which is conducive to accurate prevention and can be used to formulate HFMD early warning systems.
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Affiliation(s)
- Xiaoyi He
- Shantou University Medical College, Shantou, China
| | - Shengjie Dong
- Orthopedic Department, Yantaishan Hospital, Yantai, Shandong, China
| | - Liping Li
- Shantou University Medical College, Shantou, China
| | - Xiaojian Liu
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Yongsheng Wu
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Zhen Zhang
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Shujiang Mei
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
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He Y, Feng Z, Wang W, Chen Y, Cheng J, Meng J, Yang H, Wang Y, Yao X, Feng Q, Chen L, Zhang H, Wang MHT, Zee BCY, Wang X, He ML. Global cytokine/chemokine profile identifies potential progression prediction indicators in hand-foot-and-mouth disease patients with Enterovirus A71 infections. Cytokine 2019; 123:154765. [PMID: 31255913 DOI: 10.1016/j.cyto.2019.154765] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 05/27/2019] [Accepted: 06/18/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVE New clinical indicators are urgently needed for predicting the progression and complications of hand-foot-and-mouth disease (HFMD) caused by EV-A71 infections. MATERIALS AND METHODS Serum specimens from 132 EV-A71 HFMD patients and 73 health children were collected during 2012-2014 in Shenzhen, China. The specific cytokines/chemokines were detected with a 274-human cytokine antibody array, followed by a 38-inflammation cytokine array, and further validated by ELISA. RESULTS Cytokines varied in different severity of EV-A71 HFMD patients. The ROC curve analysis revealed 5 serum cytokines with high sensitivity and specificity in predicting the disease progression. Eotaxin, IL-8 and IP-10 have showed high AUC values (0.90-0.95) for discrimination between the health controls and the patient group. The three cytokines showed high sensitivity (80-91%) and specificity (88-95%). MMP-8 had a high sensitivity and specificity to predict mild HFMD (100%, 100%). IL-1b and leptin discriminated the severe/critical group from the mild group (79% and 69% in sensitivity, 73% and 63% in specificity). CONCLUSIONS Eotaxin, IP-10 and IL-8 could be potential indicators for predicting HFMD progression with EV-A71 infection. MMP-8 is a specific indicator for mild infection, while IL-1b and leptin display potential for predicting the severity and criticality.
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Affiliation(s)
- Yaqing He
- Major Infectious Disease Control Key Laboratory, The Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong Province, China
| | - Zhuoying Feng
- Department of Biomedical Science, The City University of Hong Kong, China
| | - Wei Wang
- Department of Biomedical Science, The City University of Hong Kong, China
| | - Ying Chen
- Department of Biomedical Science, The City University of Hong Kong, China
| | - Jinquan Cheng
- Major Infectious Disease Control Key Laboratory, The Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong Province, China
| | - Jun Meng
- Major Infectious Disease Control Key Laboratory, The Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong Province, China
| | - Hong Yang
- Major Infectious Disease Control Key Laboratory, The Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong Province, China
| | - Yujie Wang
- The Zhenzhou Hospital of Traditional Chinese Medicine, Zhenzhou, Henan Province, China
| | - Xiangjie Yao
- Major Infectious Disease Control Key Laboratory, The Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong Province, China
| | - Qianjin Feng
- The Cancer Institute, Zhongshan People's Hospital, Zhongshan, Guangdong Province, China
| | - Long Chen
- Major Infectious Disease Control Key Laboratory, The Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong Province, China
| | - Hailong Zhang
- Major Infectious Disease Control Key Laboratory, The Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong Province, China
| | - Maggie H T Wang
- The Cancer Institute, Zhongshan People's Hospital, Zhongshan, Guangdong Province, China; Division of Biostatistics, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; The CUHK Shenzhen Research Institute, Shenzhen, China
| | - Benny C Y Zee
- The Cancer Institute, Zhongshan People's Hospital, Zhongshan, Guangdong Province, China; Division of Biostatistics, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; The CUHK Shenzhen Research Institute, Shenzhen, China
| | - Xin Wang
- The CityU Shenzhen Research Institute, Shenzhen, Guangdong Province, China
| | - Ming-Liang He
- Department of Biomedical Science, The City University of Hong Kong, China; The CityU Shenzhen Research Institute, Shenzhen, Guangdong Province, China.
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Liu XF, Sun XM, Sun XW, Yang YQ, Huang CH, Wen H. Epidemiological study on hand, foot and mouth disease in Tongzhou District, Beijing, 2013-2017. J Int Med Res 2019; 47:2615-2625. [PMID: 31099288 PMCID: PMC6567722 DOI: 10.1177/0300060519841974] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Objective To study the epidemiological characteristics of hand, foot and mouth disease (HFMD) in Tongzhou District, Beijing between 2013 and 2017. Methods Data on HFMD infections from 1 January 2013 to 31 December 2017 were collected from the Notifiable Infectious Diseases Reporting Information System and analysed. Serotyping of enteroviruses from samples from patients with HFMD was undertaken using reverse transcription–polymerase chain reaction. Results A total of 15 341 patients with HFMD were reported and 32 patients (0.2%) were classified as having severe HFMD. The annual mean incidence rate of HFMD was 219.3/100 000 of the general population. The incidence and case-severity rates of HFMD generally decreased between 2013 and 2017. In the floating migrant population, the incidence and cases-severity rates of HFMD were significantly higher than in the local population. The peak incidence and severity-case rates were at 2 years of age and > 90% of patients were ≤5 years. Enterovirus A71 and Coxsackievirus A16 were the predominant pathogens in 2013–2017. Conclusions During the 5-year period 2013–2017, the incidence rate and case-severity rate of HFMD generally decreased in Tongzhou District, Beijing. The floating migrant population and children ≤5 years of age were at the highest risk of HFMD.
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Affiliation(s)
- Xiao-Feng Liu
- 1 Administrative Office, Beijing Centre for Disease Prevention and Control, Dongcheng District, Beijing, China
| | - Xiu-Mei Sun
- 2 Business Management Office, Tongzhou District Centre for Disease Prevention and Control, Tongzhou District, Beijing, China
| | - Xiao-Wei Sun
- 2 Business Management Office, Tongzhou District Centre for Disease Prevention and Control, Tongzhou District, Beijing, China
| | - Yu-Qing Yang
- 2 Business Management Office, Tongzhou District Centre for Disease Prevention and Control, Tongzhou District, Beijing, China
| | - Cong-Hui Huang
- 2 Business Management Office, Tongzhou District Centre for Disease Prevention and Control, Tongzhou District, Beijing, China
| | - Han Wen
- 2 Business Management Office, Tongzhou District Centre for Disease Prevention and Control, Tongzhou District, Beijing, China
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Li J, Zhu R, Huo D, Du Y, Yan Y, Liang Z, Luo Y, Yang Y, Jia L, Chen L, Wang Q, He Y. An outbreak of Coxsackievirus A6-associated hand, foot, and mouth disease in a kindergarten in Beijing in 2015. BMC Pediatr 2018; 18:277. [PMID: 30131060 PMCID: PMC6103857 DOI: 10.1186/s12887-018-1253-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2018] [Accepted: 08/13/2018] [Indexed: 12/13/2022] Open
Abstract
Background Coxsackievirus A6 (CVA6) is one of the major agents to cause hand, foot and mouth disease (HFMD) outbreaks globally. The objective of this study is to investigate the epidemiologic and clinical manifestations of CVA6 outbreak, and thus guide the diagnosis and treatment of the disease, as well as disease prevention. Methods An HFMD outbreak in a kindergarten was reported to Shijingshan District Center for Disease Control and Prevention (SCDC) on November 2, 2015 in Beijing, China. Epidemiological investigation was conducted. We performed a nine-week follow-up study to collect and analyze the clinical manifestations of HFMD cases. Results The outbreak yield 56 (15.7%) clinical diagnosed HFMD cases out of 357 registered children in the kindergarten with the mean age of 3.5 years old. This outbreak lasted for three days and ceased after initiating infectious disease controlling procedures, including periodical suspension of the kindergarten activities, environmental disinfection, and family health education. Fifty-one cases were followed for nine weeks. The positive rate of clinical manifestations of rash, fever, desquamation, pigmentation and onychomadesis were 100.0%, 84.3%, 68.6%, 17.6% and 43.1%, respectively. Children developed desquamation within the first 4 weeks after disease onset and developed onychomadesis between the 3th and 8th week after disease onset. Children with desquamation had 9.3 (95%CI: 1.836–47.437) times higher odds of developing onychomadesis compared to those without this manifestation. Ten out of 14 collected samples were CVA6 positive, and five positive samples shared a high degree of similarity in the VP1 nucleotide and amino acid sequences (99.9–100.0% and 100%). Conclusion This HFMD outbreak was caused by CVA6, featured with delayed symptoms. Emerging CVA6-associated HFMD and its delayed symptoms should be paid more attention to reduce outbreaks and provide more information to doctors and parents. Electronic supplementary material The online version of this article (10.1186/s12887-018-1253-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jie Li
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, No. 10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, People's Republic of China.,Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, No.16, Hepingli Middle Street, Beijing, 100013, People's Republic of China
| | - Rong Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, No. 10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, People's Republic of China
| | - Da Huo
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, No.16, Hepingli Middle Street, Beijing, 100013, People's Republic of China
| | - Yiwei Du
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, No.16, Hepingli Middle Street, Beijing, 100013, People's Republic of China
| | - Yuxiang Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, No. 10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, People's Republic of China
| | - Zhichao Liang
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, No.16, Hepingli Middle Street, Beijing, 100013, People's Republic of China
| | - Yanxia Luo
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, No. 10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, People's Republic of China
| | - Yang Yang
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, No.16, Hepingli Middle Street, Beijing, 100013, People's Republic of China
| | - Lei Jia
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, No.16, Hepingli Middle Street, Beijing, 100013, People's Republic of China
| | - Lijuan Chen
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, No.16, Hepingli Middle Street, Beijing, 100013, People's Republic of China
| | - Quanyi Wang
- Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, No.16, Hepingli Middle Street, Beijing, 100013, People's Republic of China.
| | - Yan He
- Department of Epidemiology and Biostatistics, School of Public Health, Capital Medical University, No. 10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, People's Republic of China.
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