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Roh D, Jeon W, Lee J. Enterovirus Meningitis without Pleocytosis: a Retrospective Observational Study in Adults. Jpn J Infect Dis 2023; 76:329-334. [PMID: 37394460 DOI: 10.7883/yoken.jjid.2023.123] [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] [Indexed: 07/04/2023]
Abstract
Reverse-transcription polymerase chain reaction (RT-PCR)-confirmed enterovirus (EV) meningitis without pleocytosis has only been previously reported in children. In this study, we examined the frequency of EV meningitis without pleocytosis in adults and compared its clinical features. We retrospectively analyzed the data of adult patients with EV meningitis confirmed using cerebrospinal fluid (CSF) RT-PCR. Among the 17 patients included in this study, 58.8% showed no pleocytosis. The median age and clinical symptoms did not differ between the pleocytosis and non-pleocytosis groups. There were no statistically significant differences in seasonal variation or time from the onset of meningitis symptoms to lumbar puncture. The peripheral white blood cell (WBC) count in patients with pleocytosis was significantly higher than that in patients without pleocytosis. The median CSF pressure showed a higher trend in the non-pleocytosis group. Patients with CSF pressures higher than normal were more common in the non-pleocytosis group. The median CSF protein values were higher than the normal values in both groups. We confirmed the high frequency of EV meningitis without pleocytosis in adults. Accurate diagnosis using RT-PCR is necessary when meningitis symptoms are prominent during an EV epidemic, and CSF protein levels and pressure are high, even if the CSF WBC count is normal.
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Affiliation(s)
- Dongkeun Roh
- Department of Emergency Medicine, Ajou University School of Medicine, Republic of Korea
| | - Woochan Jeon
- Department of Emergency Medicine, Inje University Ilsan Paik Hospital, Republic of Korea
| | - Jisook Lee
- Department of Emergency Medicine, Ajou University School of Medicine, Republic of Korea
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Kim MJ, Lee JE, Kim KG, Park DW, Cho SJ, Kim TS, Kee HY, Kim SH, Park HJ, Seo MH, Chung JK, Seo JJ. Long-term sentinel surveillance of enteroviruses in Gwangju, South Korea, 2011-2020. Sci Rep 2023; 13:2798. [PMID: 36797345 PMCID: PMC9933826 DOI: 10.1038/s41598-023-29461-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Accepted: 02/06/2023] [Indexed: 02/18/2023] Open
Abstract
Human enteroviruses (EVs) are associated with a broad spectrum of diseases. To understand EV epidemiology, we present longitudinal data reflecting changing EV prevalence patterns in South Korea. We collected 7160 specimens from patients with suspected EV infections in ten hospitals in Gwangju, Korea during 2011-2020. RNA extraction and real-time reverse transcription polymerase chain reaction using EV-specific probes and primers were performed. EV genotyping and phylogenetic analysis were performed; EVs were detected in 3076 samples (43.0%), and the annual EV detection rate varied. EV infection rates did not differ with sex, and children aged ≤ 4 years were the most prone to EV infection; this trend did not change over time. Overall, 35 different EV types belonging to four distinctive species and rhinoviruses were identified. Although serotype distribution changed annually, the most frequently observed EVs were EV-A71 (13.1% of the cases), CVA6 (8.3%), CVB5 (7.6%), CVA16 (7.6%), CVA10 (7.5%), E18 (7.5%), E30 (7.0%), and E11 (5.0%) during 2011-2020. The predominant EV genotypes by clinical manifestation were CVB5 for aseptic meningitis; EV-A71 for hand, foot, and mouth disease cases; and CVA10 for herpangina. These results will aid the development of vaccines against EV infection and allow comprehensive disease control.
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Affiliation(s)
- Min Ji Kim
- Department of Infectious Disease Research, Health & Environment Research Institute of Gwangju, 584 Mujin-Daero, Seogu, Gwangju, Republic of Korea, 61954.
| | - Ji-eun Lee
- Department of Infectious Disease Research, Health & Environment Research Institute of Gwangju, 584 Mujin-Daero, Seogu, Gwangju, Republic of Korea 61954
| | - Kwang gon Kim
- Department of Infectious Disease Research, Health & Environment Research Institute of Gwangju, 584 Mujin-Daero, Seogu, Gwangju, Republic of Korea 61954
| | - Duck Woong Park
- Department of Infectious Disease Research, Health & Environment Research Institute of Gwangju, 584 Mujin-Daero, Seogu, Gwangju, Republic of Korea 61954
| | - Sun Ju Cho
- Department of Infectious Disease Research, Health & Environment Research Institute of Gwangju, 584 Mujin-Daero, Seogu, Gwangju, Republic of Korea 61954
| | - Tae sun Kim
- Department of Infectious Disease Research, Health & Environment Research Institute of Gwangju, 584 Mujin-Daero, Seogu, Gwangju, Republic of Korea 61954
| | - Hye-young Kee
- Department of Infectious Disease Research, Health & Environment Research Institute of Gwangju, 584 Mujin-Daero, Seogu, Gwangju, Republic of Korea 61954
| | - Sun-Hee Kim
- Department of Infectious Disease Research, Health & Environment Research Institute of Gwangju, 584 Mujin-Daero, Seogu, Gwangju, Republic of Korea 61954
| | - Hye jung Park
- Department of Infectious Disease Research, Health & Environment Research Institute of Gwangju, 584 Mujin-Daero, Seogu, Gwangju, Republic of Korea 61954
| | - Mi Hee Seo
- Department of Infectious Disease Research, Health & Environment Research Institute of Gwangju, 584 Mujin-Daero, Seogu, Gwangju, Republic of Korea 61954
| | - Jae Keun Chung
- Department of Infectious Disease Research, Health & Environment Research Institute of Gwangju, 584 Mujin-Daero, Seogu, Gwangju, Republic of Korea 61954
| | - Jin-jong Seo
- Department of Infectious Disease Research, Health & Environment Research Institute of Gwangju, 584 Mujin-Daero, Seogu, Gwangju, Republic of Korea 61954
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Puenpa J, Saengdao N, Khanarat N, Korkong S, Chansaenroj J, Yorsaeng R, Wanlapakorn N, Poovorawan Y. Evolutionary and Genetic Recombination Analyses of Coxsackievirus A6 Variants Associated with Hand, Foot, and Mouth Disease Outbreaks in Thailand between 2019 and 2022. Viruses 2022; 15:73. [PMID: 36680113 PMCID: PMC9863931 DOI: 10.3390/v15010073] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 12/30/2022] Open
Abstract
Coxsackievirus (CV)-A6 infections cause hand, foot, and mouth disease (HFMD) in children and adults. Despite the serious public health threat presented by CV-A6 infections, our understanding of the mechanisms by which new CV-A6 strains emerge remains limited. This study investigated the molecular epidemiological trends, evolutionary dynamics, and recombination characteristics of CV-A6-associated HFMD in Thailand between 2019 and 2022. In the HFMD patient samples collected during the 4-year study period, we identified enterovirus (EV) RNA in 368 samples (48.7%), of which CV-A6 (23.7%) was the predominant genotype, followed by CV-A4 (6%), EV-A71 (3.7%), and CV-A16 (3.4%). According to the partial viral protein (VP) 1 sequences, all these CV-A6 strains belonged to the D3 clade. Based on the viral-RNA-dependent RNA polymerase (RdRp) gene, four recombinant forms (RFs), RF-A (147, 84.5%), RF-N (11, 6.3%), RF-H (1, 0.6%), and newly RF-Y (15, 8.6%), were identified throughout the study period. Results from the similarity plot and bootscan analyses revealed that the 3D polymerase (3Dpol) region of the D3/RF-Y subclade consists of sequences highly similar to CV-A10. We envisage that the epidemiological and evolutionarily insights presented in this manuscript will contribute to the development of vaccines to prevent the spread of CV-A6 infection.
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Affiliation(s)
- Jiratchaya Puenpa
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Nutsada Saengdao
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
- Department of Microbiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Nongkanok Khanarat
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Sumeth Korkong
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Jira Chansaenroj
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Ritthideach Yorsaeng
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Nasamon Wanlapakorn
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
| | - Yong Poovorawan
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand
- FRS(T), The Royal Society of Thailand, Sanam Sueapa, Dusit, Bangkok 10300, Thailand
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Javadi M, Nejati A, Yousefi M, Mahmoodi M, Shoja Z, Shahmahmoodi S. First seroepidemiological investigation of human enterovirus 71 in Iran. IRANIAN JOURNAL OF MICROBIOLOGY 2021; 13:502-508. [PMID: 34557279 PMCID: PMC8421584 DOI: 10.18502/ijm.v13i4.6975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background and Objectives: Human Enterovirus 71 (EV-A71) is the causative agent for many dermal to neurological diseases especially polio-like paralysis outbreaks around the world. This study, the first of this kind in Iran, aimed to find neutralizing antibodies against EV-A71 in serum of healthy individuals in different age groups based on neutralization test (NT). Materials and Methods: In this cross-sectional study, 547 serum samples were collected from healthy individuals who were referring for routine checkup tests (aged from under 6 months to over 31 years old) to Imam-Khomeini Hospital in Tehran during January-December 2015. Serum samples were examined by NT in cell culture to detect neutralizing antibodies against EV-A71. In the next step, some of the positive samples were subjected to complete titration to determine the exact titer of anti-EV-A71 antibodies. Results: Of 547 samples, 310 (56.7%) were positive for EV-A71 neutralizing antibody. The presence of the antibody increased with age (p<0.001), and there was a significant statistical relationship between sex and the presence of antibody (p=0.009). Conclusion: Our results demonstrated an apparent but limited circulation of EV-A71 in our society. After the worldwide eradication of poliovirus, EV-A71 which can cause polio-likes syndrome, might be the new challenge for our health care system as regard more in depth research is however needed.
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Affiliation(s)
- Mahsa Javadi
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Department of Virology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ahmad Nejati
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Yousefi
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmood Mahmoodi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Shohreh Shahmahmoodi
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Janetanakit T, Chaiyawong S, Charoenkul K, Tangwangvivat R, Chamsai E, Udom K, Jairak W, Amonsin A. Distribution and genetic diversity of Enterovirus G (EV-G) on pig farms in Thailand. BMC Vet Res 2021; 17:277. [PMID: 34399753 PMCID: PMC8369780 DOI: 10.1186/s12917-021-02988-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 08/02/2021] [Indexed: 11/28/2022] Open
Abstract
Background Enterovirus G (EV-G) causes subclinical infections and is occasionally associated with diarrhea in pigs. In this study, we conducted a cross-sectional survey of EV-G in pigs from 73 pig farms in 20 provinces of Thailand from December 2014 to January 2018. Results Our results showed a high occurrence of EV-Gs which 71.6 % of fecal and intestinal samples (556/777) and 71.2 % of pig farms (52/73) were positive for EV-G by RT-PCR specific to the 5’UTR. EV-Gs could be detected in all age pig groups, and the percentage positivity was highest in the fattening group (89.7 %), followed by the nursery group (89.4 %). To characterize the viruses, 34 EV-G representatives were characterized by VP1 gene sequencing. Pairwise sequence comparison and phylogenetic analysis showed that Thai-EV-Gs belonged to the EV-G1, EV-G3, EV-G4, EV-G8, EV-G9 and EV-G10 genotypes, among which the EV-G3 was the predominant genotype in Thailand. Co-infection with different EV-G genotypes or with EV-Gs and porcine epidemic diarrhea virus (PEDV) or porcine deltacoronavirus (PDCoV) on the same pig farms was observed. Conclusions Our results confirmed that EV-G infection is endemic in Thailand, with a high genetic diversity of different genotypes. This study constitutes the first report of the genetic characterization of EV-GS in pigs in Thailand. Supplementary Information The online version contains supplementary material available at 10.1186/s12917-021-02988-6.
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Affiliation(s)
- Taveesak Janetanakit
- Center of Excellence for Emerging and Re-emerging Infectious Diseases in Animals and One Health Research Cluster, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand.,Department of Veterinary Public Health, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Supassama Chaiyawong
- Center of Excellence for Emerging and Re-emerging Infectious Diseases in Animals and One Health Research Cluster, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand.,Department of Veterinary Public Health, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Kamonpan Charoenkul
- Center of Excellence for Emerging and Re-emerging Infectious Diseases in Animals and One Health Research Cluster, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand.,Department of Veterinary Public Health, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, 10330, Thailand
| | - Ratanaporn Tangwangvivat
- Center of Excellence for Emerging and Re-emerging Infectious Diseases in Animals and One Health Research Cluster, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Ekkapat Chamsai
- Center of Excellence for Emerging and Re-emerging Infectious Diseases in Animals and One Health Research Cluster, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Kitikhun Udom
- Center of Excellence for Emerging and Re-emerging Infectious Diseases in Animals and One Health Research Cluster, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Waleemas Jairak
- Center of Excellence for Emerging and Re-emerging Infectious Diseases in Animals and One Health Research Cluster, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand
| | - Alongkorn Amonsin
- Center of Excellence for Emerging and Re-emerging Infectious Diseases in Animals and One Health Research Cluster, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, Thailand. .,Department of Veterinary Public Health, Faculty of Veterinary Science, Chulalongkorn University, Bangkok, 10330, Thailand.
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Huang H, Deng L, Jia L, Zhu R. A clinical scoring system for pediatric hand-foot-mouth disease. BMC Infect Dis 2021; 21:722. [PMID: 34332544 PMCID: PMC8325785 DOI: 10.1186/s12879-021-06424-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 07/09/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The aim of the present study was to develop a clinical scoring system for the diagnosis of hand-foot-mouth disease (HFMD) with improved accuracy. METHODS A retrospective analysis was performed on standardized patient history and clinical examination data obtained from 1435 pediatric patients under the age of three years who presented with acute rash illness and underwent enterovirus nucleic acid detection. Patients were then divided into the HFMD (1094 patients) group or non-HFMD (341 patients) group based on a positive or a negative result from the assay, respectively. We then divided the data into a training set (1004 cases, 70%) and a test set (431 cases, 30%) using a random number method. Multivariate logistic regression was performed on 15 clinical variables (e.g. age, exposure history, number of rash spots in a single body region) to identify variables highly predictive of a positive diagnosis in the training set. Using the variables with high impact on the diagnostic accuracy, we generated a scoring system for predicting HFMD and subsequently evaluated this system in the test set by receiver operating characteristic curve (ROC curve). RESULTS Using the logistic model, we identified seven clinical variables (age, exposure history, and rash density at specific regions of the body) to be included into the scoring system. The final scores ranged from - 5 to 24 (higher scores positively predicted HFMD diagnosis). Through our training set, a cutoff score of 7 resulted in a sensitivity of 0.76 and specificity of 0.68. The area under the receiver operating characteristic curve (AUC) was 0.804 (95% confidence interval [CI]: 0.773-0.835) (P < 0.001). Using the test set, we obtained an AUC of 0.76 (95% CI: 0.710-0.810) with a sensitivity of 0.76 and a specificity of 0.62. These results from the test set were consistent with those from the training set. CONCLUSIONS This study establishes an objective scoring system for the diagnosis of typical and atypical HFMD using measures accessible through routine clinical encounters. Due to the accuracy and sensitivity achieved by this scoring system, it can be employed as a rapid, low-cost method for establishing diagnoses in children with acute rash illness.
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Affiliation(s)
- Hui Huang
- Department of Infectious Diseases, The Affiliated Children's Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Li Deng
- Department of Infectious Diseases, The Affiliated Children's Hospital, Capital Institute of Pediatrics, Beijing, China.
| | - Liping Jia
- Department of Infectious Diseases, The Affiliated Children's Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Runan Zhu
- Department of Infectious Diseases, The Affiliated Children's Hospital, Capital Institute of Pediatrics, Beijing, China
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Kang HJ, Yoon Y, Lee YP, Kim HJ, Lee DY, Lee JW, Hyeon JY, Yoo JS, Lee S, Kang C, Choi W, Han MG. A Different Epidemiology of Enterovirus A and Enterovirus B Co-circulating in Korea, 2012-2019. J Pediatric Infect Dis Soc 2021; 10:398-407. [PMID: 33150450 DOI: 10.1093/jpids/piaa111] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/01/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Enteroviruses (EVs) occur frequently worldwide and are known to be associated with a broad spectrum of clinical manifestations from mild syndromes to neurological disease. To understand the epidemiology of EV in Korea, we characterized EV-infected cases during 2012-2019 based on national surveillance. METHODS We collected specimens from patients with suspected EV infections and analyzed the data using real-time reverse-transcription polymerase chain reaction and VP1 gene sequencing. RESULTS Among the 18 261 specimens collected, EVs were detected in 6258 (34.3%) cases. Although the most common EV types changed annually, EV-A71, echovirus 30, coxsackievirus B5, coxsackievirus A6, and coxsackievirus A10 were commonly identified. Among the human EVs, the case numbers associated with the 2 major epidemic species (EV-A and EV-B) peaked in the summer. While EV-A species affected 1-year-old children and were associated with herpangina and hand, foot, and mouth disease, EV-B species were mostly associated with neurologic manifestations. The highest incidence of EV-B species was observed in infants aged <12 months. Feces and respiratory specimens were the most predictive of EV infection. Specimens collected within 5 days of symptom onset allowed for timely virus detection. CONCLUSIONS EV-A and EV-B species co-circulating in Korea presented different epidemiologic trends in clinical presentation, affected subjects, and seasonality trends. This study could provide information for the characterization of EVs circulating in Korea to aid the development of EV antivirals and vaccines, as well as public health measures to control enteroviral diseases.
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Affiliation(s)
- Hae Ji Kang
- Division of Viral Diseases, Center for Laboratory Control of Infectious Diseases, Korea Centers for Disease Control and Prevention, Osong, Republic of Korea
| | - Youngsil Yoon
- Division of Viral Diseases, Center for Laboratory Control of Infectious Diseases, Korea Centers for Disease Control and Prevention, Osong, Republic of Korea
| | - Young-Pyo Lee
- Division of Viral Diseases, Center for Laboratory Control of Infectious Diseases, Korea Centers for Disease Control and Prevention, Osong, Republic of Korea
| | - Hye-Jin Kim
- Division of Infectious Diseases Control, Center for Laboratory Control of Infectious Diseases, Korea Centers for Disease Control and Prevention, Osong, Republic of Korea
| | - Deog-Yong Lee
- Division of Viral Diseases, Center for Laboratory Control of Infectious Diseases, Korea Centers for Disease Control and Prevention, Osong, Republic of Korea
| | - June-Woo Lee
- Division of Vaccine Research, National Institute of Health, Korea Centers for Disease Control and Prevention, Osong, Republic of Korea
| | - Ji-Yeon Hyeon
- Division of Vaccine Research, National Institute of Health, Korea Centers for Disease Control and Prevention, Osong, Republic of Korea
| | - Jung Sik Yoo
- Division of Vaccine Research, National Institute of Health, Korea Centers for Disease Control and Prevention, Osong, Republic of Korea
| | - Sangwon Lee
- Division of Infectious Diseases Control, Center for Laboratory Control of Infectious Diseases, Korea Centers for Disease Control and Prevention, Osong, Republic of Korea
| | - Chun Kang
- Division of Viral Diseases, Center for Laboratory Control of Infectious Diseases, Korea Centers for Disease Control and Prevention, Osong, Republic of Korea
| | - Wooyoung Choi
- Division of Viral Diseases, Center for Laboratory Control of Infectious Diseases, Korea Centers for Disease Control and Prevention, Osong, Republic of Korea
| | - Myung-Guk Han
- Division of Viral Diseases, Center for Laboratory Control of Infectious Diseases, Korea Centers for Disease Control and Prevention, Osong, Republic of Korea
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Gao Q, Liu Z, Xiang J, Tong M, Zhang Y, Wang S, Zhang Y, Lu L, Jiang B, Bi P. Forecast and early warning of hand, foot, and mouth disease based on meteorological factors: Evidence from a multicity study of 11 meteorological geographical divisions in mainland China. ENVIRONMENTAL RESEARCH 2021; 192:110301. [PMID: 33069698 DOI: 10.1016/j.envres.2020.110301] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/24/2020] [Accepted: 10/05/2020] [Indexed: 05/14/2023]
Abstract
BACKGROUND Hand, foot, and mouth disease (HFMD) is a significant public health issue in China. Early warning and forecasting are one of the most cost-effective ways for HFMD control and prevention. However, relevant research is limited, especially in China with a large population and diverse climatic characteristics. This study aims to identify local specific HFMD epidemic thresholds and construct a weather-based early warning model for HFMD control and prevention across China. METHODS Monthly notified HFMD cases and meteorological data for 22 cities selected from different climate zones from 2014 to 2018 were extracted from the National Notifiable Disease Surveillance System and the Meteorological Data Sharing Service System, respectively. A generalized additive model (GAM) based on meteorological factors was conducted to forecast HFMD epidemics. The receiver operator characteristic curve (ROC) was generated to determine the value of optimal warning threshold. RESULTS The developed model was solid in forecasting the epidemic of HFMD with all R square (R2) in the 22 cities above 85%, and mean absolute percentage error (MAPE) less than 1%. The warning thresholds varied by cities with the highest threshold observed in Shenzhen (n = 7195) and the lowest threshold in Liaoyang (n = 12). The areas under the curve (AUC) was greater than 0.9 for all regions, indicating a satisfied discriminating ability in epidemics detection. CONCLUSIONS The weather-based HFMD forecasting and early warning model we developed for different climate zones provides needed information on occurrence time and size of HFMD epidemics. An effective early warning system for HFMD could provide sufficient time for local authorities to implement timely interventions to minimize the HFMD morbidity and mortality.
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Affiliation(s)
- Qi Gao
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, People's Republic of China; Shandong University Climate Change and Health Center, Jinan, Shandong Province, People's Republic of China
| | - Zhidong Liu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, People's Republic of China; Shandong University Climate Change and Health Center, Jinan, Shandong Province, People's Republic of China
| | - Jianjun Xiang
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia; School of Public Health, Fujian Medical University, Fuzhou, 350108, People's Republic of China
| | - Michael Tong
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Ying Zhang
- School of Public Health, China Studies Centre, The University of Sydney, New South Wales, Australia
| | - Shuzi Wang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, People's Republic of China; Shandong University Climate Change and Health Center, Jinan, Shandong Province, People's Republic of China
| | - Yiwen Zhang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, People's Republic of China; Shandong University Climate Change and Health Center, Jinan, Shandong Province, People's Republic of China
| | - Liang Lu
- Shandong University Climate Change and Health Center, Jinan, Shandong Province, People's Republic of China; State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, People's Republic of China
| | - Baofa Jiang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, People's Republic of China; Shandong University Climate Change and Health Center, Jinan, Shandong Province, People's Republic of China.
| | - Peng Bi
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
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9
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Epidemiological and aetiological characteristics of hand, foot, and mouth disease in Sichuan Province, China, 2011-2017. Sci Rep 2020; 10:6117. [PMID: 32273569 PMCID: PMC7145801 DOI: 10.1038/s41598-020-63274-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 03/25/2020] [Indexed: 01/27/2023] Open
Abstract
Hand, foot, and mouth disease (HFMD) remains a threat to the Asia-Pacific region. The epidemiological characteristics and pathogen spectrum of HFMD vary with space and time. These variations are crucial for HFMD interventions but poorly understood in Sichuan Province, China, particularly after the introduction of the EV-A71 vaccine. Using descriptive methods, regression analyses, spatial autocorrelation analysis, and space-time scan statistics, we analysed the epidemiological and aetiological characteristics of HFMD surveillance data in Sichuan Province between 2011 and 2017 to identify spatio-temporal variations. The dominant serotypes of HFMD have changed from enterovirus 71 and coxsackievirus A16 to other enteroviruses since 2013. The seasonal pattern of HFMD showed two peaks generally occurring from April to July and November to December; however, the seasonal pattern varied by prefecture and enterovirus serotype. From 2011 to 2017, spatio-temporal clusters were increasingly concentrated in Chengdu, with several small clusters in northeast Sichuan. The clusters observed in southern Sichuan from 2011 to 2015 disappeared in 2016–2017. These findings highlight the importance of pathogen surveillance and vaccination strategies for HFMD interventions; future prevention and control of HFMD should focus on Chengdu and its vicinity.
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Won YJ, Kang LH, Lee AR, Paik B, Kim H, Lee SG, Park SW, Hong SJ, Paik SY. Sequence analysis of the first B5 subgenogroup strain of enterovirus 71 isolated in Korea. J Microbiol 2020; 58:422-429. [PMID: 32222942 PMCID: PMC7223378 DOI: 10.1007/s12275-020-9539-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 02/04/2020] [Accepted: 02/13/2020] [Indexed: 11/25/2022]
Abstract
Enterovirus A71 (EV71), the main etiological agent of handfoot- mouth disease (HFMD), circulates in many areas of the world and has caused large epidemics since 1997, especially in the Asia-Pacific region. In this study, we determined the full-genome sequence of CMC718, a newly isolated EV71 strain in Korea. The CMC718 genome was 7,415 nucleotides in length and was confirmed by whole-genome phylogenetic analysis to belong to the B5 genotype. In particular, CMC718 demonstrated maximum identity with strain M988 of the B5 genotype and numerous amino acid variants were detected in the 3D domain of the viral protein P3, which is consistent with the mutation pattern of a B5 strain isolated in 2012–2013. Comparison of the CMC718 sequence with other EV71 reference strains confirmed the relationship and genetic variation of CMC718. Our study was a full-genome sequence analysis of the first EV71 strain of the B5 genotype isolated in South Korea. This information will be a valuable reference for the development of methods for the detection of recombinant viruses, the tracking of infections, and the diagnosis of EV71.
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Affiliation(s)
- Yu Jung Won
- Department of Microbiology, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Lae Hyung Kang
- Department of Microbiology, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Ah Ra Lee
- Department of Microbiology, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Bomina Paik
- Department of Microbiology, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Hyun Kim
- Department of Microbiology, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Sung Geun Lee
- Korea Zoonosis Research Institute, Jeonbuk National University, Iksan, 54596, Republic of Korea
| | - Seung Won Park
- Department of Biotechnology, Daegu Catholic University, Gyeongsan-si, Gyeongsangbuk-do, 38430, Republic of Korea
| | - Seung Jin Hong
- Department of Microbiology, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea.
| | - Soon Young Paik
- Department of Microbiology, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea.
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11
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Chiu ML, Luo ST, Chen YY, Chung WY, Duong V, Dussart P, Chan YF, Perera D, Ooi MH, Thao NTT, Truong HK, Lee MS. Establishment of Asia-Pacific Network for Enterovirus Surveillance. Vaccine 2019; 38:1-9. [PMID: 31679864 DOI: 10.1016/j.vaccine.2019.09.111] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/16/2019] [Accepted: 09/30/2019] [Indexed: 12/11/2022]
Abstract
Enteroviruses (EV), the major pathogens of hand, foot, and mouth disease (HFMD) and herpangina, affect millions of children each year. Most human enteroviruses cause self-limited infections except polioviruses, enterovirus A71 (EV-A71), enterovirus D68 (EV-D68), and several echoviruses (Echo) and coxsackieviruses (CV). Especially, EV-A71 has repeatedly caused large-scale outbreaks in the Asia-Pacific region since 1997. Some Asian countries have experienced cyclical outbreaks of severe EV-A71 infections and initiated development of EV-A71 vaccines. Five EV-A71 vaccine candidates have been clinically evaluated and three of them were approved for marketing in China. However, none of the China-approved products seek marketing approval in other countries. This situation supports a role for collaboration among Asian countries to facilitate clinical trials and licensure of EV-A71 vaccines. Additionally, enterovirus D68 outbreaks have been reported in the US and Taiwan currently and caused severe complications and deaths. Hence, an Asia-Pacific Network for Enterovirus Surveillance (APNES) has been established to estimate disease burden, understand virus evolution, and facilitate vaccine development through harmonizing laboratory diagnosis and data collection. Founded in 2017, the APNES is comprised of internationally recognized experts in the field of enterovirus in Asian countries working to raise awareness of this potentially fatal and debilitating disease. This article demonstrated the summaries of the first expert meeting, 2017 International Workshop on Enterovirus Surveillance and Vaccine Development, held by APNES in Taipei, Taiwan, March 2017.
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Affiliation(s)
- Mu-Lin Chiu
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan
| | - Shu-Ting Luo
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan
| | - Ya-Yen Chen
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan
| | - Wan Yu Chung
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan
| | - Veasna Duong
- Virology Unit, Institut Pasteur du Cambodge, Cambodia
| | | | - Yoke-Fun Chan
- Department of Medical Microbiology, Faculty of Medicine, University Malaya, Malaysia
| | - David Perera
- Institute of Health & Community Medicine, Universiti Malaysia Sarawak, Malaysia
| | - Mong How Ooi
- Institute of Health & Community Medicine, Universiti Malaysia Sarawak, Malaysia; Sarawak General Hospital, Sarawak, Malaysia
| | | | - Huu Khanh Truong
- Department of Infectious Diseases, Children Hospital 1, Ho Chi Minh City, Viet Nam
| | - Min-Shi Lee
- National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan.
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12
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Fu X, Wan Z, Li Y, Hu Y, Jin X, Zhang C. National Epidemiology and Evolutionary History of Four Hand, Foot and Mouth Disease-Related Enteroviruses in China from 2008 to 2016. Virol Sin 2019; 35:21-33. [PMID: 31664644 PMCID: PMC7035399 DOI: 10.1007/s12250-019-00169-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 08/27/2019] [Indexed: 01/21/2023] Open
Abstract
Hand, foot and mouth disease (HFMD) is a major public health concern in China. The most predominant enteroviruses that cause HFMD have traditionally been attributed to enterovirus A71 (EVA71) and coxsackievirus A16 (CVA16). Since its first large outbreak in 2008, the dominant HFMD pathogens are constantly changing. In 2013 and 2015, CVA6 exceeded both EVA71 and CVA16 to become the leading cause of HFMD in some provinces. However, there still lacks a comprehensive overview on the molecular epidemiology and evolution of HFMD-related enteroviruses at the national level. In this study, we performed systematic epidemiological analyses of HFMD-related enteroviruses using the data of 64 published papers that met the inclusion criteria, and conducted phylogenetic analyses based on 12,080 partial VP1 sequences identified in China before 31st June 2018. We found that EVA71 prevalence has decreased sharply but other enteroviruses have increased rapidly from 2008 to 2016 and that one subtype of each enterovirus is represented during the epidemic. In addition, four genotypes EVA71_C4, CVA16_B1, CVA6_D and CVA10_C are the most predominant enterovirus strains and collectively they cause over 90% of all HFMD cases in China according to the phylogenetic trees using representative partial VP1 sequences. These four major enterovirus genotypes have different geographical distributions, and they may co-circulate with other genotypes and serotypes. These results suggest that more molecular epidemiological studies should be performed on several enteroviruses simultaneously, and such information should have implications for virological surveillance, disease management, vaccine development and policy-making on the prevention and control of HFMD.
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Affiliation(s)
- Xuemin Fu
- Pathogen Discovery and Big Data Center, CAS Key Laboratory of Molecular Virology and Immunology, Institut Pasteur of Shanghai, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai, 200031, China
| | - Zhenzhou Wan
- Medical Laboratory of Taizhou Fourth People's Hospital, Taizhou, 225300, China
| | - Yanpeng Li
- Pathogen Discovery and Big Data Center, CAS Key Laboratory of Molecular Virology and Immunology, Institut Pasteur of Shanghai, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai, 200031, China
| | - Yihong Hu
- Pathogen Discovery and Big Data Center, CAS Key Laboratory of Molecular Virology and Immunology, Institut Pasteur of Shanghai, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai, 200031, China
| | - Xia Jin
- Viral Disease and Vaccine Translational Research Unit, CAS Key Laboratory of Molecular Virology and Immunology, Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai, 200031, China
| | - Chiyu Zhang
- Pathogen Discovery and Big Data Center, CAS Key Laboratory of Molecular Virology and Immunology, Institut Pasteur of Shanghai, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai, 200031, China.
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13
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Puenpa J, Wanlapakorn N, Vongpunsawad S, Poovorawan Y. The History of Enterovirus A71 Outbreaks and Molecular Epidemiology in the Asia-Pacific Region. J Biomed Sci 2019; 26:75. [PMID: 31627753 PMCID: PMC6798416 DOI: 10.1186/s12929-019-0573-2] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 10/01/2019] [Indexed: 01/01/2023] Open
Abstract
Enterovirus A71 (EV-A71) is one of the common causative pathogens for hand foot and mouth disease (HFMD) affecting young children. HFMD outbreak can result in a substantial pediatric hospitalization and burden the healthcare services, especially in less-developed countries. Since the initial epidemic of predominantly EV-A71 in California in 1969, the high prevalence of HFMD in the Asia-pacific region and elsewhere around the world represents a significant morbidity in this age group. With the advent of rapid and accurate diagnostic tools, there has been a dramatic increase in the number of laboratory-confirmed EV-A71 infection over the past two decades. The population, cultural, and socioeconomic diversity among countries in the Asia-Pacific region all influence the transmission and morbidity associated with HFMD. This review summarizes the current state of epidemiology of EV-A71 in Asia-Pacific countries based on the most recent epidemiological data and available information on the prevalence and disease burden. This knowledge is important in guiding the prevention, control and future research on vaccine development of this highly contagious disease of significant socioeconomic implications in public health.
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Affiliation(s)
- Jiratchaya Puenpa
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nasamon Wanlapakorn
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Division of Academic Affairs, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sompong Vongpunsawad
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Yong Poovorawan
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
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14
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Yang TO, Arthur Huang KY, Chen MH, Chen PC, Huang WT. Comparison of Nonpolio Enteroviruses in Children With Herpangina and Hand, Foot and Mouth Disease in Taiwan. Pediatr Infect Dis J 2019; 38:887-893. [PMID: 31033911 DOI: 10.1097/inf.0000000000002351] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nonpolio enterovirus (NPEV) infections are often present with herpangina (HA) and hand, foot and mouth disease (HFMD). Most countries sample NPEVs in HFMD cases, targeting enterovirus A71 (EV-A71) and coxsackievirus A16 (CV-A16) that are associated with outbreaks and severe complications. HA is also monitored in Taiwan and several other countries, but its viral characteristics are underreported. METHODS Through Taiwan's National Virologic Surveillance, information regarding ~100,000 child respiratory samples (2002-2015) was linked to concurrent (0-6 days before the sampling date) outpatient records from the National Health Insurance databases, including ~15,000 HA-related and ~7000 HFMD-related samples. We assessed sample representation and NPEV positive rates, and estimated total numbers of EV-A71 and CV-A16. RESULTS There were more HA events (4.0 millions) than HFMD events (1.2 millions) in Taiwan. In every 1000 events with HFMD and HA, 6.0 and 4.1, respectively, respiratory samples were collected. The NPEV positive rate in HFMD-related samples was 48%, consistent across most sampling seasons, and predominantly EV-A71 or CV-A16 (74%). By comparison, the HA-related samples had a lower positive rate overall (43%), occasionally EV-A71 or CV-A16 (13%), and the positive rate depended strongly on HA incidence (P < 10). Compared with sampling HFMD alone, inclusion of HA-related information predicted an earlier onset of EV-A71 outbreak in 2011, and predicted 30% more EV-A71 cases. CONCLUSIONS This is the first representative report on viral characteristics of HA. Our findings confirm that HFMD monitoring is a reliable strategy, but there is a measurable additional benefit when HA is also monitored.
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Affiliation(s)
- TienYu Owen Yang
- From the Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Kuan-Ying Arthur Huang
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan
| | - Mei-Huei Chen
- Institute of Population Health Sciences, National Health Research Institutes, Miaoli
| | - Pau-Chung Chen
- Department of Public Health and Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health
- Department of Environmental and Occupational Medicine, National Taiwan University College of Medicine and Hospital
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15
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The Clinical and Epidemiological Study of Children with Hand, Foot, and Mouth Disease in Hunan, China from 2013 to 2017. Sci Rep 2019; 9:11662. [PMID: 31406192 PMCID: PMC6690890 DOI: 10.1038/s41598-019-48259-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 07/29/2019] [Indexed: 02/05/2023] Open
Abstract
Hand, foot, and mouth disease (HFMD) is endemic in the Pacific region, especially in mainland China. The case-fatality ratio of HFMD is increasing steadily. Knowledge of the changing epidemiology of HFMD in different regions is necessary for implementing appropriate intervention strategies. In this study, we describe the clinical and epidemiological characteristics of HFMD in Hunan Children’s Hospital between 2013 and 2017. A total of 7203 patients with HFMD were admitted, with complication and mortality rates of 35.62% and 0.78%, respectively. The total number of children with HFMD, proportion of severely ill children, and HFMD mortality rate were the highest in 2014. The number of cases caused by EV-A71 and CV-A16 decreased continuously, while the number of cases caused by ‘other enteroviruses’ increased yearly since 2014, suggesting that other enteric viruses will gradually replace EV-A71 and CV-A16 as the main pathogenic HFMD agents. Furthermore, EV-A71 and mixed infections accounted for the high case fatality rates in children with severe HFMD, among whom EV-A71 infection resulted in the highest complication and mortality rates; the mild form of the disease was dominated by ‘other enteroviruses’. In conclusion, the changing etiological pattern highlights the need to improve pathogen surveillance and vaccine strategies for HFMD control.
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16
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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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17
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Cai K, Wang Y, Guo Z, Yu H, Li H, Zhang L, Xu S, Zhang Q. Clinical characteristics and managements of severe hand, foot and mouth disease caused by enterovirus A71 and coxsackievirus A16 in Shanghai, China. BMC Infect Dis 2019; 19:285. [PMID: 30917800 PMCID: PMC6438032 DOI: 10.1186/s12879-019-3878-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 03/05/2019] [Indexed: 12/14/2022] Open
Abstract
Background Hand, foot and mouth disease (HFMD) is a transmissible infectious disease caused by human enteroviruses (EV). Here, we described features of children with severe HFMD caused by EV-A71 or coxsackievirus A16 (CV-A16) in Shanghai, China. Methods Severe EV-A71 or CV-A16 caused HFMD children admitted to the Xinhua Hospital from January 2014 and December 2016, were recruited retrospectively to the study. Symptoms and findings at the time of hospitalization, laboratory tests, treatments, length of stay and residual findings at discharge were systematically recorded and analyzed. Results Of 19,995 children visited clinic service with probable HFMD, 574 children (2.87%) were admitted, 234 children (40.76%) were confirmed with EV-A71 (90/574) or CV-A16 (144/574) disease. Most (91.02%) of the patients were under 5 years. Initial clinical symptoms of EV-A71 and CV-A16 cases were: fever > 39 °C in 81 (90%) and 119 (82.63%), vomiting in 31 (34.44%) and 28 (19.44%), myoclonic twitching in 19 (21.11%) and 11(7.64%), startle in 21 (23.33%) and 20 (13.69%), respectively. Serum levels of interleukin-1β (IL-1β), IL-2, IL-6, IL-8, interferon-γ (IFN-γ), tumor necrosis factor-α (TNF-α) were significantly upregulated in severe HFMD subjects. Forty-seven children (20.08%) treated with intravenous gamma globulin (IVIG) showed decreased duration of illness episodes. All children were discharged without complications. Conclusions EV-A71 and CV-A16 accounted 40.76% of admitted HFMD during 2014 to 2016 in Xinhua Hospital. IVIG appeared to be beneficial in shortening the duration of illness episodes of severe HFMD.
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Affiliation(s)
- Kang Cai
- Department of Pediatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Yizhong Wang
- Department of Infectious Diseases, Shanghai Children's Hospital, Shanghai Jiao Tong University, 355 Luding Road, Shanghai, 200062, China.
| | - Zhongqin Guo
- School of Public Health and Management, Ningxia Medical University, Yinchuan, China
| | - Huiju Yu
- Department of Pediatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Huajun Li
- Department of Pediatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Liya Zhang
- Department of Pediatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Shanshan Xu
- Department of Pediatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Qingli Zhang
- Department of Pediatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 1665 Kongjiang Road, Shanghai, 200092, China. .,Department of Pediatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Chongming Branch, Shanghai, China.
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18
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Li T, Wang H, Lu Y, Li Q, Chen C, Wang D, Li M, Li Y, Lu J, Chen Z, Ma Y, Liu W, Ma M, Wu D, Lu J, Yang Z. Willingness and influential factors of parents to vaccinate their children with novel inactivated enterovirus 71 vaccines in Guangzhou, China. Vaccine 2018; 36:3772-3778. [DOI: 10.1016/j.vaccine.2018.05.054] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 05/09/2018] [Accepted: 05/10/2018] [Indexed: 01/08/2023]
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19
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Gou F, Liu X, He J, Liu D, Cheng Y, Liu H, Yang X, Wei K, Zheng Y, Jiang X, Meng L, Hu W. Different responses of weather factors on hand, foot and mouth disease in three different climate areas of Gansu, China. BMC Infect Dis 2018; 18:15. [PMID: 29310596 PMCID: PMC5759838 DOI: 10.1186/s12879-017-2860-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Accepted: 11/26/2017] [Indexed: 01/25/2023] Open
Abstract
Background To determine the linear and non-linear interacting relationships between weather factors and hand, foot and mouth disease (HFMD) in children in Gansu, China, and gain further traction as an early warning signal based on weather variability for HFMD transmission. Method Weekly HFMD cases aged less than 15 and meteorological information from 2010 to 2014 in Jiuquan, Lanzhou and Tianshu, Gansu, China were collected. Generalized linear regression models (GLM) with Poisson link and classification and regression trees (CART) were employed to determine the combined and interactive relationship of weather factors and HFMD in both linear and non-linear ways. Results GLM suggested an increase in weekly HFMD of 5.9% [95% confidence interval (CI): 5.4%, 6.5%] in Tianshui, 2.8% [2.5%, 3.1%] in Lanzhou and 1.8% [1.4%, 2.2%] in Jiuquan in association with a 1 °C increase in average temperature, respectively. And 1% increase of relative humidity could increase weekly HFMD of 2.47% [2.23%, 2.71%] in Lanzhou and 1.11% [0.72%, 1.51%] in Tianshui. CART revealed that average temperature and relative humidity were the first two important determinants, and their threshold values for average temperature deceased from 20 °C of Jiuquan to 16 °C in Tianshui; and for relative humidity, threshold values increased from 38% of Jiuquan to 65% of Tianshui. Conclusion Average temperature was the primary weather factor in three areas, more sensitive in southeast Tianshui, compared with northwest Jiuquan; Relative humidity’s effect on HFMD showed a non-linear interacting relationship with average temperature.
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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
| | - Jian He
- Institute for Communicable Disease Control and Prevention, Gansu Center for Diseases Prevention and Control, Lanzhou, Gansu, China
| | - Dongpeng Liu
- 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
| | - Haixia Liu
- 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
| | - Kongfu Wei
- 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
| | - Lei Meng
- Institute for Communicable Disease Control and Prevention, Gansu Center for Diseases Prevention and Control, Lanzhou, Gansu, China.
| | - Wenbiao Hu
- School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
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Dang D, Zhang C, Zhang R, Wu W, Chen S, Ren J, Zhang P, Zhou G, Feng D, Sun T, Li Y, Liu Q, Li M, Xi Y, Jin Y, Duan G. Involvement of inducible nitric oxide synthase and mitochondrial dysfunction in the pathogenesis of enterovirus 71 infection. Oncotarget 2017; 8:81014-81026. [PMID: 29113363 PMCID: PMC5655258 DOI: 10.18632/oncotarget.21250] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2017] [Accepted: 08/28/2017] [Indexed: 01/10/2023] Open
Abstract
Enterovirus71 (EV71) is recognized as the main causative agent of severe hand, foot and mouth disease (HFMD). However, the pathogenesis of EV71 infection has not been well characterized. Clinical evidence indicated that inducible nitric oxide synthase (iNOS) induction in the lung of HFMD patients contributes to the severe symptoms of pulmonary edema. In the present study, we recruited 142 subjects including HFMD patients and controls, and serum level of nitric oxide (NO) was determined. Next, cellular and animal model were used to further investigate the roles of iNOS and mitochondria damage during EV71 infection. Serum NO level in HFMD patients with mild or severe symptoms was higher than that in controls, and there was a trend towards an increase in the serum NO level of severe cases relative to mild cases. EV71 infection caused apoptosis and increased levels of NO, iNOS, superoxide dismutase (SOD) activity and malondialdehyde (MDA), and degraded mitochondrial membrane potential (ΔΨm) in vitro. Pathological alterations of mitochondrial morphology were observed in vitro and in vivo. Furthermore, the expression of iNOS levels in target organs including brain, spinal cord, skeletal muscle, lung and heart were increased with the progression of the pathogenesis of EV71 infection in mice. Taken together, iNOS and mitochondrial damage participate in the pathogenesis of EV71 infection.
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Affiliation(s)
- Dejian Dang
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Chao Zhang
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Rongguang Zhang
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China.,Henan Collaborative Innovation Center of Molecular Diagnosis and Laboratory Medicine, Xinxiang, People's Republic of China
| | - Weidong Wu
- Henan Collaborative Innovation Center of Molecular Diagnosis and Laboratory Medicine, Xinxiang, People's Republic of China.,School of Public Health, Xinxiang Medical University, Xinxiang, People's Republic of China
| | - Shuaiyin Chen
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Jingchao Ren
- Henan Collaborative Innovation Center of Molecular Diagnosis and Laboratory Medicine, Xinxiang, People's Republic of China.,School of Public Health, Xinxiang Medical University, Xinxiang, People's Republic of China
| | - Peng Zhang
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Guangyuan Zhou
- School of Public Health, Xinxiang Medical University, Xinxiang, People's Republic of China
| | - Demin Feng
- The Third Affiliated Hospital of Zhengzhou University, Zhengzhou, People's Republic of China
| | - Tiantian Sun
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Ying Li
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Qiaoli Liu
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Mengchen Li
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Yuanlin Xi
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Yuefei Jin
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China
| | - Guangcai Duan
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, People's Republic of China.,Henan Collaborative Innovation Center of Molecular Diagnosis and Laboratory Medicine, Xinxiang, People's Republic of China
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Recombinant heat shock protein 78 enhances enterovirus 71 propagation in Vero cells and is induced in SK-N-SH cells during the infection. Arch Virol 2017; 162:1649-1660. [DOI: 10.1007/s00705-017-3287-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 02/04/2017] [Indexed: 12/23/2022]
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22
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Laboratory Surveillance of Polio and Other Enteroviruses in High-Risk Populations and Environmental Samples. Appl Environ Microbiol 2017; 83:AEM.02872-16. [PMID: 28039136 DOI: 10.1128/aem.02872-16] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 12/19/2016] [Indexed: 11/20/2022] Open
Abstract
In the context of poliomyelitis eradication, a reinforced supplementary laboratory surveillance of enteroviruses was implemented in Greece. Between 2008 and 2014, the Hellenic Polioviruses/Enteroviruses Reference Laboratory performed detailed supplementary surveillance of circulating enteroviruses among healthy individuals in high-risk population groups, among immigrants from countries in which poliovirus is endemic, and in environmental samples. In total, 722 stool samples and 179 sewage water samples were included in the study. No wild-type polioviruses were isolated during these 7 years of surveillance, although two imported vaccine polioviruses were detected. Enterovirus presence was recorded in 25.3 and 25.1% of stool and sewage water samples, respectively. Nonpolio enteroviruses isolated from stool samples belonged to species A, B, or C; coxsackievirus A24 was the most frequently identified serotype. Only enteroviruses of species B were identified in sewage water samples, including four serotypes of echoviruses and four serotypes of coxsackie B viruses. Phylogenetic analysis revealed close genetic relationships among virus isolates from sewage water samples and stool samples, which in most cases fell into the same cluster. To the best of our knowledge, this is the first study to compare enterovirus serotypes circulating in fecal specimens of healthy individuals and environmental samples, emphasizing the burden of enterovirus circulation in asymptomatic individuals at high risk. Given that Greece continues to receive a large number of short-term arrivals, students, migrants, and refugees from countries in which poliovirus is endemic, it is important to guarantee high-quality surveillance in order to maintain its polio-free status until global eradication is achieved.IMPORTANCE This article summarizes the results of supplementary poliovirus surveillance in Greece and the subsequent characterization of enteroviral circulation in human feces and the environment. The examination of stool samples from healthy refugees and other individuals in "high-risk" groups for poliovirus enables the identification of enterovirus cases and forms the basis for further investigation of the community-level risk of viral transmission. In addition, the examination of composite human fecal samples through environmental surveillance links poliovirus and nonpoliovirus isolates from unknown individuals to populations served by the sewage or wastewater system. Supplementary surveillance is necessary to comply with the prerequisites imposed by the World Health Organization for monitoring the emergence of vaccine-derived polioviruses, reemergence of wild polioviruses, or disappearance of all vaccine-related strains in order for countries such as Greece to maintain their polio-free status and contribute to global poliovirus eradication.
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