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Kim HS, Moon HJ, Choi JB, Han BK, Woo SD. Efficient Production of Enterovirus 71 (EV71) Virus-like Particles by Controlling Promoter Strength in Insect Cells. Viruses 2024; 16:834. [PMID: 38932128 PMCID: PMC11209064 DOI: 10.3390/v16060834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Revised: 05/19/2024] [Accepted: 05/22/2024] [Indexed: 06/28/2024] Open
Abstract
This study was conducted to efficiently produce virus-like particles (VLPs) of enterovirus 71 (EV71), a causative virus of hand, foot, and mouth disease (HFMD). The expression level of the P1 precursor, a structural protein of EV71, was modified to increase VLP production, and the optimal expression level and duration of the 3CD protein for P1 cleavage were determined. The expression level and duration of 3CD were controlled by the p10 promoter, which was weakened by repeated burst sequence (BS) applications, as well as the OpIE2 promoter, which was weakened by the insertion of random untranslated region sequences of various lengths. The cleavage and production efficiency of the P1 precursor were compared based on the expression time and level of 3CD, revealing that the p10-BS5 promoter with four repeated BSs was the most effective. When P1 and 3CD were expressed using the hyperexpression vector and the p10-BS5 promoter, high levels of structural protein production and normal HFMD-VLP formation were observed, respectively. This study suggests that the production efficiency of HFMD-VLPs can be significantly enhanced by increasing the expression of the P1 precursor and controlling the amount and duration of 3CD expression.
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Affiliation(s)
- Hyun-Soo Kim
- Department of Agricultural Biology, College of Agriculture, Life & Environment Science, Chungbuk National University, Cheongju 28644, Republic of Korea; (H.-S.K.); (H.-J.M.)
| | - Hyuk-Jin Moon
- Department of Agricultural Biology, College of Agriculture, Life & Environment Science, Chungbuk National University, Cheongju 28644, Republic of Korea; (H.-S.K.); (H.-J.M.)
| | - Jae-Bang Choi
- Optipharm Inc., Osong 28158, Republic of Korea; (J.-B.C.); (B.-K.H.)
| | - Beom-Ku Han
- Optipharm Inc., Osong 28158, Republic of Korea; (J.-B.C.); (B.-K.H.)
| | - Soo Dong Woo
- Department of Agricultural Biology, College of Agriculture, Life & Environment Science, Chungbuk National University, Cheongju 28644, Republic of Korea; (H.-S.K.); (H.-J.M.)
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Kordi R, Chang AJ, Hicar MD. Seasonal Testing, Results, and Effect of the Pandemic on Coxsackievirus Serum Studies. Microorganisms 2024; 12:367. [PMID: 38399771 PMCID: PMC10893248 DOI: 10.3390/microorganisms12020367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/25/2024] Open
Abstract
Coxsackieviruses (CVs) are common causes of infections and can be life-threatening. Unfortunately, rigorous studies guiding the clinician in interpreting CV serum antibody titer testing is lacking. To explore the epidemiology of circulating CVs and the serological test utility in aiding diagnosis of CV infections in our community, we obtained results of CV immunologic diagnostic tests between 2018 and 2022 from a regional healthcare database. For CV type A, rare individuals had positive CF (complement fixation) tests whereas all 16 individuals with IFA testing showed at least one positive serotype. For CV type B CF testing, 52.2% of 222 patients had at least one serotype positive, with B5 being most common and also the most common with higher titers (14.8% with ≥1:32). We found a significant reduction in seropositivity rate during the pandemic in 2020 compared to 2018, which continued through 2022 (OR: 0.2, 95% CI: 0.08-0.49, p-value < 0.001). During the pandemic, the seasonal pattern of positive tests varied from the pre-pandemic pattern. Testing for CVs was increased after the first year of the pandemic. Overall, the variability by month and seasonal change in our data support that CF testing can be used to identify recent CVB infection.
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Affiliation(s)
- Ramesh Kordi
- Department of Pediatric Infectious Diseases, State University of New York at Buffalo, Buffalo, NY 14203, USA;
| | - Arthur J. Chang
- Division of Pediatric Infectious Diseases, University of Nebraska Medical Center, Omaha, NE 68198, USA;
| | - Mark D. Hicar
- Department of Pediatric Infectious Diseases, State University of New York at Buffalo, Buffalo, NY 14203, USA;
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Bao NT, Luan VT, Liem BT, Nhu VHT, Viet DC, Tung TH, Burza S, Thanh NT. Extracorporeal life support and continuous renal replacement therapy in a patient with Enterovirus A71 associated cardiopulmonary failure: A case report. Medicine (Baltimore) 2024; 103:e36797. [PMID: 38181280 PMCID: PMC10766259 DOI: 10.1097/md.0000000000036797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 12/06/2023] [Indexed: 01/07/2024] Open
Abstract
RATIONALE Hand-foot-mouth disease (HFMD) caused by Enterovirus A71, complicated by cardiopulmonary failure, is associated with a high mortality rate despite intensive treatment. To date, there is a paucity of clinical management data, regarding the use of extracorporeal life support (VA-ECMO) for Enterovirus-A71 associated cardiopulmonary failure reported. PATIENT CONCERNS The patient in this study presented with severe HFMD complicated by cardiopulmonary failure, polymorphic ventricular tachycardia, and cardiac arrest. DIAGNOSES Clinical presentations, laboratory data, and polymerase chain reaction (PCR) results from rectal swabs were used to confirm the diagnosis of severe HFMD caused by Enterovirus A71. INTERVENTIONS The patient was managed with chest compression and an automatic external defibrillator, mechanical ventilation, intravenous immunoglobulin (IVIG), continuous renal replacement therapy (CRRT) and inotrope (milrinone). The patient did not respond to these interventions and subsequently required further management with VA-ECMO. OUTCOMES The patient achieved a favorable outcomes. LESSONS Our study highlights that extracorporeal membrane oxygenation and CRRT can enhance the survival outcomes of patients with severe HFMD with cardiopulmonary failure complications. Furthermore, we propose specific indications for the initiation of VA-ECMO.
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Affiliation(s)
- Nguyen Trung Bao
- Department of Infectious Diseases, Children Hospital No.2, Ho Chi Minh City, Vietnam
| | - Vo Thanh Luan
- Department of Infectious Diseases, Children Hospital No.2, Ho Chi Minh City, Vietnam
| | - Bui Thanh Liem
- Department of Infectious Diseases, Children Hospital No.2, Ho Chi Minh City, Vietnam
- Faculty of Pediatrics, University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | | | - Do Chau Viet
- Department of Infectious Diseases, Children Hospital No.2, Ho Chi Minh City, Vietnam
| | - Trinh Huu Tung
- Department of Infectious Diseases, Children Hospital No.2, Ho Chi Minh City, Vietnam
| | - Sakib Burza
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Health in Harmony, London, United Kingdom
| | - Nguyen Tat Thanh
- Department of Infectious Diseases, Children Hospital No.2, Ho Chi Minh City, Vietnam
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- Woolcock Institute of Medical Research, Ho Chi Minh City, Vietnam
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Sun Y, Zhou J, Nie W, Tian D, Ye Q. Study on the epidemiological characteristics of enterovirus among pediatric patients in Hangzhou, China: A comparison between the pre-COVID-19, COVID-19 pandemic, and post-COVID-19 periods. J Med Virol 2024; 96:e29412. [PMID: 38258311 DOI: 10.1002/jmv.29412] [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: 08/27/2023] [Revised: 12/19/2023] [Accepted: 01/09/2024] [Indexed: 01/24/2024]
Abstract
Nonpharmaceutical interventions (NPIs) for coronavirus disease 2019 (COVID-19) not only reduce the prevalence of this disease among children but also influence the transmission of other viruses. This retrospective study investigated the impact of NPIs on human enterovirus (HEV) infection in children diagnosed with hand, foot, and mouth disease (HFMD) or herpangina (HA) in Hangzhou, China. We collected and analyzed the laboratory results and clinical data of children diagnosed with HFMD or HA during the following periods: pre-COVID-19 (January 2019 to December 2019), the COVID-19 pandemic (January 2020 to December 2022), and post-COVID-19 (January to December 2023). A total of 41 742 specimens that met the inclusion criteria were obtained, of which 1998 (4.79%) tested positive for enterovirus. In comparison to those in the pre-COVID-19 period, which had 695 (5.63%) HEV-positive specimens, the numbers dramatically decreased to 69 (1.19%), 398 (5.12%), and 112 (1.58%) in 2020, 2021, and 2022, respectively, but significantly increased to 724 (8.27%) in 2023. Seasonal peaks of infections occurred in May, June, July, and August each year, with the total detection rate ranging from 2019 to 2023 being 9.41% in May, 22.47% in June, 28.23% in July, and 12.16% in August, respectively. The difference in the detection rates of HEV infection between males and females was statistically significant (p < 0.005), with 5.11% (1221/23 898) of males and 4.35% (777/17 844) of females testing positive, resulting in a male-to-female positive ratio of 1.57:1. Among the age groups, 11.25% (378/3360) of the children aged 3-5 years had the highest detection rate, which steadily decreased with increasing or decreasing age. The detection of HEV indicated that >95% of the viruses were other types than the previously commonly reported enterovirus 71 (EV-A71) and coxsackievirus A16 (CV-A16). In conclusion, NPIs for COVID-19 may be effective at reducing the transmission of HEV. However, with the relaxation of NPIs, the detection rate of HEVs increased slowly to a certain extent. Active awareness and surveillance of the epidemiological characteristics of HEV are essential for preventing, controlling, and managing the development of HFMD and HA, as well as contributing to the development of a multivalent HFMD vaccine.
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Affiliation(s)
- Yanhong Sun
- Department of Clinical Laboratory, National Clinical Research Center for Child Health, National Children's Regional Medical Center, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jianming Zhou
- Department of Clinical Laboratory, National Clinical Research Center for Child Health, National Children's Regional Medical Center, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Wenjian Nie
- Department of Clinical Laboratory, National Clinical Research Center for Child Health, National Children's Regional Medical Center, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Dandan Tian
- Department of Clinical Laboratory, National Clinical Research Center for Child Health, National Children's Regional Medical Center, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Qing Ye
- Department of Clinical Laboratory, National Clinical Research Center for Child Health, National Children's Regional Medical Center, The Children's Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Guo Z, Wang Y, Li Y, Zhou L. Impact of meteorological factors on the incidence of hand-foot-mouth disease in Yangzhou from 2017 to 2022: a time series study. Front Public Health 2023; 11:1278516. [PMID: 37881347 PMCID: PMC10597706 DOI: 10.3389/fpubh.2023.1278516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 09/26/2023] [Indexed: 10/27/2023] Open
Abstract
Background Hand, foot, and mouth disease (HFMD) is a significant public health issue in China, and numerous studies have indicated a close association between HFMD incidence and meteorological factors. This study aims to investigate the relationship between meteorological factors and HFMD in Yangzhou City, Jiangsu Province, China. Methods HFMD case reports and meteorological data from Yangzhou City between 2017 and 2022 were extracted from the National Notifiable Infectious Disease Surveillance System and the Meteorological Data Sharing Service System, respectively. A generalized additive model (GAM) was employed to assess the exposure-response relationship between meteorological factors and HFMD. Subsequently, a distributed lag nonlinear model (DLNM) was used to explore the exposure-lag-effect of meteorological factors on HFMD. Results HFMD in Yangzhou City exhibits obvious seasonality and periodicity. There is an inverted "U" shaped relationship between average temperature and the risk of HFMD, with the maximum lag effect observed at a temperature of 25°C with lag 0 day (RR = 2.07, 95% CI: 1.74-2.47). As the duration of sunshine and relative humidity increase, the risk of HFMD continuously rises, with the maximum lag effect observed at a sunshine duration of 12.4 h with a lag of 14 days (RR = 2.10, 95% CI: 1.17-3.77), and a relative humidity of 28% with a lag of 14 days (RR = 1.21, 95% CI: 1.01-1.64). There is a "U" shaped relationship between average atmospheric pressure and the risk of HFMD, with the maximum effect observed at an atmospheric pressure of 989 hPa with no lag (RR = 1.45, 95% CI: 1.25-1.69). As precipitation increases, the risk of HFMD decreases, with the maximum effect observed at a precipitation of 151 mm with a lag of 14 days (RR = 1.45, 95% CI: 1.19-2.53). Conclusion Meteorological factors including average temperature, average atmospheric pressure, relative humidity, precipitation, and sunshine duration significantly influenced the risk of HFMD in Yangzhou City. Effective prevention measures for HFMD should be implemented, taking into account the local climate conditions.
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Affiliation(s)
- Zaijin Guo
- Clinical Medical College, Yangzhou University, Yangzhou, China
- Northern Jiangsu People’s Hospital, Yangzhou, China
| | - Yin Wang
- Department of Acute Infectious Disease Control and Prevention, Yangzhou Centre for Disease Control and Prevention, Yangzhou, China
| | - Yunshui Li
- Clinical Medical College, Yangzhou University, Yangzhou, China
- Northern Jiangsu People’s Hospital, Yangzhou, China
| | - Luojing Zhou
- Clinical Medical College, Yangzhou University, Yangzhou, China
- Northern Jiangsu People’s Hospital, Yangzhou, China
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Zhu H, Chen S, Liang R, Feng Y, Joldosh A, Xie Z, Chen G, Li L, Chen K, Fang Y, Ou J. Study of the influence of meteorological factors on HFMD and prediction based on the LSTM algorithm in Fuzhou, China. BMC Infect Dis 2023; 23:299. [PMID: 37147566 PMCID: PMC10161995 DOI: 10.1186/s12879-023-08184-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 03/20/2023] [Indexed: 05/07/2023] Open
Abstract
BACKGROUND This study adopted complete meteorological indicators, including eight items, to explore their impact on hand, foot, and mouth disease (HFMD) in Fuzhou, and predict the incidence of HFMD through the long short-term memory (LSTM) neural network algorithm of artificial intelligence. METHOD A distributed lag nonlinear model (DLNM) was used to analyse the influence of meteorological factors on HFMD in Fuzhou from 2010 to 2021. Then, the numbers of HFMD cases in 2019, 2020 and 2021 were predicted using the LSTM model through multifactor single-step and multistep rolling methods. The root mean square error (RMSE), mean absolute error (MAE), mean absolute percentage error (MAPE) and symmetric mean absolute percentage error (SMAPE) were used to evaluate the accuracy of the model predictions. RESULTS Overall, the effect of daily precipitation on HFMD was not significant. Low (4 hPa) and high (≥ 21 hPa) daily air pressure difference (PRSD) and low (< 7 °C) and high (> 12 °C) daily air temperature difference (TEMD) were risk factors for HFMD. The RMSE, MAE, MAPE and SMAPE of using the weekly multifactor data to predict the cases of HFMD on the following day, from 2019 to 2021, were lower than those of using the daily multifactor data to predict the cases of HFMD on the following day. In particular, the RMSE, MAE, MAPE and SMAPE of using weekly multifactor data to predict the following week's daily average cases of HFMD were much lower, and similar results were also found in urban and rural areas, which indicating that this approach was more accurate. CONCLUSION This study's LSTM models combined with meteorological factors (excluding PRE) can be used to accurately predict HFMD in Fuzhou, especially the method of predicting the daily average cases of HFMD in the following week using weekly multifactor data.
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Affiliation(s)
- Hansong Zhu
- Fujian Provincial Center for Disease Control and Prevention, Fujian Provincial Key Laboratory of Zoonosis Research, The Practice Base On the School of Public Health Fujian Medical University, Fuzhou, Fujian, 350012, China
| | - Si Chen
- Fujian Climate Center, Fuzhou, 350028, Fujian, China
| | - Rui Liang
- Department of Nutrition, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, Henan, China
| | - Yulin Feng
- School of Public Health, Fujian Medical University, Fuzhou, 350108, Fujian, China
| | - Aynur Joldosh
- School of Public Health, Xiamen University, Xiamen, 361005, Fujian, China
| | - Zhonghang Xie
- Fujian Provincial Center for Disease Control and Prevention, Fujian Provincial Key Laboratory of Zoonosis Research, The Practice Base On the School of Public Health Fujian Medical University, Fuzhou, Fujian, 350012, China
| | - Guangmin Chen
- Fujian Provincial Center for Disease Control and Prevention, Fujian Provincial Key Laboratory of Zoonosis Research, The Practice Base On the School of Public Health Fujian Medical University, Fuzhou, Fujian, 350012, China
| | - Lingfang Li
- Fujian Provincial Center for Disease Control and Prevention, Fujian Provincial Key Laboratory of Zoonosis Research, The Practice Base On the School of Public Health Fujian Medical University, Fuzhou, Fujian, 350012, China
| | - Kaizhi Chen
- College of Computer and Data Science, Fuzhou University, Fuzhou, 350108, Fujian, China.
| | - Yuanyuan Fang
- Department of Pediatric Surgery, Fujian Children's Hospital, Fuzhou, 350001, Fujian, China.
| | - Jianming Ou
- Fujian Provincial Center for Disease Control and Prevention, Fujian Provincial Key Laboratory of Zoonosis Research, The Practice Base On the School of Public Health Fujian Medical University, Fuzhou, Fujian, 350012, China.
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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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Yan R, He J, Liu G, Zhong J, Xu J, Zheng K, Ren Z, He Z, Zhu Q. Drug Repositioning for Hand, Foot, and Mouth Disease. Viruses 2022; 15:75. [PMID: 36680115 PMCID: PMC9861398 DOI: 10.3390/v15010075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/11/2022] [Accepted: 12/24/2022] [Indexed: 12/29/2022] Open
Abstract
Hand, foot, and mouth disease (HFMD) is a highly contagious disease in children caused by a group of enteroviruses. HFMD currently presents a major threat to infants and young children because of a lack of antiviral drugs in clinical practice. Drug repositioning is an attractive drug discovery strategy aimed at identifying and developing new drugs for diseases. Notably, repositioning of well-characterized therapeutics, including either approved or investigational drugs, is becoming a potential strategy to identify new treatments for virus infections. Various types of drugs, including antibacterial, cardiovascular, and anticancer agents, have been studied in relation to their therapeutic potential to treat HFMD. In this review, we summarize the major outbreaks of HFMD and the progress in drug repositioning to treat this disease. We also discuss the structural features and mode of action of these repositioned drugs and highlight the opportunities and challenges of drug repositioning for HFMD.
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Affiliation(s)
- Ran Yan
- School of Pharmaceutical Sciences, Shenzhen University, Shenzhen 518060, China
- College of Pharmacy, Shenzhen Technology University, Shenzhen 518118, China
| | - Jiahao He
- School of Pharmaceutical Sciences, Shenzhen University, Shenzhen 518060, China
| | - Ge Liu
- College of Pharmacy, Shenzhen Technology University, Shenzhen 518118, China
| | - Jianfeng Zhong
- School of Pharmaceutical Sciences, Shenzhen University, Shenzhen 518060, China
| | - Jiapeng Xu
- College of Pharmacy, Shenzhen Technology University, Shenzhen 518118, China
| | - Kai Zheng
- School of Pharmaceutical Sciences, Shenzhen University, Shenzhen 518060, China
| | - Zhe Ren
- Institute of Biomedicine, College of Life Science and Technology, Jinan University, Guangzhou 510632, China
- National Engineering Research Center of Genetic Medicine, Guangzhou 510632, China
| | - Zhendan He
- School of Pharmaceutical Sciences, Shenzhen University, Shenzhen 518060, China
| | - Qinchang Zhu
- College of Pharmacy, Shenzhen Technology University, Shenzhen 518118, China
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Guo J, Cao Z, Liu H, Xu J, Zhao L, Gao L, Zuo Z, Song Y, Han Z, Zhang Y, Wang J. Epidemiology of hand, foot, and mouth disease and the genetic characteristics of Coxsackievirus A16 in Taiyuan, Shanxi, China from 2010 to 2021. Front Cell Infect Microbiol 2022; 12:1040414. [PMID: 36439232 PMCID: PMC9692002 DOI: 10.3389/fcimb.2022.1040414] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 10/26/2022] [Indexed: 11/13/2022] Open
Abstract
Hand, foot, and mouth disease (HFMD) is a common childhood infectious disease caused by human enteroviruses (EV). This study aimed to describe the epidemiological features of HFMD and the genetic characteristics of Coxsackievirus A16 (CVA16) in Taiyuan, Shanxi, China, from 2010 to 2021. Descriptive epidemiological methods were used to analyze the time and population distribution of HFMD and the genetic characteristics of CVA16. Except being affected by the COVID-19 epidemic in 2020, HFMD epidemics were sporadic from January to March each year, and began to increase in April, with a major epidemic peak from May to August, which declined in September, followed by a secondary peak from October to December. The prevalence of EV infection was the highest in children aged one to five years (84.42%), whereas its incidence was very low in children under one year of age (5.48%). Enterovirus nucleic acid was detected by real-time reverse transcription polymerase chain reaction in 6641 clinical specimens collected from patients with HFMD from 2010 to 2021, and 4236 EV-positive specimens were detected, including 988 enterovirus A71 (EV-A71), 1488 CVA16, and 1760 other enteroviruses. CVA16 remains prevalent and has co-circulated with other EVs in Taiyuan from 2010 to 2021. A phylogenetic tree constructed based on the VP1 region showed that all CVA16 strains belonged to two different clades of the B1 genotype, B1a and B1b. They showed a nucleotide similarity of 86.5-100%, and an amino acid similarity of 96.9-100%. Overall, these findings add to the global genetic resources of CVA16, demonstrate the epidemiological characteristics of HFMD as well as the genetic features of CVA16 in Taiyuan City during 2010-2021, and provide supporting evidence for the prevention and control of HFMD.
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Affiliation(s)
- Jiane Guo
- School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China,Department of Microbiology Test, Taiyuan Center for Disease Control and Prevention, Taiyuan, Shanxi, China
| | - Zijun Cao
- School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Hongyan Liu
- School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jihong Xu
- Department of Microbiology Test, Taiyuan Center for Disease Control and Prevention, Taiyuan, Shanxi, China
| | - Lifeng Zhao
- Department of Microbiology Test, Taiyuan Center for Disease Control and Prevention, Taiyuan, Shanxi, China
| | - Li Gao
- Department of Microbiology Test, Taiyuan Center for Disease Control and Prevention, Taiyuan, Shanxi, China
| | - Zhihong Zuo
- Department of Microbiology Test, Taiyuan Center for Disease Control and Prevention, Taiyuan, Shanxi, China
| | - Yang Song
- World Health Organization (WHO) Western Pacific Region Office (WPRO) Regional Polio Reference Laboratory, National Health Commission Key Laboratory of Biosafety, National Health Commission Key Laboratory of Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhenzhi Han
- World Health Organization (WHO) Western Pacific Region Office (WPRO) Regional Polio Reference Laboratory, National Health Commission Key Laboratory of Biosafety, National Health Commission Key Laboratory of Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yong Zhang
- World Health Organization (WHO) Western Pacific Region Office (WPRO) Regional Polio Reference Laboratory, National Health Commission Key Laboratory of Biosafety, National Health Commission Key Laboratory of Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China,Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, China,*Correspondence: Jitao Wang, ; Yong Zhang,
| | - Jitao Wang
- School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China,Department of Microbiology Test, Taiyuan Center for Disease Control and Prevention, Taiyuan, Shanxi, China,*Correspondence: Jitao Wang, ; Yong Zhang,
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10
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Leung AKC, Lam JM, Barankin B, Leong KF, Hon KL. Hand, Foot, and Mouth Disease: A Narrative Review. RECENT ADVANCES IN INFLAMMATION & ALLERGY DRUG DISCOVERY 2022; 16:77-95. [PMID: 36284392 DOI: 10.2174/1570180820666221024095837] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 09/08/2022] [Accepted: 09/19/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Hand, foot, and mouth disease is a common viral disease in childhood. Because the disease has the potential to reach epidemic levels and mortality is high in some countries, early recognition of this disease is of paramount importance. OBJECTIVE This purpose of this article is to familiarize pediatricians with the clinical manifestations and management of hand, foot, and mouth disease. METHODS A search was conducted in February 2022 in PubMed Clinical Queries using the key term "hand, foot, and mouth disease". The search strategy included all clinical trials, observational studies, and reviews published within the past 10 years. Only papers published in English were included in this review. RESULTS Hand, foot, and mouth disease is characterized by a painful oral enanthem and asymptomatic exanthem on the palms and soles. Children younger than 5 years are most commonly affected. Hand, foot, and mouth disease caused by enterovirus A71 is more severe and has a higher rate of complications than that attributed to other viruses such as coxsackievirus A16. Circulatory failure secondary to myocardial impairment and neurogenic pulmonary edema secondary to brainstem damage are the main causes of death. Fortunately, the disease is usually benign and resolves in 7 to10 days without sequelae. Given the self-limited nature of most cases, treatment is mainly symptomatic and supportive. Intravenous immunoglobulin should be considered for the treatment of severe/complicated hand, foot, and mouth disease and has been recommended by several national and international guideline committees. Currently, there are no specific antiviral agents approved for the treatment of the disease. Drugs such as ribavirin, suramin, mulberroside C, aminothiazole analogs, and sertraline have emerged as potential candidates for the treatment of hand, foot, and mouth disease. Vaccination of susceptible individuals in high-risk areas and good personal hygiene are important preventative measures to combat the disease. CONCLUSION Familiarity of the disease including its atypical manifestations is crucial so that a correct diagnosis can be made, and appropriate treatment initiated. A timely diagnosis can help avoid contact with the affected individual and decrease the risk of an outbreak.
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Affiliation(s)
- Alexander K C Leung
- Department of Paediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Joseph M Lam
- Department of Pediatrics and Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Kin Fon Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | - Kam Lun Hon
- Department of Paediatrics, Hong Kong Institute of Integrative Medicine, and the Jockey Club School of Public Health and Primary Care, The Chinese University Hong Kong, Hong Kong
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11
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Zhou Y, Zhou J, Yang J, Qiu Q, Wang L, Yang J, Li Y, Liang L, Cui P, Cheng Y, Zheng W, Shi H, Gong H, Wang K, Zhou C, Chu JJH, Yu H. Comparison of Neutralizing Antibody Response Kinetics in Patients with Hand, Foot, and Mouth Disease Caused by Coxsackievirus A16 or Enterovirus A71: A Longitudinal Cohort Study of Chinese Children, 2017-2019. JOURNAL OF IMMUNOLOGY (BALTIMORE, MD. : 1950) 2022; 209:280-287. [PMID: 35777850 DOI: 10.4049/jimmunol.2200143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
Hand, foot, and mouth disease (HFMD), which is mainly caused by coxsackievirus A16 (CVA16) or enterovirus A71 (EV-A71), poses a serious threat to children's health. However, the long-term dynamics of the neutralizing Ab (NAb) response and ideal paired-serum sampling time for serological diagnosis of CVA16-infected HFMD patients were unclear. In this study, 336 CVA16 and 253 EV-A71 PCR-positive HFMD inpatients were enrolled and provided 452 and 495 sera, respectively, for NAb detection. Random-intercept modeling with B-spline was conducted to characterize NAb response kinetics. The NAb titer of CVA16 infection patients was estimated to increase from negative (2.1, 95% confidence interval [CI]: 1.4-3.3) on the day of onset to a peak of 304.8 (95% CI: 233.4-398.3) on day 21 and then remained >64 until 26 mo after onset. However, the NAb response level of EV-A71-infected HFMD patients was much higher than that of CVA16-infected HFMD patients throughout. The geometric mean titer was significantly higher in severe EV-A71-infected patients than in mild patients, with a 2.0-fold (95% CI: 1.4-3.2) increase. When a 4-fold rise in titer was used as the criterion for serological diagnosis of CVA16 and EV-A71 infection, acute-phase serum needs to be collected at 0-5 d, and the corresponding convalescent serum should be respectively collected at 17.4 (95% CI: 9.6-27.4) and 24.4 d (95% CI: 15.3-38.3) after onset, respectively. In conclusion, both CVA16 and EV-A71 infection induce a persistent humoral immune response but have different NAb response levels and paired-serum sampling times for serological diagnosis. Clinical severity can affect the anti-EV-A71 NAb response.
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Affiliation(s)
- Yonghong Zhou
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Jiaxin Zhou
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Jianli Yang
- Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou, China
| | - Qi Qiu
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Lili Wang
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Junmei Yang
- Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou, China
| | - Yu Li
- Division of Infectious Disease, Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lu Liang
- West China School of Public Health, Sichuan University, Sichuan, China; and
| | - Peng Cui
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Yibing Cheng
- Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou, China
| | - Wen Zheng
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Huilin Shi
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Hui Gong
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Kai Wang
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Chongchen Zhou
- Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou, China
| | - Justin Jang Hann Chu
- Laboratory of Molecular RNA Virology and Antiviral Strategies, Department of Microbiology and Immunology and Infectious Disease Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Hongjie Yu
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China;
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12
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Yi Z, Pei S, Suo W, Wang X, Huang Z, Yi A, Wang B, He Z, Wang R, Li Y, Fan W, Huang X. Epidemiological characteristics, routine laboratory diagnosis, clinical signs and risk factors for hand, -foot -and -mouth disease: A systematic review and meta-analysis. PLoS One 2022; 17:e0267716. [PMID: 35482791 PMCID: PMC9049560 DOI: 10.1371/journal.pone.0267716] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 04/13/2022] [Indexed: 01/18/2023] Open
Abstract
Background For the past few years, only a few monovalent EV71 vaccines have been developed, while other enterovirus vaccines are in short supply. We conducted a quantitative meta-analysis to explore the epidemiological characteristics, routine laboratory diagnosis, clinical signs and risk factors for hand, foot and mouth disease (HFMD). Methods PubMed, Embase and the Web of Science were searched for eligible reports published before April 16, 2021, with no publication time or language restrictions. The primary outcome was the odds ratio of the epidemiological characteristics, routine laboratory diagnosis, and clinical signs associated with HFMD severity and death. Results After screening 10522 records, we included 32 articles comprising 781903 cases of hand, foot and mouth disease. Patients with severe illness developed some clinical signs (hypersomnia (OR = 21.97, 95% CI: 4.13 to 116.74), convulsion (OR = 16.18, 95% CI: 5.30 to 49.39), limb shaking (OR = 47.96, 95% CI: 15.17 to 151.67), and breathlessness (OR = 7.48, 95% CI: 1.90 to 29.40)) and had some changes in laboratory parameters (interleukin-6 levels standardized mean difference (SMD) = 1.57, 95%CI: 0.55 to 2.60), an increased neutrophils ratio (SMD = 0.55, 95%CI: 0.17 to 0.93), cluster of differentiation 4 (CD4+) (SMD = -1.38, 95%CI: -2.33 to -0.43) and a reduced lymphocytes ratio (SMD = -0.48, 95%CI: -0.93 to -0.33)) compared with patients with mild illness. The risk factors for death included cyanosis (OR = 5.82, 95% CI: 2.29 to 14.81), a fast heart rate (OR = 3.22, 95% CI: 1.65 to 6.30), vomiting (OR = 2.70, 95% CI: 1.33 to 5.49) and an increased WBC count (SMD = 0.60, 95% CI: 0.27 to 0.93). Conclusions China has the highest incidence of HFMD. Our meta-analyses revealed important risk factors that are associated with the severity and mortality of HFMD.
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Affiliation(s)
- Zhijie Yi
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Shujun Pei
- College of Public Health, Xinxiang Medical University, Xinxiang, China
| | - Wenshuai Suo
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Xiaoyang Wang
- College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Zengyuan Huang
- Fifth Clinical Medical College of Henan University of Chinese Medicine, Zhengzhou, China
| | - Aihua Yi
- First Affiliated Hospital of Shaoyang University, Shaoyang, China
| | - Bohao Wang
- Quality Control Department of Henan Children’s Hospital, Zhengzhou, China
| | - Zhiquan He
- Henan Province Center for Disease Control and Prevention, Zhengzhou, China
| | - Ruolin Wang
- Henan Province Center for Disease Control and Prevention, Zhengzhou, China
| | - Yi Li
- Henan Province Center for Disease Control and Prevention, Zhengzhou, China
| | - Wei Fan
- Henan Province Center for Disease Control and Prevention, Zhengzhou, China
| | - Xueyong Huang
- College of Public Health, Zhengzhou University, Zhengzhou, China
- * E-mail:
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13
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Wu Z, Zhu S, Qian J, Hu Y, Ji W, Li D, Zhu P, Liang R, Jin Y. Analysis of miRNAs Involved in Mouse Heart Injury Upon Coxsackievirus A2 Infection. Front Cell Infect Microbiol 2022; 12:765445. [PMID: 35155276 PMCID: PMC8831793 DOI: 10.3389/fcimb.2022.765445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 01/03/2022] [Indexed: 12/03/2022] Open
Abstract
Coxsackievirus A2 (CVA2) has recently been constantly detected, and is associated with viral myocarditis in children. Our previous study demonstrated that CVA2 led to heart damage in a neonatal murine model. However, the molecular mechanism of heart injury caused by CVA2 remains largely unknown. Emerging evidence suggests the significant functions of miRNAs in Coxsackievirus infection. To investigate potential miRNAs involved in heart injury caused by CVA2, our study, for the first time, conducted a RNA-seq in vivo employing infected mice hearts. In total, 87, 101 and 76 differentially expressed miRNAs were identified at 3 days post infection (dpi), 7 dpi and 7 dpi vs 3 dpi. Importantly, above 3 comparison strategies shared 34 differentially expressed miRNAs. These results were confirmed by quantitative PCR (qPCR). Next, we did GO, KEGG, and miRNA-mRNA integrated analysis of differential miRNAs. The dual-luciferase reporter assay confirmed the miRNA-mRNA pairs. To further confirm the above enriched pathways and processes, we did Western blotting and immunofluorescence staining. Our results suggest that inflammatory responses, T cell activation, apoptosis, autophagy, antiviral immunity, NK cell infiltration, and the disruption of tight junctions are involved in the pathogenesis of heart injury caused by CVA2. The dysregulated miRNAs and pathways recognized in the current study can improve the understanding of the intricate interactions between CVA2 and the heart injury, opening a novel avenue for the future study of CVA2 pathogenesis.
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Affiliation(s)
- Zhaoke Wu
- Department of Gerontology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shenshen Zhu
- Department of Gerontology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Juanfeng Qian
- Department of Gerontology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yanmin Hu
- Department of Gerontology, The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Wangquan Ji
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Dong Li
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Peiyu Zhu
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Ruonan Liang
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yuefei Jin
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
- *Correspondence: Yuefei Jin,
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14
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Ji H, Fan H, Ai J, Shi C, Bi J, Chen YH, Lu XP, Chen QH, Tian JM, Bao CJ, Zhang XF, Jin Y. Neurocognitive Deficits and Sequelae Following Severe hand, foot, and mouth disease from 2009 to 2017, in JiangSu Province, China: A Long-Term Follow-Up Study. Int J Infect Dis 2021; 115:245-255. [PMID: 34910955 DOI: 10.1016/j.ijid.2021.11.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND To evaluate the long-term sequela and cognitive profile resulting from severe hand, foot and mouth disease (HFMD) with central nervous system (CNS) involvement. METHODS Two-hundred-and-ninety-four HFMD cases were included in a retrospective follow-up study. Physical examination were conducted. The Chinese Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition (WPPSI-IV) was used to assess intelligence. RESULTS Fifty-eight mild HFMD cases and 99 severe HFMD cases with mild CNS involvement did not present any neurological sequelae. While the sequelae incidence of severe HFMD with more severe CNS complications were 50.0%. The proportion of full scale intelligence quotient (FSIQ) impairment was 45.0%. In the 2:6-3:11 age group, severe HFMD with more severe CNS complications and lower maternal education level were risk factors for verbal comprehension disorder. Urban-rural residence and lower paternal education level were risk factors for FSIQ disorder. Furthermore, in the 4:0-6:11 age group, severe HFMD with more severe CNS complication was a risk factor for visual spatial disorder and fluid reasoning disorder. Lower paternal education level was a risk factor for FSIQ disorder. CONCLUSION Early assessment and intervention among severe HFMD patients with more severe CNS involvement at a very young age will prove beneficial for their future performance.
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Affiliation(s)
- Hong Ji
- Department of Acute Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009; Medical School of Nanjing University, Nanjing 210093, China
| | - Huan Fan
- Department of Acute Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009
| | - Jing Ai
- Department of Acute Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009
| | - Chao Shi
- Wuxi Municipal Center for Disease Control and Prevention, Wuxi 214023, China
| | - Jun Bi
- Xuzhou Municipal Center for Disease Control and Prevention, Xuzhou 221006, China
| | - Yin-Hua Chen
- Children's Hospital of Nanjing Medical University, Nanjing 210008, China
| | - Xiao-Peng Lu
- Children's Hospital of Nanjing Medical University, Nanjing 210008, China
| | - Qin-Hui Chen
- Children's Hospital of Soochow University, Nanjing 211166, China
| | - Jian-Mei Tian
- Children's Hospital of Soochow University, Nanjing 211166, China
| | - Chang-Jun Bao
- Department of Acute Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009
| | - Xue-Feng Zhang
- Department of Acute Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009.
| | - Yu Jin
- Medical School of Nanjing University, Nanjing 210093, China; Children's Hospital of Nanjing Medical University, Nanjing 210008, China.
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15
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Li P, Chen Y, Tang A, Gao F, Yan JB. Seroprevalence of coxsackievirus A16 antibody among people of various age groups: a systematic review and meta-analysis. Arch Public Health 2021; 79:166. [PMID: 34535186 PMCID: PMC8447778 DOI: 10.1186/s13690-021-00688-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 09/07/2021] [Indexed: 08/30/2023] Open
Abstract
BACKGROUND Coxsackie virus group A type 16 (CoxA16) is the main pathogen and usually an alternative to or joins in prevalence with enterovirus 71 (EV71) causing hand, foot and mouth disease (HFMD). The objective of this study was to estimate the seroprevalence of CoxA16 antibody among people of various age groups by a systematic review and meta-analysis. METHODS The literature of seroprevalence of CoxA16 antibody among people has been systematically searched through databases from the date of their establishment to Jan. 2021. Estimates of seroprevalence of CoxA16 antibody by gender and age groups have been summarized by using fixed- and random- effect models. All analyses have been conducted in STATA version 12.0 software. RESULTS A total of 14 publications with 9 in English and 5 in Chinese containing 9562 samples were finally included in the meta-analysis. The seroprevalence of CoxA16 antibody reported in different studies range from 24.85 to 76.92 %. Meta-analysis has revealed that the seroprevalence of CoxA16 antibody was 56.3 % (95 %CI: 47.7 %~64.9 %) in the overall population and 55.1 % (95 %CI: 44.1 %~66.1 %) in the Chinese population. Subgroup analysis by gender has revealed that the seroprevalence of CoxA16 antibody was 56.1 % (95 %CI: 45.2 %~67.1 %) in males and 60.0 % (95 %CI: 50.0 %~69.9 %) in females. Subgroup analysis by age groups has revealed that the seroprevalence of CoxA16 antibody was 49.1 % (95 %CI: 36.2 %~62.0 %) in the 0 ~ 5 age group and 63.9 % (95 %CI: 53.1 %~74.7 %) in the over 5 age group. Begg's funnel plots have suggested that there were no publication bias in all groups. Sensitive analysis has suggested that the result of the meta-analysis was stable. CONCLUSIONS The seroprevalence of CoxA16 antibody was closely related to age. Children under 5 years old were the main susceptible groups for CoxA16 and also the key groups for the prevention and control of HFMD.
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Affiliation(s)
- Peng Li
- Zhoushan Municipal Center for Disease Control and Prevention, No.568 Wengshan Road, Zhoushan City, Zhejiang Province, 316021, People's Republic of China
| | - Yan Chen
- Zhoushan Municipal Center for Disease Control and Prevention, No.568 Wengshan Road, Zhoushan City, Zhejiang Province, 316021, People's Republic of China
| | - An Tang
- Zhoushan Municipal Center for Disease Control and Prevention, No.568 Wengshan Road, Zhoushan City, Zhejiang Province, 316021, People's Republic of China
| | - Fan Gao
- Department of Ophthalmology, Zhoushan Hospital, Zhoushan City, Zhejiang Province, 316021, People's Republic of China.
| | - Jian-Bo Yan
- Zhoushan Municipal Center for Disease Control and Prevention, No.568 Wengshan Road, Zhoushan City, Zhejiang Province, 316021, People's Republic of China.
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16
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Abstract
The prevalence of oral ulcers in children is reported to be 9%, however diagnosis of oral lesions can be challenging, being an unspecific symptom of several diseases. Differential diagnosis can range from classic infectious disease of childhood (e.g. herpangina, hand-foot-and-mouth-disease) over nutritional deficiencies, gastrointestinal disorders, inflammations (e.g. pemphigus vulgaris, lichen planus, mucous membrane pemphigoid) to side effects of medications (Stevens-Johnson Syndrome) or chronic dieseases (e.g. sarcoidosis, systemic Lupus erythematodes, familial Mediterrenean fever). Therefore, children with oral ulcers are treated by many different specialists such as dentists, family doctors, paediatricians, rheumatologists, haematologists, gastroenterologists and otorhinolaryngologists.A systematic literature search and a narrative literature review about the potential 48 diseases connected to oral ulcers were performed. According to the duration of symptoms and size of the lesions, a tabular overview was created to support the clinician in making a correct diagnosis, additionally different treatment options are presented.
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Affiliation(s)
- Corinne Légeret
- University Children’s Hospital of Basel, Spitalstrasse 33, 4056 Basel, Switzerland
- University Children’s Hospital Basel, Spitalstrasse 31, 4055 Basel, Switzerland
| | - Raoul Furlano
- University Children’s Hospital of Basel, Spitalstrasse 33, 4056 Basel, Switzerland
- University Children’s Hospital Basel, Spitalstrasse 31, 4055 Basel, Switzerland
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17
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Nhu LNT, Nhan LNT, Anh NT, Hong NTT, Van HMT, Thanh TT, Hang VTT, Han DDK, Ny NTH, Nguyet LA, Quy DT, Qui PT, Khanh TH, Hung NT, Tuan HM, Chau NVV, Thwaites G, van Doorn HR, Tan LV. Coxsackievirus A16 in Southern Vietnam. Front Microbiol 2021; 12:689658. [PMID: 34248913 PMCID: PMC8265502 DOI: 10.3389/fmicb.2021.689658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 05/11/2021] [Indexed: 12/22/2022] Open
Abstract
Background: Hand, Foot and Mouth Disease (HFMD) is a major public health concern in the Asia-Pacific region. Most recent HFMD outbreaks have been caused by enterovirus A71 (EV-A71), coxsackievirus A16 (CVA16), CVA10, and CVA6. There has been no report regarding the epidemiology and genetic diversity of CVA16 in Vietnam. Such knowledge is critical to inform the development of intervention strategies. Materials and Methods: From 2011 to 2017, clinical samples were collected from in- and outpatients enrolled in a HFMD research program conducted at three referral hospitals in Ho Chi Minh City (HCMC), Vietnam. Throat or rectal swabs positive for CVA16 with sufficient viral load were selected for whole genome sequencing and evolutionary analysis. Results: Throughout the study period, 320 CVA16 positive samples were collected from 2808 HFMD patients (11.4%). 59.4% of patients were male. The median age was 20.8 months (IQR, 14.96–31.41). Patients resided in HCMC (55.3%), Mekong Delta (22.2%), and South East Vietnam (22.5%). 10% of CVA16 infected patients had moderately severe or severe HFMD. CVA16 positive samples from 153 patients were selected for whole genome sequencing, and 66 complete genomes were obtained. Phylogenetic analysis demonstrated that Vietnamese CVA16 strains belong to a single genogroup B1a that clusters together with isolates from China, Japan, Thailand, Malaysia, France and Australia. The CVA16 strains of the present study were circulating in Vietnam some 4 years prior to its detection in HFMD cases. Conclusion: We report for the first time on the molecular epidemiology of CVA16 in Vietnam. Unlike EV-A71, which showed frequent replacement between subgenogroups B5 and C4 every 2–3 years in Vietnam, CVA16 displays a less pronounced genetic alternation with only subgenogroup B1a circulating in Vietnam since 2011. Our collective findings emphasize the importance of active surveillance for viral circulation in HFMD endemic countries, critical to informing outbreak response and vaccine development.
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Affiliation(s)
| | | | - Nguyen To Anh
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | - Hoang Minh Tu Van
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Children's Hospital 2, Ho Chi Minh City, Vietnam
| | - Tran Tan Thanh
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Vu Thi Ty Hang
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Do Duong Kim Han
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | - Lam Anh Nguyet
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Du Tuan Quy
- Children's Hospital 1, Ho Chi Minh City, Vietnam
| | - Phan Tu Qui
- Hospital for Tropical Disease, Ho Chi Minh City, Vietnam
| | | | | | - Ha Manh Tuan
- Children's Hospital 2, Ho Chi Minh City, Vietnam
| | | | - Guy Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - H Rogier van Doorn
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Le Van Tan
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
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18
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Chen W, Dai S, Xu L. Clinical characterization of benign enterovirus infection in neonates. Medicine (Baltimore) 2021; 100:e25706. [PMID: 33950953 PMCID: PMC8104291 DOI: 10.1097/md.0000000000025706] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 03/19/2021] [Indexed: 01/04/2023] Open
Abstract
Enteroviruses is a group of positive single-stranded RNA viruses ubiquitous in the environment, which is a causative agent of epidemic diseases in children and infants. But data on neonates are still limited. The present study aimed to describe the clinical characteristics of enterovirus infection in neonates and arise the awareness of this disease to general public.Between March 2018 and September 2019, data from all of the neonates diagnosed with enterovirus infection were collected and analyzed from neonatal intensive care unit of Zhangzhou Hospital in Fujian, China.A total of 23 neonates were enrolled. All of them presented with fever (100%), and some with rashes (39.1%). The incidence of aseptic meningitis was high (91.3%), but only a small proportion (28.6%) presented with cerebrospinal fluid (CSF) leukocytosis. The positive value for nucleic acid detection in CSF was significantly higher than throat swab (91.3% vs 43.5%, P = .007). Five of the infected neonates presented with aseptic meningitis (23.8%) underwent brain magnetic resonance imaging examination and no craniocerebral injuries were found. Subsequent follow-ups were performed in 15 of them (71.4%) and no neurological sequelae was found.Aseptic meningitis is a common type of enterovirus infection in neonates with a benign course. Nucleic acid detection of CSF has an important diagnostic value. Febrile neonates would be suggested to screen for enterovirus infection in addition to complete septic workup. An unnecessary initiation or earlier cessation of antibiotics could be considered in enterovirus infection, but that indications still need further studies to guarantee the safety.
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MESH Headings
- Brain/diagnostic imaging
- China/epidemiology
- Enterovirus/genetics
- Enterovirus/isolation & purification
- Enterovirus Infections/cerebrospinal fluid
- Enterovirus Infections/diagnosis
- Enterovirus Infections/epidemiology
- Enterovirus Infections/virology
- Exanthema/cerebrospinal fluid
- Exanthema/diagnosis
- Exanthema/epidemiology
- Exanthema/virology
- Female
- Fever/cerebrospinal fluid
- Fever/diagnosis
- Fever/epidemiology
- Fever/virology
- Humans
- Incidence
- Infant, Newborn
- Intensive Care Units, Neonatal/statistics & numerical data
- Magnetic Resonance Imaging
- Male
- Meningitis, Aseptic/cerebrospinal fluid
- Meningitis, Aseptic/diagnosis
- Meningitis, Aseptic/epidemiology
- Meningitis, Aseptic/virology
- Meningitis, Viral/cerebrospinal fluid
- Meningitis, Viral/diagnosis
- Meningitis, Viral/epidemiology
- Meningitis, Viral/virology
- Pharynx/virology
- RNA, Viral/cerebrospinal fluid
- RNA, Viral/isolation & purification
- Retrospective Studies
- Skin Diseases, Viral/cerebrospinal fluid
- Skin Diseases, Viral/epidemiology
- Skin Diseases, Viral/virology
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19
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Ai Y, Zhang W, Wu J, Zhang J, Shen M, Yao S, Deng C, Li X, Wu D, Tian P, Cheng X, Zha H, Wu K. Molecular Epidemiology and Clinical Features of Enteroviruses-Associated Hand, Foot, and Mouth Disease and Herpangina Outbreak in Zunyi, China, 2019. Front Med (Lausanne) 2021; 8:656699. [PMID: 33981716 PMCID: PMC8109248 DOI: 10.3389/fmed.2021.656699] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 03/31/2021] [Indexed: 11/25/2022] Open
Abstract
Background: Hand, foot and mouth disease (HFMD) and herpangina (HA), two of the most common childhood infectious diseases, are associated with enteroviruses (EVs) infection. The aim of this study was to identify the molecular epidemiology of enterovirus causing HFMD/HA in Zunyi, China, during 2019, and to describe the clinical features of the cases. Methods: We collected the information on demographic and clinical characteristics, laboratory data of laboratory-confirmed EVs associated HFMD/HA cases in Zunyi Medical University Third Affiliated Hospital between March 1 and July 31, 2019. EV types were determined by either one-step real time RT-PCR or partial VP1 gene sequencing and sequence alignment. Phylogenetic analysis of CVA6, CVA2, and CVA5 were established based on the partial VP1 gene sequences by neighbor-joining method. Differences in clinical characteristics and laboratory results of the cases were compared among patients infected with the most prevalent EV types. Results: From 1 March to 31 July 2019, 1,377 EVs associated HFMD/HA inpatients were confirmed. Of them, 4 (0.3%, 4/1,377) were EV-A71-associated cases, 84 (6.1%, 84/1,377) were CVA16-associated cases, and 1,289 (93.6%, 1,289/1,377) were non-EV-A71/CVA16-associated cases. Of the randomly selected 372 non-EV-A71/CVA16 cases, EV types have been successfully determined in 273 cases including 166 HFMD and 107 HA cases. For HFMD cases, the three most common types were CVA6 (80.7%, 134/166), CVA2 (5.4%, 9/166) and CVA5 (3.0%, 5/166); similarly, for HA cases, the three most prevalent serotypes were CVA6 (36.5%, 39/107), CVA2 (21.5%, 23/107) and CVA5 (18.7%, 20/107). Phylogenetic analysis showed that subclade D of CVA5, and subclade E of CVA6 and CVA2 were predominant in Zunyi during the outbreak in 2019. Compared with the cases caused by CVA16, the incidence of high fever and severe infection associated with CVA2, CVA5, and CVA6 was higher. Conclusions: The recent HFMD/HA outbreak in Zunyi is due to a larger incidence of CVA6, CVA2, and CVA5. Novel diagnostic reagents and vaccines against these types would be important to monitor and control EV infections.
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Affiliation(s)
- Yuanhang Ai
- Department of Clinical Laboratory, Zunyi Medical University Third Affiliated Hospital, Zunyi, China
| | - Weiwei Zhang
- Department of Pediatrics and Child Health, Zunyi Medical University Third Affiliated Hospital, Zunyi, China
| | - Jie Wu
- Department of Scientific Research Laboratory, Zunyi Medical University Third Affiliated Hospital, Zunyi, China
| | - Jingzhi Zhang
- Department of Clinical Laboratory, Zunyi Medical University Third Affiliated Hospital, Zunyi, China
| | - Meijing Shen
- Department of Clinical Laboratory, Zunyi Medical University Third Affiliated Hospital, Zunyi, China
| | - Shifei Yao
- Department of Clinical Laboratory, Zunyi Medical University Third Affiliated Hospital, Zunyi, China
| | - Chengmin Deng
- Department of Scientific Research Laboratory, Zunyi Medical University Third Affiliated Hospital, Zunyi, China
| | - Xiaoqian Li
- Department of Scientific Research Laboratory, Zunyi Medical University Third Affiliated Hospital, Zunyi, China
| | - Dejing Wu
- Department of Scientific Research Laboratory, Zunyi Medical University Third Affiliated Hospital, Zunyi, China
| | - Peng Tian
- Department of Scientific Research Laboratory, Zunyi Medical University Third Affiliated Hospital, Zunyi, China
| | - Xiaoju Cheng
- Department of Scientific Research Laboratory, Zunyi Medical University Third Affiliated Hospital, Zunyi, China
| | - He Zha
- Department of Clinical Laboratory, Zunyi Medical University Third Affiliated Hospital, Zunyi, China
| | - Kaifeng Wu
- Department of Clinical Laboratory, Zunyi Medical University Third Affiliated Hospital, Zunyi, China.,Department of Scientific Research Laboratory, Zunyi Medical University Third Affiliated Hospital, Zunyi, China
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20
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Wang B, Zhu Y, Liu L, Wang B, Chen M, Wang J, Yang L, Liu J. Enterovirus 71 induces autophagy in mice via mTOR inhibition and ERK pathway activation. Life Sci 2021; 271:119188. [PMID: 33581126 DOI: 10.1016/j.lfs.2021.119188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Revised: 02/01/2021] [Accepted: 02/02/2021] [Indexed: 10/22/2022]
Abstract
AIMS Enterovirus 71 (EV71) is one of the main viruses that cause hand-foot-mouth disease; however, its pathogenic mechanism remains unclear. This study characterized the relationship between EV71 infection and autophagy in vivo and explored the molecular mechanism underlying EV71-induced autophagy. MATERIALS AND METHODS A mouse model of EV71 infection was prepared by intraperitoneally injecting one-day-old BALB/c suckling mice with 30 μL/g of EV71 virus stock solution for 3 days. The behavior, fur condition, weight, and mice mortality were monitored, and disease scores were calculated. The pathological damage to the brain, lung, and muscle tissues after the viral infection was assessed by hematoxylin and eosin staining. Western blot and immunofluorescence analyses were used to detect the expression levels of viral protein 1, Beclin-1, microtubule-associated protein light chain 3B, mammalian target of rapamycin (mTOR), phosphorylated (p)-mTOR, extracellular signal-regulated protein kinase (ERK) 1/2, and p-ERK. KEY FINDINGS EV71 infection can trigger autophagy in the brains, lungs, and muscles of infected mice. The autophagy response triggered by EV71 is achieved by the simultaneous mTOR inhibition and the ERK pathway activation. Blocking the mTOR pathway may aggravate autophagy, whereas ERK inhibition alleviates autophagy but cannot completely prevent it. SIGNIFICANCE EV71 infection can induce autophagy in mice, involving mTOR and ERK signaling pathways. These two signaling pathways are independent and do not interfere with each other.
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Affiliation(s)
- Baixin Wang
- School of Basic Medicine, Jiamusi University, Jiamusi 154007, China
| | - Yuanzhi Zhu
- School of Basic Medicine, Jiamusi University, Jiamusi 154007, China
| | - Lei Liu
- School of Basic Medicine, Jiamusi University, Jiamusi 154007, China
| | - Binshan Wang
- School of Basic Medicine, Jiamusi University, Jiamusi 154007, China
| | - Mei Chen
- School of Basic Medicine, Jiamusi University, Jiamusi 154007, China
| | - Jingtao Wang
- School of Basic Medicine, Jiamusi University, Jiamusi 154007, China
| | - Limin Yang
- School of Medicine, Dalian University, Dalian 116622, China.
| | - JiGuang Liu
- School of Basic Medicine, Jiamusi University, Jiamusi 154007, China.
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21
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Pan Q, Liu F, Zhang J, Zhao X, Hu Y, Fan C, Yang F, Chang Z, Xiao X. Regional-level risk factors for severe hand-foot-and-mouth disease: an ecological study from mainland China. Environ Health Prev Med 2021; 26:4. [PMID: 33419405 PMCID: PMC7792012 DOI: 10.1186/s12199-020-00927-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 12/21/2020] [Indexed: 12/27/2022] Open
Abstract
Background Severe hand-foot-and-mouth disease (HFMD) is a life-threatening contagious disease among young children and infants. Although enterovirus A71 has been well acknowledged to be the dominant cause of severe HFMD, there still remain other unidentified risk factors for severe HFMD. Previous studies mainly focused on identifying the individual-level risk factors from a clinical perspective, while rare studies aimed to clarify the association between regional-level risk factors and severe HFMD, which may be more important from a public health perspective. Methods We retrieved the clinical HFMD counts between 2008 and 2014 from the Chinese Center for Disease Control and Prevention, which were used to calculated the case-severity rate in 143 prefectural-level cities in mainland China. For each of those 143 cities, we further obtained city-specific characteristics from the China City Statistical Yearbook (social and economic variables) and the national meteorological monitoring system (meteorological variables). A Poisson regression model was then used to estimate the associations between city-specific characteristics (reduced by the principal component analysis to avoid multicollinearity) and the case-severity rate of HFMD. The above analysis was further stratified by age and gender to examine potential modifying effects and vulnerable sub-populations. Results We found that the case-severity rate of HFMD varied dramatically between cities, ranging from 0 to 8.09%. Cities with high case-severity rates were mainly clustered in Central China. By relating the case-severity rate to city-specific characteristics, we found that both the principal component characterized by a high level of social and economic development (RR = 0.823, 95%CI 0.739, 0.916) and another that characterized by warm and humid climate (RR = 0.771, 95%CI 0.619, 0.960) were negatively associated with the case-severity rate of HFMD. These estimations were consistent across age and gender sub-populations. Conclusion Except for the type of infected pathogen, the case-severity rate of HFMD was closely related to city development and meteorological factor. These findings suggest that social and environmental factors may also play an important role in the progress of severe HFMD. Supplementary Information The online version contains supplementary material available at 10.1186/s12199-020-00927-9.
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Affiliation(s)
- Qing Pan
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
| | - Fengfeng Liu
- Division of Infectious Disease & Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, 102206, PR China
| | - Juying Zhang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
| | - Xing Zhao
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
| | - Yifan Hu
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
| | - Chaonan Fan
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
| | - Fan Yang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
| | - Zhaorui Chang
- Division of Infectious Disease & Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, 102206, PR China.
| | - Xiong Xiao
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China.
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22
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Zhang Z, Liu Y, Liu F, Ren M, Nie T, Cui J, Chang Z, Li Z. Basic Reproduction Number of Enterovirus 71 Coxsackievirus A16 and A6: Evidence from Outbreaks of Hand, Foot and Mouth Disease in China between 2011 and 2018. Clin Infect Dis 2020; 73:e2552-e2559. [PMID: 33320199 DOI: 10.1093/cid/ciaa1853] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Enterovirus 71 (EV-A71), Coxsackievirus A16 (CV-A16) and Coxsackievirus A6 (CV-A6) are common serotypes causing hand, foot, and mouth disease (HFMD). Analyses on the basic reproduction number (R0) of common pathogens causing HFMD are limited and there are no related studies using field data from outbreaks in mainland China. METHODS We estimated the pathogen-specific basic reproduction number based on laboratory-confirmed HFMD outbreaks (clusters of ≥10 HFMD cases) reported to the national surveillance system between 2011 and 2018. The reproduction numbers were calculated using a mathematical model and the cumulative cases during the initial growth periods. RESULTS This study included 539 outbreaks, of which 198 were caused by EV-A71, 316 by CV-A16, and 25 by CV-A6. All 10417 cases involved were children. Assuming the outbreaks occurred in closed systems and the incubation period is 5 days, the median R0s of EV-A71, CV-A16, and CV-A6 were 5.06 [2.81, 10.20], 4.84 [3.00, 9.00] and 5.94 [3.27, 10.00] (Median [IQR]). After adjusting for seroprevalences, the R0s for EV-A71, CV-A16 (optimistic and conservative scenarios), and CV-A6 were 12.60 [IQR: 7.35, 25.40], 9.29 [IQR: 6.01, 19.20], 15.50 [IQR: 9.77, 30.40], and 25.80 [IQR: 14.20, 43.50], respectively. We did not observe changes in the R0s of EV-A71 after vaccine licensure (p-value = 0.67). CONCLUSIONS HFMD is highly transmissible when caused by the three most common serotypes. In mainland China, it primarily affects young children. Although a vaccine became available in 2016, we have not yet observed any related changes in the disease dynamics.
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Affiliation(s)
- Zhong Zhang
- Nanjing Municipal Center for Disease Control and Prevention, Nanjing, China.,Chinese Field Epidemiology Training Program (CFETP), Beijing, China
| | - Yang Liu
- Centre for Mathematical Modelling of Infectious Diseases, Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene & Tropical Medicine, Beijing, China
| | - Fengfeng Liu
- Division of Infectious disease, Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Minrui Ren
- Division of Infectious disease, Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Taoran Nie
- Division of Infectious disease, Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Jinzhao Cui
- Division of Infectious disease, Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhaorui Chang
- Division of Infectious disease, Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhongjie Li
- Division of Infectious disease, Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
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23
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Fang Y, Lian C, Huang D, Xu L. Analysis of Clinical Related Factors of Neonatal Hand-Foot-Mouth Disease Complicated With Encephalitis. Front Neurol 2020; 11:543013. [PMID: 33281697 PMCID: PMC7689027 DOI: 10.3389/fneur.2020.543013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 09/29/2020] [Indexed: 12/05/2022] Open
Abstract
Objective: To explore the clinical related factors of neonatal hand-foot-mouth disease (HFMD) complicated with encephalitis. Method: The neonatal HFMD complicated with encephalitis treated in our hospital from July 2015 to July 2020 was taken as the object of study. According to the NBNA score at discharge, the patients were divided into normal group and abnormal group. The clinical symptoms, auxiliary examination and prognosis of the two groups were compared. Result: (1) General condition: there was no significant difference in sex, age, duration of fever, treatment time and etiological test between the two groups (P > 0.05). (2) Clinical symptoms and signs: there was significant difference in abnormal consciousness between the two groups (P < 0.05). However, there was no significant difference in skin rash, respiratory system symptoms, digestive system symptoms, signs of high intracranial pressure, increased muscle tone and weakening of primitive reflex (P > 0.05). (3) Auxiliary examination: the number of white blood cells and the level of cytokines (CK-BB, UCH-L1) in cerebrospinal fluid (CSF) in the group with abnormal NBNA score were significantly higher than those in the group with normal NBNA score (P < 0.05). The serum IgM level in the abnormal NBNA score group was higher than that in the normal NBNA score group, and the serum IgG level in the abnormal NBNA score group was lower than that in the normal NBNA score group, and the difference was statistically significant (P < 0.05). The abnormal rate of Craniocerebral MRI in abnormal NBNA score group was higher than that in normal NBNA score group, and there was significant difference between the two groups (P < 0.05). There was no significant difference in the levels of protein, sugar, chloride, lactate dehydrogenase, and MMP-9 in CSF and the abnormal rate of amplitude integrated EEG (aEEG) between the two groups (P > 0.05). (4) The prognoses of patients with normal and abnormal NBNA score are good, and there are not significantly differences in the prognosis between the two groups (P > 0.05). Conclusion: (1) Neonatal HFMD complicated with encephalitis occurs more than 10 days after birth, there is no obvious abnormality in male and female, the vast majority of newborns have febrile symptoms, rash is not its specific manifestation, and most of them are atypical. (2) The positive rate of HFMD-related virus detected in CSF of neonatal HFMD is high. For newborns with abnormal consciousness, CSF examination should be accomplished in time, which has certain clinical significance for early diagnosis and treatment of severe newborns. (3) The increase of white blood cell count and cytokines (CK-BB, UCH-L1) in CSF of neonatal HFMD complicated with encephalitis has a certain clinical reference value for early diagnosis and identification of severe newborns. (4) There is a certain humoral immune disorder in newborns with HFMD complicated with encephalitis, but the overall prognosis is better due to the protective effect of maternal IgG.
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Affiliation(s)
- Yanling Fang
- Zhangzhou Hospital Affiliated to Fujian Medical University, Zhangzhou, China
| | | | - Dali Huang
- Zhangzhou Hospital Affiliated to Fujian Medical University, Zhangzhou, China
| | - Liping Xu
- Zhangzhou Hospital Affiliated to Fujian Medical University, Zhangzhou, China
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24
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Li M, Li YP, Deng HL, Wang MQ, Wang WJ, Wang J, Wu FP, Dang SS. Association of gene polymorphisms of CD55 with susceptibility to and severity of hand, foot, and mouth disease caused by enterovirus 71 in the Han Chinese population. J Med Virol 2020; 92:3119-3124. [PMID: 32470169 DOI: 10.1002/jmv.26088] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 05/23/2020] [Indexed: 12/13/2022]
Abstract
Hand, foot, and mouth disease (HFMD) caused by enterovirus 71 (EV71) can lead to high morbidity and mortality, and genetic background plays an important role during the disease process. We investigated the association between the single-nucleotide polymorphism (SNP) rs2564978 of the CD55 gene and susceptibility to and severity of HFMD using the SNPs can multiple SNP typing methods. Soluble CD55 (sCD55) expression was significantly lower in the EV71 HFMD group than in the control group and lower in severe cases than in mild cases (P < .001). Moreover, CD55 rs2564978 (C vs T OR = 1.300, 95% CI, 1.120-1.509) was associated with the risk of EV71 infection, and genotype TC was related to the severity of the infection (TC vs TT OR = 4.523, 95% CI, 2.033-10.066). Our results suggest that sCD55 expression and the CD55 polymorphism rs2564978 may influence the susceptibility to and severity of EV71 infection.
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Affiliation(s)
- Mei Li
- Department of Infectious Diseases, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Ya-Ping Li
- Department of Infectious Diseases, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Hui-Ling Deng
- Department of Infectious Diseases, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Department of Infectious Diseases, Xi'an Children's Hospital, Xi'an, China
| | - Mu-Qi Wang
- Department of Infectious Diseases, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Wen-Jun Wang
- Department of Infectious Diseases, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Jun Wang
- Department of Infectious Diseases, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
- Department of Infectious Diseases, Xi'an Children's Hospital, Xi'an, China
| | - Feng-Ping Wu
- Department of Infectious Diseases, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Shuang-Suo Dang
- Department of Infectious Diseases, Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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25
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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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26
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Chen FH, Liu X, Fang HL, Nan N, Li Z, Ning NZ, Luo DY, Li T, Wang H. VP1 of Enterovirus 71 Protects Mice Against Enterovirus 71 and Coxsackievirus B3 in Lethal Challenge Experiment. Front Immunol 2019; 10:2564. [PMID: 31787970 PMCID: PMC6856078 DOI: 10.3389/fimmu.2019.02564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 10/16/2019] [Indexed: 12/16/2022] Open
Abstract
Enterovirus and Coxsackievirus are the major viruses that cause hand, foot, and mouth disease (HFMD) outbreaks worldwide. Several studies have shown the potential of viral envelope protein 1 (VP1) on providing protective effects from viral strains of different genotypes. However, whether VP1 has the cross-protection in Enteroviruses or Coxsackievirus has not been studied in-depth. In this study, the vp1 gene of Enterovirus 71 (EV71) and Coxsackievirus B3 (CB3) was inserted into the vector pET22b (+) to form the respective expression plasmids pEVP1 or pCVP1, and then transformed into Escherichia coli strain BL21 (DE3). The recombinant EVP1 or CVP1 protein was overexpressed successfully and effectively purified to homogeneity. Then, we identified that EVP1 and CVP1 protein could generate effectively specific humoral immunity and cellular immunity in mice, what's more, we determined the cross-protection of VP1 between EV71 and CB3 in a murine model. The results showed that immunization with EVP1 could effectively induce specific IgG and secretory IgA against CVP1 and the sera from EVP1-immunized mice could neutralize CB3 with mean titers 1:440. In contrast, no measurable neutralizing antibodies to EV71 were detected in CVP1-immunized mice. Then, newborn BALB/C mice, whose mother was immunized with EVP1 or CVP1, were administered with different lethal doses of EV71 or CB3. The EVP1 immunized group showed a 90% protective efficacy for a CB3 dosage of 120 LD50, but the CVP1 immunized group showed no significantly different protective efficacy against 15 LD50 of EV71 compared with the BSA immunized group. Hence, EVP1 is a promising subunit vaccine candidate against Enterovirus 71 and Coxsackievirus B3 caused HFMD.
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Affiliation(s)
- Fang-Hong Chen
- State Key Laboratory of Pathogens and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China.,Department of Microbiology, Anhui Medical University, Anhui, China
| | - Xiong Liu
- State Key Laboratory of Pathogens and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China.,PLA Center for Disease Control and Prevention, Beijing, China
| | - Hua-Li Fang
- State Key Laboratory of Pathogens and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China.,Department of Microbiology, Anhui Medical University, Anhui, China
| | - Nan Nan
- State Key Laboratory of Pathogens and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Zhan Li
- State Key Laboratory of Pathogens and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Nian-Zhi Ning
- State Key Laboratory of Pathogens and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - De-Yan Luo
- State Key Laboratory of Pathogens and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Tao Li
- State Key Laboratory of Pathogens and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Hui Wang
- State Key Laboratory of Pathogens and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China.,Department of Microbiology, Anhui Medical University, Anhui, China
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