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Yew JS, Ong SK, Lim HX, Tan SH, Ong KC, Wong KT, Poh CL. Immunogenicity of trivalent DNA vaccine candidate encapsulated in Chitosan-TPP nanoparticles against EV-A71 and CV-A16. Nanomedicine (Lond) 2024; 19:1779-1799. [PMID: 39140594 PMCID: PMC11418279 DOI: 10.1080/17435889.2024.2372243] [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: 03/08/2024] [Accepted: 06/21/2024] [Indexed: 08/15/2024] Open
Abstract
Aim: To develop a trivalent DNA vaccine candidate encapsulated in Chitosan-TPP nanoparticles against hand foot and mouth disease (HFMD) and assess its immunogenicity in mice.Materials & methods: Trivalent plasmid carrying the VP1 and VP2 genes of EV-A71, VP1 gene of CV-A16 was encapsulated in Chitosan-TPP nanoparticles through ionic gelation. In vitro characterization and in vivo immunization studies of the CS-TPP-NPs (pIRES-VP121) were performed.Results: Mice administered with CS-TPP NPs (pIRES-VP121) intramuscularly were observed to have the highest IFN-γ response. Sera from mice immunized with the naked pDNA and CS-TPP-NPs (pIRES-VP121) demonstrated good viral clearance against wild-type EV-A71 and CV-A16 in RD cells.Conclusion: CS-TPP-NPs (pIRES-VP121) could serve as a prototype for future development of multivalent HFMD DNA vaccine candidates.
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Affiliation(s)
- Jia Sheng Yew
- Centre for Virus & Vaccine Research, School of Medical & Life Sciences, Sunway University, Petaling Jaya, 47500, Malaysia
| | - Seng-Kai Ong
- Department of Biological science, School of Medical & Life Sciences, Sunway University, Petaling Jaya, 47500, Malaysia
| | - Hui Xuan Lim
- Centre for Virus & Vaccine Research, School of Medical & Life Sciences, Sunway University, Petaling Jaya, 47500, Malaysia
- Sunway Microbiome Centre, School of Medical & Life Sciences, Sunway University, Petaling Jaya, 47500, Malaysia
| | - Soon Hao Tan
- Department of Biomedical Science, Faculty of Medicine, Universiti Malaya, Federal Territory of Kuala Lumpur, Kuala Lumpur, 50603, Malaysia
| | - Kien Chai Ong
- Department of Biomedical Science, Faculty of Medicine, Universiti Malaya, Federal Territory of Kuala Lumpur, Kuala Lumpur, 50603, Malaysia
| | - Kum Thong Wong
- Department of Pathology, Faculty of Medicine, Universiti Malaya, Federal Territory of Kuala Lumpur, Kuala Lumpur, 50603, Malaysia
| | - Chit Laa Poh
- Centre for Virus & Vaccine Research, School of Medical & Life Sciences, Sunway University, Petaling Jaya, 47500, Malaysia
- ALPS Global Holding Berhad, The ICON, No.1, Off Jalan Tun Razak, Kuala Lumpur, 50400, Malaysia
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Chen Y, Nguyet LA, Nhan LNT, Qui PT, Nhu LNT, Hong NTT, Ny NTH, Anh NT, Thanh LK, Phuong HT, Vy NHT, Thanh NTL, Khanh TH, Hung NT, Viet DC, Nam NT, Chau NVV, van Doorn HR, Tan LV, Clapham H. Age-time-specific transmission of hand-foot-and-mouth disease enterovirus serotypes in Vietnam: A catalytic model with maternal immunity. Epidemics 2024; 46:100754. [PMID: 38428358 PMCID: PMC10945305 DOI: 10.1016/j.epidem.2024.100754] [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: 08/22/2023] [Revised: 02/05/2024] [Accepted: 02/24/2024] [Indexed: 03/03/2024] Open
Abstract
Hand, foot and mouth disease (HFMD) is highly prevalent in the Asia Pacific region, particularly in Vietnam. To develop effective interventions and efficient vaccination programs, we inferred the age-time-specific transmission patterns of HFMD serotypes enterovirus A71 (EV-A71), coxsackievirus A6 (CV-A6), coxsackievirus A10 (CV-A10), coxsackievirus A16 (CV-A16) in Ho Chi Minh City, Vietnam from a case data collected during 2013-2018 and a serological survey data collected in 2015 and 2017. We proposed a catalytic model framework with good adaptability to incorporate maternal immunity using various mathematical functions. Our results indicate the high-level transmission of CV-A6 and CV-A10 which is not obvious in the case data, due to the variation of disease severity across serotypes. Our results provide statistical evidence supporting the strong association between severe illness and CV-A6 and EV-A71 infections. The HFMD dynamic pattern presents a cyclical pattern with large outbreaks followed by a decline in subsequent years. Additionally, we identify the age group with highest risk of infection as 1-2 years and emphasise the risk of future outbreaks as over 50% of children aged 6-7 years were estimated to be susceptible to CV-A16 and EV-A71. Our study highlights the importance of multivalent vaccines and active surveillance for different serotypes, supports early vaccination prior to 1 year old, and points out the potential utility for vaccinating children older than 5 years old in Vietnam.
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Affiliation(s)
- Yining Chen
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.
| | - Lam Anh Nguyet
- Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam
| | | | - Phan Tu Qui
- Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam
| | | | | | - Nguyen Thi Han Ny
- Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam
| | - Nguyen To Anh
- Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam
| | - Le Kim Thanh
- Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam
| | - Huynh Thi Phuong
- Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam
| | - Nguyen Ha Thao Vy
- Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam
| | | | | | | | - Do Chau Viet
- Children's Hospital 2, Ho Chi Minh City, Viet Nam
| | | | - Nguyen Van Vinh Chau
- Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam; Hospital for Tropical Diseases, Ho Chi Minh City, Viet Nam
| | - H Rogier van Doorn
- Oxford University Clinical Research Unit, Hanoi, Viet Nam; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Le Van Tan
- Oxford University Clinical Research Unit, Ho Chi Minh City, Viet Nam; Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Hannah Clapham
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
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Shrestha S, Malla B, Sangsanont J, Sirikanchana K, Ngo HTT, Inson JGM, Enriquez MLD, Alam ZF, Setiyawan AS, Setiadi T, Takeda T, Kitajima M, Haramoto E. Detection of enteroviruses related to hand foot and mouth disease in wastewater of Asian communities. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 912:169375. [PMID: 38110101 DOI: 10.1016/j.scitotenv.2023.169375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 11/25/2023] [Accepted: 12/12/2023] [Indexed: 12/20/2023]
Abstract
Hand, foot, and mouth disease (HFMD) is contagious and predominantly affects children below the age of five. HFMD-associated serotypes of Enterovirus A (EVA) family include EVA71, Coxsackievirus A type 6 (CVA6), 10 (CVA10), and 16 (CVA16). Although prevalent in numerous Asian countries, studies on HFMD-causing agents in wastewater are scarce. This study aimed to conduct wastewater surveillance in various Asian communities to detect and quantify serotypes of EVA associated with HFMD. In total, 77 wastewater samples were collected from Indonesia, the Philippines, Thailand, and Vietnam from March 2022 to February 2023. The detection ratio for CVA6 RNA in samples from Vietnam was 40 % (8/20). The detection ratio for CVA6 and EVA71 RNA each was 25 % (5/20) for the Indonesian samples, indicating the need for clinical surveillance of CVA6, as clinical reports have been limited. For the Philippines, 12 % (2/17) of the samples were positive for CVA6 and EVA71 RNA each, with only one quantifiable sample each. Samples from Thailand had a lower detection ratio (1/20) for CVA6 RNA, and the concentration was unquantifiable. Conversely, CVA10 and CVA16 RNAs were not detected in any of the samples. The minimum and maximum concentrations of CVA6 RNA were 2.7 and 3.9 log10 copies/L and those for EVA71 RNA were 2.5 and 4.9 log10 copies/L, respectively. This study underscores the importance of wastewater surveillance in understanding the epidemiology of HFMD-associated EVA serotypes in Asian communities. Long-term wastewater surveillance is recommended to monitor changes in dominant serotypes, understand seasonality, and develop effective prevention and control strategies for HFMD.
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Affiliation(s)
- Sadhana Shrestha
- Interdisciplinary Center for River Basin Environment, University of Yamanashi, 4-3-11 Takeda, Kofu, Yamanashi 400-8511, Japan
| | - Bikash Malla
- Interdisciplinary Center for River Basin Environment, University of Yamanashi, 4-3-11 Takeda, Kofu, Yamanashi 400-8511, Japan
| | - Jatuwat Sangsanont
- Department of Environmental Science, Chulalongkorn University, Phayathai Road, Pathumwan, Bangkok 10330, Thailand; Water Science and Technology for Sustainable Environmental Research Group, Chulalongkorn University, Bangkok 10330, Thailand.
| | - Kwanrawee Sirikanchana
- Research Laboratory of Biotechnology, Chulabhorn Research Institute, 54 Kamphaeng Phet 6 Rd., Talat Bang Khen, Lak Si, Bangkok 10210, Thailand; Center of Excellence on Environmental Health and Toxicology (EHT), OPS, MHESI, Bangkok 10400, Thailand.
| | - Huong Thi Thuy Ngo
- Faculty of Biotechnology, Chemistry and Environmental Engineering, Phenikaa University, Yen Nghia, Ha Dong, Hanoi 12116, Viet Nam; Environmental Chemistry and Ecotoxicology Lab, Phenikaa University, Yen Nghia Ward - Ha Dong District, Hanoi 12116, Viet Nam.
| | - Jessamine Gail M Inson
- Department of Biology, De La Salle University, 2401 Taft Avenue, Manila 1004, Philippines.
| | - Ma Luisa D Enriquez
- Department of Biology, De La Salle University, 2401 Taft Avenue, Manila 1004, Philippines.
| | - Zeba F Alam
- Department of Biology, De La Salle University, 2401 Taft Avenue, Manila 1004, Philippines.
| | - Ahmad Soleh Setiyawan
- Department of Environmental Engineering, Institut Teknologi Bandung, Jl. Ganesha No. 10, Bandung 40132, Indonesia.
| | - Tjandra Setiadi
- Department of Chemical Engineering, Institut Teknologi Bandung, Jl. Ganesa 10, Bandung 40132, Indonesia.
| | - Tomoko Takeda
- Department of Earth and Planetary Science, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan.
| | - Masaaki Kitajima
- Division of Environmental Engineering, Hokkaido University, North 13 West 8, Kita-ku, Sapporo, Hokkaido 060-8628, Japan.
| | - Eiji Haramoto
- Interdisciplinary Center for River Basin Environment, University of Yamanashi, 4-3-11 Takeda, Kofu, Yamanashi 400-8511, Japan.
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Wei Y, Ma Y, Zhang T, Luo X, Yin F, Shui T. Spatiotemporal patterns and risk mapping of provincial hand, foot, and mouth disease in mainland China, 2014-2017. Front Public Health 2024; 12:1291361. [PMID: 38344231 PMCID: PMC10853440 DOI: 10.3389/fpubh.2024.1291361] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 01/08/2024] [Indexed: 02/15/2024] Open
Abstract
Background Hand, foot, and mouth disease (HFMD) has remained a serious public health threat since its first outbreak in China. Analyzing the province-level spatiotemporal distribution of HFMD and mapping the relative risk in mainland China will help determine high-risk provinces and periods of infection outbreaks for use in formulating new priority areas for prevention and control of this disease. Furthermore, our study examined the effect of air pollution on HFMD nationwide, which few studies have done thus far. Methods Data were collected on the number of provincial monthly HFMD infections, air pollution, meteorological variables, and socioeconomic variables from 2014 to 2017 in mainland China. We used spatial autocorrelation to determine the aggregate distribution of HFMD incidence. Spatiotemporal patterns of HFMD were analyzed, risk maps were developed using the Bayesian spatiotemporal model, and the impact of potential influencing factors on HFMD was assessed. Results In our study, from 2014 to 2017, the HFMD annual incidence rate in all provinces of mainland China ranged from 138.80 to 203.15 per 100,000 people, with an average annual incidence rate of 165.86. The temporal risk of HFMD for 31 Chinese provinces exhibited cyclical and seasonal characteristics. The southern and eastern provinces had the highest spatial relative risk (RR > 3) from 2014 to 2017. The HFMD incidence risk in provinces (Hunan, Hubei, and Chongqing) located in central China increased over time. Among the meteorological variables, except for the mean two-minute wind speed (RR 0.6878; 95% CI 0.5841, 0.8042), all other variables were risk factors for HFMD. High GDP per capita (RR 0.9922; 95% CI 0.9841, 0.9999) was a protective factor against HFMD. The higher the birth rate was (RR 1.0657; 95% CI 1.0185, 1.1150), the higher the risk of HFMD. Health workers per 1,000 people (RR 1.2010; 95% CI 1.0443, 1.3771) was positively correlated with HFMD. Conclusions From 2014 to 2017, the central provinces (Hunan, Hubei, and Chongqing) gradually became high-risk regions for HFMD. The spatiotemporal pattern of HFMD risk may be partially attributed to meteorological and socioeconomic factors. The prevalence of HFMD in the central provinces requires attention, as prevention control efforts should be strengthened there.
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Affiliation(s)
- Yuxin Wei
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yue Ma
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Tao Zhang
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Xuelian Luo
- National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Fei Yin
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Tiejun Shui
- Yunnan Center for Disease Control and Prevention, Kunming, China
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Shrestha S, Malla B, Haramoto E. Monitoring hand foot and mouth disease using long-term wastewater surveillance in Japan: Quantitative PCR assay development and application. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 901:165926. [PMID: 37527711 DOI: 10.1016/j.scitotenv.2023.165926] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 07/28/2023] [Accepted: 07/29/2023] [Indexed: 08/03/2023]
Abstract
Hand, foot, and mouth disease (HFMD) is a highly contagious disease that primarily affects children under five years of age. It is mainly caused by serotypes of Enterovirus A (EVA): EVA71, Coxsackievirus A types 6 (CVA6), 10 (CVA10), and 16 (CVA16). Despite being highly prevalent in Japan and other countries in the Asia-Pacific region, few studies have investigated HFMD pathogens in wastewater. The present study aimed to develop a highly sensitive and broadly reactive quantitative polymerase chain reaction (qPCR) assay of dominant serotype CVA6, to revise previously developed CVA6, CVA10, and CVA16 assays, and to test these assays in wastewater samples from Yamanashi Prefecture, Japan. The new-CVA6 qPCR assay was developed with maximal nucleotide percent identity among CVA6 isolates from Japan. The new-CVA6 and revised assays were highly sensitive and had the ability to quantify respective positive controls at levels as low as 1 copy/μL. Among the 53 grab influent samples collected between March 2022 and March 2023, EVA71, CVA10, and CVA16 RNA were not detected in any samples, whereas the new-CVA6 assay could detect CVA6 RNA in 38 % (20/53) of samples. CVA6 RNA was detected at a significantly higher concentration in the summer season (3.3 ± 0.8 log10 copies/L; 79 % (11/14)) than in autumn (2.7 ± 0.6 log10 copies/L; 69 % (9/13)). The seasonal trend of CVA6 RNA detection in wastewater aligned with the trend of HFMD case reports in the catchment of the wastewater treatment plant. This is the first study to report the detection and seasonal trends of the EVA serotypes associated with HFMD in wastewater samples in Japan. It provides evidence that wastewater-based epidemiology is applicable even for diseases that are prevalent only in specific population groups.
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Affiliation(s)
- Sadhana Shrestha
- Interdisciplinary Center for River Basin Environment, University of Yamanashi, 4-3-11 Takeda, Kofu, Yamanashi 400-8511, Japan
| | - Bikash Malla
- Interdisciplinary Center for River Basin Environment, University of Yamanashi, 4-3-11 Takeda, Kofu, Yamanashi 400-8511, Japan
| | - Eiji Haramoto
- Interdisciplinary Center for River Basin Environment, University of Yamanashi, 4-3-11 Takeda, Kofu, Yamanashi 400-8511, Japan.
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Noisumdaeng P, Puthavathana P. Molecular evolutionary dynamics of enterovirus A71, coxsackievirus A16 and coxsackievirus A6 causing hand, foot and mouth disease in Thailand, 2000-2022. Sci Rep 2023; 13:17359. [PMID: 37833525 PMCID: PMC10576028 DOI: 10.1038/s41598-023-44644-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 10/11/2023] [Indexed: 10/15/2023] Open
Abstract
Hand, foot and mouth disease (HFMD) is a public health threat worldwide, particularly in the Asia-Pacific region. Enterovirus A71 (EV-A71), coxsackievirus A16 (CVA16), and CVA6 are the major pathogens causing HFMD outbreaks in several countries, including Thailand. We retrieved 385 VP1 nucleotide sequences, comprising 228 EV-A71, 33 CVA16, and 124 CVA6, deposited in the databases between 2000 and 2022 for molecular evolutionary characterization using Bayesian phylogeny. All EV-A71 identified belonged to genotype B, subgenotypes B4, and B5, and to genotype C, subgenotypes C1, C2, C4a, C4b, and C5. The analyzes demonstrated these viruses' co-circulation and subgenotypic changes throughout the past two decades. The CVA16 was grouped in genotype B1, predominantly subgenotype B1a, and the CVA6 was grouped in subgenotype D3, clades 1-4. The tMRCA of EV-A71 genotypes B and C, CVA16 B1, and CVA6 D3 dated 1993.79, 1982.62, 1995.86, and 2007.31, respectively, suggesting that the viruses were likely introduced and cryptically circulated in Thailand before the HFMD cases were recognized. We demonstrated these viruses' fluctuation and cyclical pattern throughout the two decades of observation. This study provided insight into evolutionary dynamics concerning molecular epidemiology and supported the selection of current genotype-matched vaccines, vaccine development, and implementation.
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Affiliation(s)
- Pirom Noisumdaeng
- Faculty of Public Health, Thammasat University, Pathum Thani, 12120, Thailand.
- Thammasat University Research Unit in Modern Microbiology and Public Health Genomics, Thammasat University, Pathum Thani, 12120, Thailand.
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Tan XH, Chong WL, Lee VS, Abdullah S, Jasni K, Suarni SQ, Perera D, Sam IC, Chan YF. Substitution of Coxsackievirus A16 VP1 BC and EF Loop Altered the Protective Immune Responses in Chimera Enterovirus A71. Vaccines (Basel) 2023; 11:1363. [PMID: 37631931 PMCID: PMC10458053 DOI: 10.3390/vaccines11081363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 08/09/2023] [Accepted: 08/11/2023] [Indexed: 08/29/2023] Open
Abstract
Hand, foot and mouth disease (HFMD) is a childhood disease caused by enterovirus A71 (EV-A71) and coxsackievirus A16 (CV-A16). Capsid loops are important epitopes for EV-A71 and CV-A16. Seven chimeric EV-A71 (ChiE71) involving VP1 BC (45.5% similarity), DE, EF, GH and HI loops, VP2 EF loop and VP3 GH loop (91.3% similarity) were substituted with corresponding CV-A16 loops. Only ChiE71-1-BC, ChiE71-1-EF, ChiE71-1-GH and ChiE71-3-GH were viable. EV-A71 and CV-A16 antiserum neutralized ChiE71-1-BC and ChiE71-1-EF. Mice immunized with inactivated ChiE71 elicited high IgG, IFN-γ, IL-2, IL-4 and IL-10. Neonatal mice receiving passive transfer of WT EV-A71, ChiE71-1-EF and ChiE71-1-BC immune sera had 100%, 80.0% and no survival, respectively, against lethal challenges with EV-A71, suggesting that the substituted CV-A16 loops disrupted EV-A71 immunogenicity. Passive transfer of CV-A16, ChiE71-1-EF and ChiE71-1-BC immune sera provided 40.0%, 20.0% and 42.9% survival, respectively, against CV-A16. One-day-old neonatal mice immunized with WT EV-A71, ChiE71-1-BC, ChiE71-1-EF and CV-A16 achieved 62.5%, 60.0%, 57.1%, and no survival, respectively, after the EV-A71 challenge. Active immunization using CV-A16 provided full protection while WT EV-A71, ChiE71-1-BC and ChiE71-1-EF immunization showed partial cross-protection in CV-A16 lethal challenge with survival rates of 50.0%, 20.0% and 40%, respectively. Disruption of a capsid loop could affect virus immunogenicity, and future vaccine design should include conservation of the enterovirus capsid loops.
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Affiliation(s)
- Xiu Hui Tan
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia; (X.H.T.); (I.-C.S.)
| | - Wei Lim Chong
- Department of Chemistry, Center of Theoretical and Computational Physics, Faculty of Science, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | - Vannajan Sanghiran Lee
- Department of Chemistry, Center of Theoretical and Computational Physics, Faculty of Science, Universiti Malaya, Kuala Lumpur 50603, Malaysia
| | - Syahril Abdullah
- Department of Biomedical Sciences, Faculty of Medicine & Health Sciences, Universiti Putra Malaysia, Serdang 43400, Malaysia;
- Comparative Medicine and Technology Unit, Institute of Bioscience, Universiti Putra Malaysia, Serdang 43400, Malaysia
| | - Kartini Jasni
- Comparative Medicine and Technology Unit, Institute of Bioscience, Universiti Putra Malaysia, Serdang 43400, Malaysia
| | - Saiful Qushairi Suarni
- Comparative Medicine and Technology Unit, Institute of Bioscience, Universiti Putra Malaysia, Serdang 43400, Malaysia
| | - David Perera
- Institute of Health and Community Medicine, Universiti Malaysia Sarawak, Kota Samarahan 94300, Malaysia;
| | - I-Ching Sam
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia; (X.H.T.); (I.-C.S.)
| | - Yoke Fun Chan
- Department of Medical Microbiology, Faculty of Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia; (X.H.T.); (I.-C.S.)
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Aizawa Y, Kasamatsu T, Nagasawa K, Watanabe K, Saitoh A. Molecular Evolution and Epidemiology of Parechovirus-A3 in Japan, 1997-2019. J Infect Dis 2023; 227:288-294. [PMID: 35608411 DOI: 10.1093/infdis/jiac213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/16/2022] [Accepted: 05/20/2022] [Indexed: 01/14/2023] Open
Abstract
Parechovirus-A3 (PeV-A3), first reported in 2004 in Japan, is an emerging pathogen that causes sepsis and meningoencephalitis in neonates and young infants. Although PeV-A3 has been identified worldwide, its epidemiological characteristics differ by region. To investigate the molecular evolution and epidemiology of PeV-A3, we performed genetic analyses of 131 PeV-A3 strains from the years 1997-2019 in Niigata, Japan. During 2016-2019, annual numbers remained steady, in contrast to the PeV-A3 epidemic interval of every 2-3 years that was observed in Japan from 2006. Bayesian evolutionary analysis of the complete viral protein 1 region revealed alternate dominant clusters during years of PeV-A3 epidemics. The branch including the oldest and first isolated PeV-A3 strains in Japan has been disrupted since 2001. The year of PeV-A3 emergence was estimated to be 1991. Continuous surveillance with genetic analyses of different regions will improve understanding of PeV-A3 epidemiology worldwide.
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Affiliation(s)
- Yuta Aizawa
- Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Takuhiro Kasamatsu
- Department of Medical Technology, Niigata University Graduate School of Health Sciences, Niigata, Japan
| | - Koo Nagasawa
- Chiba Cancer Center Research Institute, Chiba, Japan
| | - Kanako Watanabe
- Department of Medical Technology, Niigata University Graduate School of Health Sciences, Niigata, Japan
| | - Akihiko Saitoh
- Department of Pediatrics, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
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Shi Y, Chen P, Bai Y, Xu X, Liu Y. Seroprevalence of coxsackievirus A6 and enterovirus A71 infection in humans: a systematic review and meta-analysis. Arch Virol 2023; 168:37. [PMID: 36609748 PMCID: PMC9825098 DOI: 10.1007/s00705-022-05642-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 10/25/2022] [Indexed: 01/09/2023]
Abstract
Hand, foot, and mouth disease (HFMD) is a common infectious disease in children. Enterovirus A71 (EV-A71) is one of the main pathogens, and coxsackievirus A6 (CVA6) has gradually become the dominant pathogen of HFMD in recent years. This study was conducted mainly to assess the serological prevalence of EV-A71 and CVA6 antibodies in people of different ages, sexes, and regions through a systematic review and meta-analysis. A comprehensive study was performed based on the EV-A71 and CVA6 serological literature published before May 2022. Heterogeneity analysis (Cochrane's Q test and the I2 statistic) and random effect models were adopted. Subgroup and meta-regression analyses were used to identify potential sources of heterogeneity in the data, and all analysis was performed using STATA version 16.0. This study included 71 studies involving 55,176 people from 13 countries that met the inclusion criteria. The serological prevalence of EV-A71 antibody in different studies was 4.31-88.8%, and that of CVA6 antibody was 40.8-80.9%. Meta-analysis results showed that the serum positive rate for EV-A71 antibody was 45.9% (95% CI: 37.6-54.1%). The rate in the Chinese population was 47.8% (95% CI: 42.4-53.2%), and in the other countries, it was 38% (95% CI: 23-55%). The serum positive rate for CVA6 antibody was 58.3% (95% CI: 46.5-70.2%). The rate in the Chinese population was 49.1% (95% CI: 38.3-59.9%), and in the other countries, it was 68% (95% CI: 51-83%). Subgroup analysis was also conducted. The seroprevalence of EV-A71 and CVA6 antibodies is related to age rather than gender or region. The rates of EV-A71 and CVA6 seropositivity are considerably lower in children younger than five years of age. However, the rates gradually increase with age. The findings of this study suggest that children under five years of age may be susceptible to EV-A71 and CVA6. Thus, safety education and vaccination should be strengthened accordingly. This study provides a basis for understanding the risk factors for EV-A71 and CVA6 infection in China and for deciding how to formulate standard preventive measures to prevent the spread of the virus.
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Affiliation(s)
- Yingying Shi
- Department of Immunology, School of Medicine, Jianghan University, Wuhan, Hubei, China
| | - Peiqing Chen
- Department of Immunology, School of Medicine, Jianghan University, Wuhan, Hubei, China
| | - Yijing Bai
- Department of Immunology, School of Medicine, Jianghan University, Wuhan, Hubei, China
| | - Xuan Xu
- Department of Immunology, School of Medicine, Jianghan University, Wuhan, Hubei, China
| | - Yongjuan Liu
- Department of Central Laboratory, The Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, 222000, Jiangsu, China.
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10
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Xie Y, Hu Q, Jiang W, Ji W, Chen S, Jin Y, Duan G. Laboratory Indicators for Identifying Hand, Foot, and Mouth Disease Severity: A Systematic Review and Meta-Analysis. Vaccines (Basel) 2022; 10:1829. [PMID: 36366337 PMCID: PMC9694715 DOI: 10.3390/vaccines10111829] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2022] [Revised: 10/27/2022] [Accepted: 10/27/2022] [Indexed: 10/21/2023] Open
Abstract
OBJECTIVE The purpose of this study is to study laboratory indicators for the identification of hand, foot, and mouth disease (HFMD) severity. METHODS We searched PubMed, Embase, and the Web of Science for literature that was published before May 2022. The main results are presented as forest plots. Subgroup analyses, sensitivity analyses, and publication bias were also performed. RESULTS Our study indicated that white blood cells (WBC) (95%CI: 0.205-0.778), blood glucose (95%CI: 0.505-0.778), lymphocytes (95%CI: 0.072-0.239), creatinine (95%CI: 0.024-0.228), interleukin (IL)-2 (95%CI: 0.192-1.642), IL-6 (95%CI: 0.289-0.776), IL-8 (95%CI: 0.499-0.867), IL-10 (95%CI: 0.226-0.930), interferon-γ (IFN-γ) (95%CI: 0.193-2.584), tumor necrosis factor-α (TNF-α) (95%CI: 1.078-2.715), and creatine kinase MB isoenzyme (CK-MB) (95%CI: 0.571-1.459) were associated with an increased risk of HFMD severity, and the results of the sensitivity analysis of these indicators were stable and free of publication bias. CONCLUSIONS Our results suggest that various deleterious immune and metabolic changes can increase the risk of HFMD severity, which can provide a basis for predicting the prognosis and useful evidence for clinicians to manage patients efficiently.
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Affiliation(s)
- Yaqi Xie
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Quanman Hu
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Wenjie Jiang
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Wangquan Ji
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou 450001, China
| | - Shuaiyin Chen
- Department 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
- Henan Key Laboratory of Molecular Medicine, Zhengzhou University, Zhengzhou 450001, China
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11
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Rajamoorthy Y, Tin OH, Taib NM, Munusamy S, Wagner AL, Mudatsir M, Khin AA, Anwar S, Sidique SF, Harapan H. Parents’ knowledge and awareness towards hand foot mouth disease in Malaysia: A survey in Selangor. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2022. [DOI: 10.1016/j.cegh.2022.101027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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12
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A novel subgenotype C6 Enterovirus A71 originating from the recombination between subgenotypes C4 and C2 strains in mainland China. Sci Rep 2022; 12:593. [PMID: 35022489 PMCID: PMC8755819 DOI: 10.1038/s41598-021-04604-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/21/2021] [Indexed: 12/18/2022] Open
Abstract
Recombination plays important roles in the genetic diversity and evolution of Enterovirus A71 (EV-A71). The phylogenetics of EV-A71 in mainland China found that one strain DL71 formed a new subgenotype C6 with unknown origin. This study investigated the detailed genetic characteristics of the new variant. DL71 formed a distinct cluster within genotype C based on the genome and individual genes (5′UTR, VP4, VP1, 2A, 2B, 2C, 3D, and 3′UTR). The average genetic distances of the genome and individual genes (VP3, 2A, 2B, 2C, 3A, 3C, and 3D) between DL71 and reference strains were greater than 0.1. Nine recombination events involving smaller fragments along DL71 genome were detected. The strains Fuyang-0805a (C4) and Tainan/5746/98 (C2) were identified as the parental strains of DL71. In the non-recombination regions, DL71 had higher identities with Fuyang-0805a than Tainan/5746/98, and located in the cluster with C4 strains. However, in the recombination regions, DL71 had higher identities with Tainan/5746/98 than Fuyang-0805a, and located in the cluster with C2 strains. Thus, DL71 was a novel multiple inter-subgenotype recombinant derived from the dominant subgenotype C4 and the sporadic subgenotype C2 strains. Monitoring the emergence of new variants by the whole-genome sequencing remains essential for preventing disease outbreaks and developing new vaccines.
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13
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Chan YF, Sam IC, Nayan E, Tan XH, Yogarajah T. Seroepidemiology of enterovirus D68 infection in Kuala Lumpur, Malaysia between 2013 and 2015. J Med Virol 2021; 94:2607-2612. [PMID: 34617599 DOI: 10.1002/jmv.27381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 08/27/2021] [Accepted: 10/05/2021] [Indexed: 11/11/2022]
Abstract
Enterovirus D68 (EV-D68) is an emerging respiratory pathogen since the 2014 outbreak in the United States. A low level of virus circulation has been reported in Kuala Lumpur, Malaysia, in the past. However, the extent of the infection in Malaysia is not known. In the present study, we determine the seroepidemiology of EV-D68 in Kuala Lumpur, Malaysia, before and after the United States outbreak in August 2014. A luciferase-based seroneutralization test was developed using a clone-derived prototype Fermon strain carrying a nanoluciferase marker. We screened the neutralization capacity of 450 serum samples from children and adults (1-89 years old) collected between 2013 and 2015. EV-D68 seropositivity increased with age, with children aged 1-3 showing significantly lower seroprevalence compared to adults. Multivariate analysis showed that older age groups 13-49 years (odds ratio [OR] = 4.78; 95% confidence interval [CI] = 2.69-8.49; p < 0.0001) and ≥50 years (OR = 3.83; 95% CI = 2.19-6.68; p < 0.0001) were more likely to be EV-D68 seropositive than children <13 years. Sampling post-September 2014 compared to pre-Sept 2014 also predicted seropositivity (OR = 1.66; 95% CI = 1.04-2.65). The presence of neutralizing antibodies against EV-D68 in the study population suggests that EV-D68 was circulating before 2014. A higher seropositivity post-September 2014 suggests that Malaysia also experienced an upsurge in EV-D68 infections after the United States outbreaks in August 2014. A low seropositivity rate observed in children, especially those aged 1-3 years old, suggests that they are at risk and should be prioritized for future vaccination.
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Affiliation(s)
- Yoke Fun Chan
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - I-Ching Sam
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Elena Nayan
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Xiu Hui Tan
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Thinesshwary Yogarajah
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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14
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Fong SY, Mori D, Rundi C, Yap JF, Jikal M, Latip ALLBA, Johnny V, Ahmed K. A five-year retrospective study on the epidemiology of hand, foot and mouth disease in Sabah, Malaysia. Sci Rep 2021; 11:17814. [PMID: 34497287 PMCID: PMC8426372 DOI: 10.1038/s41598-021-96083-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Accepted: 07/27/2021] [Indexed: 11/19/2022] Open
Abstract
Hand, foot, and mouth disease (HFMD) is endemic in Malaysia, with the number of cases increasing. Sabah has experienced several HFMD outbreaks, but information on the epidemiology and molecular characteristics of responsible viruses is scarce. In this study, data of 17,574 reports of HFMD cases in Sabah from 2015 to 2019 were extracted from a public health disease surveillance system and analyzed. Twenty-one swab samples from 13 children were collected from Beaufort, Sabah, during an outbreak in August 2018 for detection and serotyping of causative viruses by semi-nested reverse transcription-polymerase chain reaction (snRT-PCR) of the VP4–VP2 region and consensus degenerate hybrid oligonucleotide primer PCR of the VP1 region, respectively. Nucleotide sequencing and phylogenetic analysis were conducted by the neighbor-joining method. The average annual incidence of HFMD was 94.3 per 100,000 people, with the greatest yearly increase between 2017 and 2018. Swabs from six children were tested positive for enterovirus, of which five were positive for CVA16 and one for EV71. All CVA16 strains belonged to sub-genotype B1a, and the EV71 strain belonged to sub-genotype B5. Phylogenetic analyses indicate that enterovirus genotype shift might be responsible for the increasing trend of HFMD in Sabah, however, further study is needed.
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Affiliation(s)
- Siat Yee Fong
- Borneo Medical and Health Research Centre, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Jalan UMS, 88400, Kota Kinabalu, Sabah, Malaysia.,Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Jalan UMS, 88400, Kota Kinabalu, Sabah, Malaysia
| | - Daisuke Mori
- Department of Pathology and Microbiology, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Jalan UMS, 88400, Kota Kinabalu, Sabah, Malaysia
| | - Christina Rundi
- Sabah State Health Department, Ministry of Health Malaysia, Jalan Mat Salleh, 88590, Kota Kinabalu, Sabah, Malaysia
| | - Jun Fai Yap
- Sabah State Health Department, Ministry of Health Malaysia, Jalan Mat Salleh, 88590, Kota Kinabalu, Sabah, Malaysia
| | - Muhammad Jikal
- Sabah State Health Department, Ministry of Health Malaysia, Jalan Mat Salleh, 88590, Kota Kinabalu, Sabah, Malaysia
| | - A L Liza Binti Abd Latip
- Beaufort Health Office, Ministry of Health Malaysia, Pekan Beaufort, 89800, Beaufort, Sabah, Malaysia
| | - Victor Johnny
- Sabah State Health Department, Ministry of Health Malaysia, Jalan Mat Salleh, 88590, Kota Kinabalu, Sabah, Malaysia
| | - Kamruddin Ahmed
- Borneo Medical and Health Research Centre, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Jalan UMS, 88400, Kota Kinabalu, Sabah, Malaysia. .,Department of Pathology and Microbiology, Faculty of Medicine and Health Sciences, Universiti Malaysia Sabah, Jalan UMS, 88400, Kota Kinabalu, Sabah, Malaysia.
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15
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Analysis of the Complete Genomes of Enterovirus 71 Subtypes in China. CANADIAN JOURNAL OF INFECTIOUS DISEASES & MEDICAL MICROBIOLOGY 2021; 2021:5564099. [PMID: 34484496 PMCID: PMC8416384 DOI: 10.1155/2021/5564099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 08/02/2021] [Accepted: 08/17/2021] [Indexed: 11/18/2022]
Abstract
Enterovirus 71 (EV-A71) is one of the most pathogens to hand, foot, and mouth disease (HFMD) as well as neurological complications in young children. Molecular characteristic of EV-A71 is important to prevent the virus outbreak. Here, the complete genomes of EV-A71 from China between 1998 and 2019 were downloaded from GenBank. The phylogenetic trees were developed by MEGA7.0 software, and the complete genetic epidemiological characteristics and amino acid mutations of EV-A71 from China were also analysed. The results showed that major epidemic EV-A71 subtype was C4b before 2004, while it turned to C4a after 2004 in mainland China, and C4 and B5 were major subtypes in Taiwan. VP1, VP4, 2C, 3C, 3D, and complete genome sequence can be used for virus genotyping, and VP1, VP4, and complete genomes have obvious advantages over other segments. There were many significant mutations in the viral complete genome sequence. This study indicated that the major C4 and B5 subtypes will contribute to the development of vaccines and drugs of EV-A71 for prevention and monitoring of EV-A71-associated HFMD in China.
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16
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Abdul Wahid NA, Suhaila J, Rahman HA. Effect of climate factors on the incidence of hand, foot, and mouth disease in Malaysia: A generalized additive mixed model. Infect Dis Model 2021; 6:997-1008. [PMID: 34466760 PMCID: PMC8379622 DOI: 10.1016/j.idm.2021.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 07/15/2021] [Accepted: 08/08/2021] [Indexed: 12/09/2022] Open
Abstract
Climate change is one of the critical determinants affecting life cycles and transmission of most infectious agents, including malaria, cholera, dengue fever, hand, foot, and mouth disease (HFMD), and the recent Corona-virus pandemic. HFMD has been associated with a growing number of outbreaks resulting in fatal complications since the late 1990s. The outbreaks may result from a combination of rapid population growth, climate change, socioeconomic changes, and other lifestyle changes. However, the modeling of climate variability and HFMD remains unclear, particularly in statistical theory development. The statistical relationship between HFMD and climate factors has been widely studied using generalized linear and additive modeling. When dealing with time-series data with clustered variables such as HFMD with clustered states, the independence principle of both modeling approaches may be violated. Thus, a Generalized Additive Mixed Model (GAMM) is used to investigate the relationship between HFMD and climate factors in Malaysia. The model is improved by using a first-order autoregressive term and treating all Malaysian states as a random effect. This method is preferred as it allows states to be modeled as random effects and accounts for time series data autocorrelation. The findings indicate that climate variables such as rainfall and wind speed affect HFMD cases in Malaysia. The risk of HFMD increased in the subsequent two weeks with rainfall below 60 mm and decreased with rainfall exceeding 60 mm. Besides, a two-week lag in wind speeds between 2 and 5 m/s reduced HFMD's chances. The results also show that HFMD cases rose in Malaysia during the inter-monsoon and southwest monsoon seasons but fell during the northeast monsoon. The study's outcomes can be used by public health officials and the general public to raise awareness, and thus, implement effective preventive measures.
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Affiliation(s)
- Nurmarni Athirah Abdul Wahid
- Department of Mathematical Sciences, Faculty of Science, Universiti Teknologi Malaysia, 81310, Johor Bahru, Johor, Malaysia
| | - Jamaludin Suhaila
- Department of Mathematical Sciences, Faculty of Science, Universiti Teknologi Malaysia, 81310, Johor Bahru, Johor, Malaysia.,UTM Centre for Industrial and Applied Mathematics (UTM-CIAM), Ibnu Sina Institute for Scientific and Industrial Research, Universiti Teknologi Malaysia, 81310, Johor Bahru, Johor, Malaysia
| | - Haliza Abd Rahman
- Department of Mathematical Sciences, Faculty of Science, Universiti Teknologi Malaysia, 81310, Johor Bahru, Johor, Malaysia
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17
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Zarif F, Anasir MI, Koh JX, Chew MF, Poh CL. Stability and antiviral activity of SP40 peptide in human serum. Virus Res 2021; 303:198456. [PMID: 34314773 DOI: 10.1016/j.virusres.2021.198456] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 04/29/2021] [Accepted: 05/15/2021] [Indexed: 12/27/2022]
Abstract
Enterovirus A71 (EV-A71) is one of the main causative agents of hand, foot and mouth disease (HFMD). SP40 peptide was previously identified to inhibit EV-A71 strains from genotypes A, B and C. However, the stability and antiviral activity of SP40 peptide in human serum are yet to be established. To address this, we evaluated the stability and anti-EV-A71 activity of SP40 peptide after incubation in 25 % human serum. Reverse-phase high-performance liquid chromatography (RP-HPLC) and liquid chromatography-mass spectrometry (LC/MS) were utilized to evaluate serum stability and cleavage patterns of SP40 peptide after incubation in human serum. Cell protection assay was used to evaluate the anti-EV-A71 activity of SP40 peptide after incubation in human serum and to identify the minimal active sequence of SP40 peptide that retained antiviral activity. The results showed that the SP40 peptide was stable in human serum with 56 % of the full-length SP40 peptide being detected after 48 h incubation in human serum. The SP40 peptide was mainly cleaved by exopeptidases and no endoprotease recognition sites were identified within the SP40 peptide. Cell protection assays revealed that the SP40 peptide retained substantial activity after 24 and 48 h incubation in human serum. Furthermore, the data revealed that three amino acids at the N-terminus and one amino acid at the C-terminus of the SP40 peptide were dispensable for its antiviral activity. Importantly, the four truncated peptides displayed better potency than the full-length SP40 peptide. Overall, this study provided insights into the stability and activity of SP40 peptide in human serum and will facilitate the development of SP40 peptide as an anti-EV-A71 agent.
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Affiliation(s)
- Faisal Zarif
- Centre for Virus and Vaccine Research, Sunway University, Bandar Sunway, Malaysia; School of Medical and Life Sciences, Sunway University, Bandar Sunway, Malaysia
| | - Mohd Ishtiaq Anasir
- Centre for Virus and Vaccine Research, Sunway University, Bandar Sunway, Malaysia; School of Medical and Life Sciences, Sunway University, Bandar Sunway, Malaysia; Virology Unit, Infectious Disease Research Center, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Selangor, Malaysia
| | - Jia Xuen Koh
- Centre for Virus and Vaccine Research, Sunway University, Bandar Sunway, Malaysia; School of Medical and Life Sciences, Sunway University, Bandar Sunway, Malaysia
| | - Miaw-Fang Chew
- Centre for Virus and Vaccine Research, Sunway University, Bandar Sunway, Malaysia
| | - Chit Laa Poh
- Centre for Virus and Vaccine Research, Sunway University, Bandar Sunway, Malaysia; School of Medical and Life Sciences, Sunway University, Bandar Sunway, Malaysia.
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18
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Xu T, Li Y, Wu HL, Chen H, Wu H, Guo M, Zhao M, Wang C, Lin T, Lin Z, Chen D, Xiang W, Zhu B. The inhibition of enterovirus 71 induced apoptosis by Durvillaea antarctica through P53 and STAT1 signaling pathway. J Med Virol 2021; 93:3532-3538. [PMID: 33230830 DOI: 10.1002/jmv.26693] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 11/20/2020] [Accepted: 11/21/2020] [Indexed: 12/14/2022]
Abstract
The infection of enterovirus 71 (EV71) resulted in hand, foot, and mouth disease and may lead to severe nervous system damage and even fatalities. There are no effective drugs to treat the EV71 virus and it is crucial to find novel drugs against it. Polysaccharide isolated from Durvillaea antarctica green algae has an antiviral effect. In this study, D. antarctica polysaccharide (DAPP) inhibited the infection of EV71 was demonstrated by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT), reverse transcription polymerase chain reaction, flow cytometry, and western blot. MTT assay showed that DAPP had no toxicity on Vero cells at the concentration 250 μg/ml. Furthermore, DAPP significantly reduced the RNA level of EV71 in a dose-dependent manner. Moreover, DAPP inhibited the Vero cells apoptosis induced by EV71 via the P53 signaling pathway. Meanwhile, the expression of signal transducer and activator of transcription 1 and mammalian target of rapamycin were increased and the proinflammatory cytokines were significantly inhibited by DAPP. Taken together, these results suggested that DAPP could be a potential pharmaceutical against the infection of EV71 virus.
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Affiliation(s)
- Tiantian Xu
- Center Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yinghua Li
- Center Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Hua-Lian Wu
- CAS Key Laboratory of Tropical Marine Bio-Resources and Ecology, Guangdong Key Laboratory of Marine Materia Medica, Institution of South China Sea Ecology and Environmental Engineering, RNAM Center for Marine Microbiology, South China Sea Institute of Oceanology, Chinese Academy of Sciences, Guangzhou, China
| | - Haiyang Chen
- Center Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Houbo Wu
- CAS Key Laboratory of Tropical Marine Bio-Resources and Ecology, Guangdong Key Laboratory of Marine Materia Medica, Institution of South China Sea Ecology and Environmental Engineering, RNAM Center for Marine Microbiology, South China Sea Institute of Oceanology, Chinese Academy of Sciences, Guangzhou, China
| | - Min Guo
- Center Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Mingqi Zhao
- Center Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Changbing Wang
- Center Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Tao Lin
- Center Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Zhengfang Lin
- Center Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Danyang Chen
- Center Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Wenzhou Xiang
- CAS Key Laboratory of Tropical Marine Bio-Resources and Ecology, Guangdong Key Laboratory of Marine Materia Medica, Institution of South China Sea Ecology and Environmental Engineering, RNAM Center for Marine Microbiology, South China Sea Institute of Oceanology, Chinese Academy of Sciences, Guangzhou, China
| | - Bing Zhu
- Center Laboratory, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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19
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Incidence of Infection of Enterovirus 71 and Coxsackieviruses A6 and A16 among Household Contacts of Index Cases in Dong Thap Province, Southern Vietnam. BIOMED RESEARCH INTERNATIONAL 2021; 2020:9850351. [PMID: 33274234 PMCID: PMC7695493 DOI: 10.1155/2020/9850351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 09/03/2020] [Accepted: 11/03/2020] [Indexed: 11/30/2022]
Abstract
Background Scarce information exists about immunity to hand, foot, and mouth disease (HFMD) among household contacts of index cases in Vietnam and what that means for reducing ongoing HFMD transmission in the community. Methods We analyzed neutralizing antibodies (NT) and the incidence of enterovirus (EVs) infection among household contacts of index cases in a province where HFMD remains endemic. Throat swab and 2 mL blood samples from household contacts were collected at enrollment, during and after 2 weeks follow-up. Results The incidence of EV-A71 infection among household contacts was 40/84 (47.6%, 95% Cl: 36.9-58.3%), compared with 106/336 (31.5%, 95% Cl: 26.6-36.5%) for CV-A6 and 36/107 (33.6%, 95% Cl: 24.7-42.6%) for CV-A16. The incidence of CV-A6 infection was fairly constant across ages; in contrast, CV-A71 and CV-A16 had some variation across ages. At baseline, higher geometric mean titer (GMT) of EV-A71, CV-A6, and CV-A16 antibody titers was found for 25-34-year groups (range 216.3 to 305.0) compared to the other age groups. There was a statistically significant difference in GMT values of CV-A6 and CV-A16 between those who had an infection or did not have infection among households with an index case of these serotypes. Conclusions Our results indicated that adults were becoming infected with HFMD and could be contributing to the transmission. There is, therefore, a need for considering the household setting as an additional target for intervention programs for HFMD.
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Tang J, Zhang Z, Zhang Z, Huang H, Du T, Wang X, Yan L, Rao Q, Yang J, Wang M, Shen R, Sun Q, Jiang H. Two cases of hand, foot and mouth disease caused by enterovirus A71 after vaccination. Int J Infect Dis 2021; 108:190-197. [PMID: 33737136 DOI: 10.1016/j.ijid.2021.03.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/04/2021] [Accepted: 03/11/2021] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND Enterovirus A71 (EVA71) is one of the main pathogens causing hand, foot and mouth disease (HFMD). In China, the proportion of cases of HFMD caused by EVA71 is known to be significantly lower following EVA71 vaccination; however, infection with EVA71 can still occur after vaccination. METHODS The complete genomic sequences of EVA71-KM18A and KM18B (from two rare cases of EVA71 infection following vaccination) were obtained. Phylogenetic analysis, nucleotide mutation analysis, recombinant analysis and comparative analysis of amino acid mutations were performed. RESULTS Phylogenetic analysis determined that the EVA71 strains belonged to the C4a subgenotype. The KM18A and KM18B strains were highly similar to the vaccine strains. For the KM18B strain, there were some obvious homologous recombination signals in the 5'non-coding region, region 2A, region 2C and region 3D. Amino acid mutations were observed in the SP55 (position 729) and 71-6 (position 500) conformational neutralizing epitopes of the KM18A and KM18B strains. CONCLUSIONS These amino acid mutations may affect the SP55 and 71-6 conformational neutralizing epitopes and change their spatial conformation, thereby weakening vaccine effectiveness.
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Affiliation(s)
- Jiaolian Tang
- Institute of Paediatrics, The Kunming Children's Hospital of Kunming Medical University, Kunming, PR China; Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, PR China
| | - Zhilei Zhang
- Institute of Paediatrics, The Kunming Children's Hospital of Kunming Medical University, Kunming, PR China
| | - Zhen Zhang
- Institute of Paediatrics, The Kunming Children's Hospital of Kunming Medical University, Kunming, PR China; Yunnan Key Laboratory of Children's Major Disease Research, Kunming, PR China
| | - Hailing Huang
- Department of Laboratory, The Kunming Children's Hospital, Kunming, PR China
| | - Tingyi Du
- Department of Laboratory, The Kunming Children's Hospital, Kunming, PR China
| | - Xiaodan Wang
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, PR China; Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming, PR China
| | - Lingmei Yan
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, PR China; Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming, PR China
| | - Qin Rao
- Institute of Paediatrics, The Kunming Children's Hospital of Kunming Medical University, Kunming, PR China
| | - Jinghui Yang
- Department of Paediatrics, The First People's Hospital of Yunnan Province, Kunming, PR China
| | - Meifeng Wang
- Institute of Paediatrics, The Kunming Children's Hospital of Kunming Medical University, Kunming, PR China
| | - Ru Shen
- Department of Laboratory, The Kunming Children's Hospital, Kunming, PR China
| | - Qiangming Sun
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, PR China; Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming, PR China.
| | - Hongchao Jiang
- Institute of Paediatrics, The Kunming Children's Hospital of Kunming Medical University, Kunming, PR China; Yunnan Key Laboratory of Children's Major Disease Research, Kunming, PR China.
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Lee MHP, Tan CW, Tee HK, Ong KC, Sam IC, Chan YF. Vaccine candidates generated by codon and codon pair deoptimization of enterovirus A71 protect against lethal challenge in mice. Vaccine 2021; 39:1708-1720. [PMID: 33640144 DOI: 10.1016/j.vaccine.2021.02.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 02/01/2021] [Accepted: 02/10/2021] [Indexed: 11/25/2022]
Abstract
Enterovirus A71 (EV-A71) causes hand, foot and mouth disease (HFMD) in young children. It is associated with severe neurological complications and death. This study aims to develop a live-attenuated vaccine by codon deoptimization (CD) and codon-pair deoptimization (CPD) of EV-A71. CD is generated by introducing the least preferred codons for amino acids while CPD increases the presence of underrepresented codon pairs in the specific genes. CD and CPD chimeras were generated by synonymous mutations at the VP2, VP3, VP1 and 2A gene regions, designated as XYZ. All twelve deoptimized viruses were viable with similar replication kinetics, but the plaque sizes were inversely proportional to the level of deoptimization. All the deoptimized viruses showed attenuated growth in vitro with reduced viral protein expression at 48 h and lower viral RNA at 39 °C. Six-week-old ICR mice were immunized intraperitoneally with selected CD and CPD X and XY vaccine candidates covering the VP2-VP3 and VP2-VP3-VP1 genes, respectively. All vaccine candidates elicited high anti-EV-A71 IgG levels similar to wild-type (WT) EV-A71. The CD X and CPD X vaccines produced robust neutralizing antibodies but not the CD XY and CPD XY. On lethal challenge, offspring of mice immunized with WT, CD X and CPD X were fully protected, but the CD XY- and CPD XY-vaccinated mice had delayed symptoms and eventually died. Similarly, active immunization of 1-day-old suckling mice with CD X, CPD X and CD XY vaccine candidates provided complete immune protection but CPD XY only protected 40% of the challenged mice. Histology of the muscles from CD X- and CPD X-vaccinated mice showed minimal pathology compared to extensive inflammation in the post-challenged mock-vaccinated mice. Overall, we demonstrated that the CD X and CPD X elicited good neutralizing antibodies, conferred immune protection and are promising live-attenuated vaccine candidates for EV-A71.
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Affiliation(s)
- Michelle Hui Pheng Lee
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Chee Wah Tan
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Han Kang Tee
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Kien Chai Ong
- Department of Biomedical Science, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - I-Ching Sam
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
| | - Yoke Fun Chan
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
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22
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Xu J, Yang M, Zhao Z, Wang M, Guo Z, Zhu Y, Rui J, Wang Y, Liu X, Lin S, Luo L, Su Y, Zhao B, Zhou Y, Frutos R, Chen T. Meteorological Factors and the Transmissibility of Hand, Foot, and Mouth Disease in Xiamen City, China. Front Med (Lausanne) 2021; 7:597375. [PMID: 33553200 PMCID: PMC7862718 DOI: 10.3389/fmed.2020.597375] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 12/30/2020] [Indexed: 11/18/2022] Open
Abstract
Background: As an emerging infectious disease, the prevention and control of hand, foot, and mouth disease (HFMD) poses a significant challenge to the development of public health in China. In this study, we aimed to explore the mechanism of the seasonal transmission characteristics of HFMD and to reveal the correlation and potential path between key meteorological factors and the transmissibility of HFMD. Methods: Combined with daily meteorological data such as average temperature, average relative humidity, average wind velocity, amount of precipitation, average air pressure, evaporation capacity, and sunshine duration, a database of HFMD incidence and meteorological factors was established. Spearman rank correlation was used to calculate the correlation between the various meteorological factors and the incidence of HFMD. The effective reproduction number (R eff ) of HFMD was used as an intermediate variable to further quantify the dynamic relationship between the average temperature and R eff . Results: A total of 43,659 cases of HFMD were reported in Xiamen from 2014 to 2018. There was a significantly positive correlation between the average temperature and the incidence of HFMD (r = 0.596, p < 0.001), and a significantly negative correlation between the average air pressure and the incidence of HFMD (r = -0.511, p < 0.001). There was no correlation between the average wind velocity (r = 0.045, p > 0.05) or amount of precipitation (r = 0.043, p > 0.05) and incidence. There was a temperature threshold for HFMD's transmissibility. Owing to the seasonal transmission characteristics of HFMD in Xiamen, the temperature threshold of HFMD's transmissibility was 13.4-18.4°C and 14.5-29.3°C in spring and summer and in autumn and winter, respectively. Conclusions: HFMD's transmissibility may be affected by the average temperature; the temperature threshold range of transmissibility in autumn and winter is slightly wider than that in spring and summer. Based on our findings, we suggest that the relevant epidemic prevention departments should pay close attention to temperature changes in Xiamen to formulate timely prevention strategies before the arrival of the high-risk period.
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Affiliation(s)
- Jingwen Xu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, China
| | - Meng Yang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, China
| | - Zeyu Zhao
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, China
| | - Mingzhai Wang
- Xiamen Center for Disease Control and Prevention, Xiamen City, China
| | - Zhinan Guo
- Xiamen Center for Disease Control and Prevention, Xiamen City, China
| | - Yuanzhao Zhu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, China
| | - Jia Rui
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, China
| | - Yao Wang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, China
| | - Xingchun Liu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, China
| | - Shengnan Lin
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, China
| | - Li Luo
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, China
| | - Yanhua Su
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, China
| | - Benhua Zhao
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, China
| | - Yulin Zhou
- United Diagnostic and Research Center for Clinical Genetics, Women and Children's Hospital, School of Medicine & School of Public Health, Xiamen University, Xiamen City, China
| | - Roger Frutos
- Agricultural Research Centre for International Development, Intertryp, Montpellier, France
- Institut d'Electronique et des Systèmes, Université de Montpellier-Centre National de la Recherche Scientifique, Montpellier, France
| | - Tianmu Chen
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, China
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23
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Yi X, Chang Z, Zhao X, Ma Y, Liu F, Xiao X. The temporal characteristics of the lag-response relationship and related key time points between ambient temperature and hand, foot and mouth disease: A multicity study from mainland China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 749:141679. [PMID: 32836135 DOI: 10.1016/j.scitotenv.2020.141679] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/26/2020] [Accepted: 08/11/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Previous studies have thoroughly elucidated the exposure-response relationship between ambient temperature and hand, foot, and mouth disease (HFMD), whereas very little concern has been to the lag-response relationship and related key time points. OBJECTIVES We aimed to clarify the temporal characteristics of the lag-response relationship between ambient temperature and HFMD and how they may vary spatially. METHODS We retrieved the daily time series of meteorological variables and HFMD counts for 143 cities in mainland China between 2009 and 2014. We estimated the city-specific lag-response curve between ambient temperature and HFMD and related key time points by applying common distributed lag nonlinear models (DLNM) and Monte Carlo simulation methods. Then, we pooled the city-specific estimates by performing a meta-regression with the city-specific characteristics as meta-predictors to explain the potential spatial heterogeneity. RESULTS We found a robust lag pattern between temperature and HFMD for different levels of temperatures. The temporal change of risk obtained its maximum value on the current day but dropped sharply thereafter and then rebounded to a secondary peak, which implied the presence of a harvesting effect. By contrast, the estimation of key time points showed substantial heterogeneity, especially at high temperature (the I2 statistics ranged from 47% to 80%). With one unit increase in the geographic index, the secondary peak would arrive 0.37 (0.02, 0.71) days later. With one unit increase in the economic index and climatic index, the duration time of the lag-response curve would be lengthened by 0.36 (0.1, 0.62) and 0.92 (0.54, 1.29) days, respectively. CONCLUSION Our study examined the lag pattern and spatial heterogeneity of the lag-response relationship between temperature and HFMD. Those findings gave us new insights into the complex association and the related mechanisms between weather and HFMD and important information for weather-based disease early warning systems.
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Affiliation(s)
- Xiaowei Yi
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Zhaorui Chang
- Division of Infectious Disease & Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Xing Zhao
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Yue Ma
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China
| | - Fengfeng Liu
- Division of Infectious Disease & Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Xiong Xiao
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, China.
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24
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Tengku Jamaluddin TZM, Mohamed NA, Mohd Rani MD, Ismail Z, Ramli S, Faroque H, Abd Samad FN, Ariffien AR, Che Amir Farid AAR, Isahak I. Assessment on Hand Hygiene Knowledge and Practices Among Pre-school Children in Klang Valley. Glob Pediatr Health 2020; 7:2333794X20976369. [PMID: 33335950 PMCID: PMC7724414 DOI: 10.1177/2333794x20976369] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 06/03/2020] [Accepted: 06/09/2020] [Indexed: 12/01/2022] Open
Abstract
Background. Pre-school children are at a higher risk to acquire
infectious diseases such as hand, foot and mouth disease due to their immature
immune system. Good hand hygiene prevents transmission of infectious diseases.
This study aimed to determine the knowledge and practices of hand hygiene among
pre-schoolers. Methods. In this prospective, multi-center
study, the pre-schools were selected according to the selection criteria. A
questionnaire consisting of socio-demographics, knowledge and practices of hand
hygiene were administered via face-to-face interview during the pre- and
post-intervention period. A total of 435 pre-schoolers aged 5 and 6 years old
from 2 pre-schools within Klang Valley, School P (test group) and School C
(control group) were involved in this study. The test group was provided with
comprehensive hand hygiene education including video on proper handwashing
technique during the 2 months intervention period, whereas the control group did
not receive any form of intervention. The data were statistically analyzed using
descriptive analysis and independent t-test.
Results. Majority of pre-schoolers gained knowledge of
handwashing from their parents. However, only 63% demonstrated good handwashing
technique. Test group were significantly better (P < 0.05)
in handwashing technique and hand hygiene routine score.
Conclusion. A comprehensive hand hygiene education program
should include proper handwashing facilities, resources, and awareness of the
care-givers in instilling and sustaining good hand hygiene behavior.
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Affiliation(s)
| | | | | | - Zarini Ismail
- Universiti Sains Islam Malaysia, Pandan Indah, Kuala Lumpur, Malaysia
| | - Shalinawati Ramli
- Universiti Sains Islam Malaysia, Pandan Indah, Kuala Lumpur, Malaysia
| | - Habibah Faroque
- Universiti Sains Islam Malaysia, Pandan Indah, Kuala Lumpur, Malaysia
| | | | | | | | - Ilina Isahak
- Universiti Sains Islam Malaysia, Pandan Indah, Kuala Lumpur, Malaysia
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25
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Brown DM, Zhang Y, Scheuermann RH. Epidemiology and Sequence-Based Evolutionary Analysis of Circulating Non-Polio Enteroviruses. Microorganisms 2020; 8:microorganisms8121856. [PMID: 33255654 PMCID: PMC7759938 DOI: 10.3390/microorganisms8121856] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/13/2020] [Accepted: 11/17/2020] [Indexed: 02/07/2023] Open
Abstract
Enteroviruses (EVs) are positive-sense RNA viruses, with over 50,000 nucleotide sequences publicly available. While most human infections are typically associated with mild respiratory symptoms, several different EV types have also been associated with severe human disease, especially acute flaccid paralysis (AFP), particularly with endemic members of the EV-B species and two pandemic types—EV-A71 and EV-D68—that appear to be responsible for recent widespread outbreaks. Here we review the recent literature on the prevalence, characteristics, and circulation dynamics of different enterovirus types and combine this with an analysis of the sequence coverage of different EV types in public databases (e.g., the Virus Pathogen Resource). This evaluation reveals temporal and geographic differences in EV circulation and sequence distribution, highlighting recent EV outbreaks and revealing gaps in sequence coverage. Phylogenetic analysis of the EV genus shows the relatedness of different EV types. Recombination analysis of the EV-A species provides evidence for recombination as a mechanism of genomic diversification. The absence of broadly protective vaccines and effective antivirals makes human enteroviruses important pathogens of public health concern.
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Affiliation(s)
- David M Brown
- Department of Synthetic Biology, J. Craig Venter Institute, Rockville, MD 20850, USA
| | - Yun Zhang
- Department of Informatics, J. Craig Venter Institute, La Jolla, CA 92037, USA
| | - Richard H Scheuermann
- Department of Informatics, J. Craig Venter Institute, La Jolla, CA 92037, USA
- Department of Pathology, University of California San Diego, La Jolla, CA 92093, USA
- La Jolla Institute for Immunology, La Jolla, CA 92065, USA
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26
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González-Sanz R, Casas-Alba D, Launes C, Muñoz-Almagro C, Ruiz-García MM, Alonso M, González-Abad MJ, Megías G, Rabella N, Del Cuerpo M, Gozalo-Margüello M, González-Praetorius A, Martínez-Sapiña A, Goyanes-Galán MJ, Romero MP, Calvo C, Antón A, Imaz M, Aranzamendi M, Hernández-Rodríguez Á, Moreno-Docón A, Rey-Cao S, Navascués A, Otero A, Cabrerizo M. Molecular epidemiology of an enterovirus A71 outbreak associated with severe neurological disease, Spain, 2016. ACTA ACUST UNITED AC 2020; 24. [PMID: 30782267 PMCID: PMC6381658 DOI: 10.2807/1560-7917.es.2019.24.7.1800089] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Introduction Enterovirus A71 (EV-A71) is an emerging pathogen that causes a wide range of disorders including severe neurological manifestations. In the past 20 years, this virus has been associated with large outbreaks of hand, foot and mouth disease with neurological complications in the Asia-Pacific region, while in Europe mainly sporadic cases have been reported. In spring 2016, however, an EV-A71 outbreak associated with severe neurological cases was reported in Catalonia and spread further to other Spanish regions. Aim Our objective was to investigate the epidemiology and clinical characteristics of the outbreak. Methods We carried out a retrospective study which included 233 EV-A71-positive samples collected during 2016 from hospitalised patients. We analysed the clinical manifestations associated with EV-A71 infections and performed phylogenetic analyses of the 3’-VP1 and 3Dpol regions from all Spanish strains and a set of EV-A71 from other countries. Results Most EV-A71 infections were reported in children (mean age: 2.6 years) and the highest incidence was between May and July 2016 (83%). Most isolates (218/233) were classified as subgenogroup C1 and 217 of them were grouped in one cluster phylogenetically related to a new recombinant variant strain associated with severe neurological diseases in Germany and France in 2015 and 2016. Moreover, we found a clear association of EV-A71-C1 infection with severe neurological disorders, brainstem encephalitis being the most commonly reported. Conclusion An emerging recombinant variant of EV-A71-C1 was responsible for the large outbreak in 2016 in Spain that was associated with many severe neurological cases.
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Affiliation(s)
- Rubén González-Sanz
- Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | | | - Cristian Launes
- CIBER de epidemiología y Salud Pública, CIBERESP, Madrid, Spain.,Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Carmen Muñoz-Almagro
- CIBER de epidemiología y Salud Pública, CIBERESP, Madrid, Spain.,Universitat Internacional de Catalunya, Barcelona, Spain.,Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | | - María Pilar Romero
- Translational Research Network in Paediatric Infectious Diseases (RITIP), IdiPaz, Madrid, Spain.,Hospital Universitario La Paz, Fundación IdiPaz, Madrid, Spain
| | - Cristina Calvo
- Translational Research Network in Paediatric Infectious Diseases (RITIP), IdiPaz, Madrid, Spain.,Hospital Universitario La Paz, Fundación IdiPaz, Madrid, Spain
| | - Andrés Antón
- Hospital Universitari Vall d´Hebron, Barcelona, Spain
| | | | | | - Águeda Hernández-Rodríguez
- Microbiology Service, University Hospital "Germans Trias i Pujol", Department of Genetics and Microbiology, Autonomous University of Barcelona, Badalona, Spain
| | | | | | | | - Almudena Otero
- Translational Research Network in Paediatric Infectious Diseases (RITIP), IdiPaz, Madrid, Spain.,Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
| | - María Cabrerizo
- Translational Research Network in Paediatric Infectious Diseases (RITIP), IdiPaz, Madrid, Spain.,CIBER de epidemiología y Salud Pública, CIBERESP, Madrid, Spain.,Centro Nacional de Microbiología, Instituto de Salud Carlos III, Madrid, Spain
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27
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Won YJ, Kang LH, Lee AR, Paik B, Kim H, Lee SG, Park SW, Hong SJ, Paik SY. Sequence analysis of the first B5 subgenogroup strain of enterovirus 71 isolated in Korea. J Microbiol 2020; 58:422-429. [PMID: 32222942 PMCID: PMC7223378 DOI: 10.1007/s12275-020-9539-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 02/04/2020] [Accepted: 02/13/2020] [Indexed: 11/25/2022]
Abstract
Enterovirus A71 (EV71), the main etiological agent of handfoot- mouth disease (HFMD), circulates in many areas of the world and has caused large epidemics since 1997, especially in the Asia-Pacific region. In this study, we determined the full-genome sequence of CMC718, a newly isolated EV71 strain in Korea. The CMC718 genome was 7,415 nucleotides in length and was confirmed by whole-genome phylogenetic analysis to belong to the B5 genotype. In particular, CMC718 demonstrated maximum identity with strain M988 of the B5 genotype and numerous amino acid variants were detected in the 3D domain of the viral protein P3, which is consistent with the mutation pattern of a B5 strain isolated in 2012–2013. Comparison of the CMC718 sequence with other EV71 reference strains confirmed the relationship and genetic variation of CMC718. Our study was a full-genome sequence analysis of the first EV71 strain of the B5 genotype isolated in South Korea. This information will be a valuable reference for the development of methods for the detection of recombinant viruses, the tracking of infections, and the diagnosis of EV71.
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Affiliation(s)
- Yu Jung Won
- Department of Microbiology, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Lae Hyung Kang
- Department of Microbiology, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Ah Ra Lee
- Department of Microbiology, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Bomina Paik
- Department of Microbiology, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Hyun Kim
- Department of Microbiology, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea
| | - Sung Geun Lee
- Korea Zoonosis Research Institute, Jeonbuk National University, Iksan, 54596, Republic of Korea
| | - Seung Won Park
- Department of Biotechnology, Daegu Catholic University, Gyeongsan-si, Gyeongsangbuk-do, 38430, Republic of Korea
| | - Seung Jin Hong
- Department of Microbiology, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea.
| | - Soon Young Paik
- Department of Microbiology, College of Medicine, The Catholic University of Korea, Seoul, 06591, Republic of Korea.
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28
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He X, Dong S, Li L, Liu X, Wu Y, Zhang Z, Mei S. Using a Bayesian spatiotemporal model to identify the influencing factors and high-risk areas of hand, foot and mouth disease (HFMD) in Shenzhen. PLoS Negl Trop Dis 2020; 14:e0008085. [PMID: 32196496 PMCID: PMC7112242 DOI: 10.1371/journal.pntd.0008085] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 04/01/2020] [Accepted: 01/23/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The epidemic of hand, foot, and mouth disease (HFMD) has become a severe public health problem in the world and has also brought a high economic and health burden. Furthermore, the prevalence of HFMD varies significantly among different locations. However, there have been few investigations of the effects of socioeconomic factors and air pollution factors on the incidence of HFMD. METHODS This study collected data on HFMD in Shenzhen, China, from 2012 to 2015. We selected eleven factors as potential risk factors for HFMD. A Bayesian spatiotemporal model was used to quantify the influence of the factors on HFMD and to identify the relative risks in different districts. RESULTS The risk factors of HFMD were the population, population density, concentration of SO2, and concentration of NO2. The relative risks (RRs) were 1.00473 (95% CI: 1.00059-1.00761), 1.00010 (95% CI: 1.00002-1.00016), 1.00215 (95% CI: 1.00170-1.00232) and 1.00058 (95% CI: 1.00028-1.00078), respectively. The protective factors against HFMD were the per capita GDP, the number of public kindergartens, the concentration of PM10, and the concentration of O3. The RRs were 0.98840 (95% CI: 0.98660-0.99026), 0.97686 (95% CI: 0.96946-0.98403), 0.99108 (95% CI: 0.98551-0.99840) and 0.99587 (95% CI: 0.99534-0.99610), respectively. The risk of incidence in Longgang district and Pingshan district decreased, while the risk of incidence in Baoan district increased. CONCLUSIONS Studies have confirmed that socioeconomic factors and air pollution factors have an impact on the incidence of HFMD in Shenzhen, China. The results will be of great practical significance to local authorities, which is conducive to accurate prevention and can be used to formulate HFMD early warning systems.
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Affiliation(s)
- Xiaoyi He
- Shantou University Medical College, Shantou, China
| | - Shengjie Dong
- Orthopedic Department, Yantaishan Hospital, Yantai, Shandong, China
| | - Liping Li
- Shantou University Medical College, Shantou, China
| | - Xiaojian Liu
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Yongsheng Wu
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Zhen Zhang
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Shujiang Mei
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China
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29
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Luo K, Rui J, Hu S, Hu Q, Yang D, Xiao S, Zhao Z, Wang Y, Liu X, Pan L, An R, Guo D, Su Y, Zhao B, Gao L, Chen T. Interaction analysis on transmissibility of main pathogens of hand, foot, and mouth disease: A modeling study (a STROBE-compliant article). Medicine (Baltimore) 2020; 99:e19286. [PMID: 32176053 PMCID: PMC7220420 DOI: 10.1097/md.0000000000019286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Hand, foot, and mouth disease (HFMD) has spread widely and led to high disease burden in many countries. In this study, we aimed to analyze the interaction of the main pathogens of HFMD using a mathematical model.A dataset on reported HFMD cases was collected from April, 2009 to December, 2017 in Changsha City. A long-term etiological surveillance was conducted focusing on the pathogens of the disease including enterovirus A71 (EV71), coxsachievirus A16 (CA16), and other enteroviruses. A susceptible-infectious-recovered model was adopted to calculate the reproduction number during the ascending period of reported cases (defined as Rasc) and the descending period (defined as Rdes).About 214,178 HFMD cases (including clinically diagnosed cases and confirmed cases) were reported in Changsha City, among which 31 were death cases with a fatality of 0.01%. The number of reported HFMD cases increased yearly with a Linear model of "f(t) = 18542.68 + 1628.91t" where f(t) and t referred to number of reported cases and sequence of year, respectively. The fatality of the disease decreased yearly with a linear model of "f(t) = - 0.012 + 0.083/t". About 5319 stool or anal swab specimens were collected from the reported cases. Among them, 1201 were tested EV71 positive, 836 were CA16 positive, and 1680 were other enteroviruses positive. Rasc and Rdes of HFMD was 1.34 (95% confidence interval [CI]: 1.28-1.40) and 0.73 (95% CI: 0.69-0.76), respectively. EV71 and CA16 interacted with each other, and the interaction between EV71 and other enteroviruses and the interaction between CA16 and other enteroviruses were both directional. However, during the reported cases decreasing period, interactions only occurred between EV71 and other enteroviruses and between CA16 and other enteroviruses. These interactions all decreased Rasc but increased Rdes of affected pathogens.The interactions of the pathogens exist in Changsha City. The effective reproduction number of the affected pathogen is adjusted and verges to 1 by the interaction.
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Affiliation(s)
- Kaiwei Luo
- Hunan Provincial Center for Disease Prevention and Control, Changsha, Hunan Province
| | - Jia Rui
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian Province, People's Republic of China
| | - Shixiong Hu
- Hunan Provincial Center for Disease Prevention and Control, Changsha, Hunan Province
| | - Qingqing Hu
- Division of Public Health, School of Medicine, University of Utah, Salt Lake City, UT
| | - Dong Yang
- Changsha Center for Disease Prevention and Control, Changsha, Hunan Province, People's Republic of China
| | - Shan Xiao
- Changsha Center for Disease Prevention and Control, Changsha, Hunan Province, People's Republic of China
| | - Zeyu Zhao
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian Province, People's Republic of China
| | - Yao Wang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian Province, People's Republic of China
| | - Xingchun Liu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian Province, People's Republic of China
| | - Lili Pan
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian Province, People's Republic of China
| | - Ran An
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian Province, People's Republic of China
| | - Dongbei Guo
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian Province, People's Republic of China
| | - Yanhua Su
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian Province, People's Republic of China
| | - Benhua Zhao
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian Province, People's Republic of China
| | - Lidong Gao
- Hunan Provincial Center for Disease Prevention and Control, Changsha, Hunan Province
| | - Tianmu Chen
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian Province, People's Republic of China
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30
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Stelzer-Braid S, Wynn M, Chatoor R, Scotch M, Ramachandran V, Teoh HL, Farrar MA, Sampaio H, Andrews PI, Craig ME, MacIntyre CR, Varadhan H, Kesson A, Britton PN, Newcombe J, Rawlinson WD. Next generation sequencing of human enterovirus strains from an outbreak of enterovirus A71 shows applicability to outbreak investigations. J Clin Virol 2019; 122:104216. [PMID: 31790967 DOI: 10.1016/j.jcv.2019.104216] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 10/08/2019] [Accepted: 11/11/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND The most recent documented Australian outbreak of enterovirus A71 (EV-A71) occurred in Sydney from 2012 to 2013. Over a four-month period more than 100 children presented to four paediatric hospitals with encephalitic presentations including fever and myoclonic jerks. The heterogeneous presentations included typical encephalomyelitis, and cardiopulmonary complications. OBJECTIVES To characterise the genomes of enterovirus strains circulating during the 2013 Sydney EV-A71 outbreak and determine their phylogeny, phylogeography and association between genome and clinical phenotype. STUDY DESIGN We performed an analysis of enterovirus (EV) positive specimens from children presenting to hospitals in the greater Sydney region of Australia during the 2013 outbreak. We amplified near full-length genomes of EV, and used next generation sequencing technology to sequence the virus. We used phylogenetic/phylogeographic analysis to characterize the outbreak viruses. RESULTS We amplified and sequenced 23/63 (37 %) genomes, and identified the majority (61 %) as EV-A71. The EV-A71 sequences showed high level sequence homology to C4a genogroups of EV-A71 circulating in China and Vietnam during 2012-13. Phylogenetic analysis showed EV-A71 strains associated with more severe symptoms, including encephalitis or cardiopulmonary failure, grouped together more closely than those from patients with hand, foot and mouth disease. Amongst the non-EV-A71 sequences were five other EV subtypes (representing enterovirus subtypes A and B), reflecting the diversity of EV co-circulation within the community. CONCLUSIONS This is the first Australian study investigating the near full-length genome of EV strains identified during a known outbreak of EV-A71. EV-A71 sequences were very similar to strains circulating in Asia during the same time period. Whole genome sequencing offers additional information over routine diagnostic testing such as characterisation of emerging recombinant strains and inform vaccine design.
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Affiliation(s)
- Sacha Stelzer-Braid
- Virology Research Laboratory, Serology and Virology Division (SAViD), NSW Health Pathology, Prince of Wales Hospital, Sydney, NSW 2031, Australia; School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia.
| | - Matthew Wynn
- Virology Research Laboratory, Serology and Virology Division (SAViD), NSW Health Pathology, Prince of Wales Hospital, Sydney, NSW 2031, Australia
| | - Richard Chatoor
- Virology Research Laboratory, Serology and Virology Division (SAViD), NSW Health Pathology, Prince of Wales Hospital, Sydney, NSW 2031, Australia
| | - Matthew Scotch
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA; Center for Environmental Health Engineering, Biodesign Institute, Arizona State University, Tempe, AZ 85287, USA; School of Public Health and Community Medicine, University of New South Wales, Sydney, NSW 2033, Australia
| | - Vidiya Ramachandran
- Serology and Virology Division (SAViD), NSW Health Pathology East, Department of Microbiology, Prince of Wales Hospital, Sydney, NSW 2031, Australia
| | - Hooi-Ling Teoh
- Department of Neurology, Sydney Children's Hospital, Sydney, Australia; School of Women's and Children's Health, University of New South Wales Medicine, Sydney, NSW 2052, Australia
| | - Michelle A Farrar
- Department of Neurology, Sydney Children's Hospital, Sydney, Australia; School of Women's and Children's Health, University of New South Wales Medicine, Sydney, NSW 2052, Australia
| | - Hugo Sampaio
- Department of Neurology, Sydney Children's Hospital, Sydney, Australia; School of Women's and Children's Health, University of New South Wales Medicine, Sydney, NSW 2052, Australia
| | - Peter Ian Andrews
- Department of Neurology, Sydney Children's Hospital, Sydney, Australia; School of Women's and Children's Health, University of New South Wales Medicine, Sydney, NSW 2052, Australia
| | - Maria E Craig
- Virology Research Laboratory, Serology and Virology Division (SAViD), NSW Health Pathology, Prince of Wales Hospital, Sydney, NSW 2031, Australia; School of Women's and Children's Health, University of New South Wales Medicine, Sydney, NSW 2052, Australia
| | - C Raina MacIntyre
- College of Health Solutions, Arizona State University, Phoenix, AZ 85004, USA; Biosecurity Program, Kirby Institute, University of New South Wales, Sydney, NSW 2052, Australia; Watts College of Public Service and Community Solutions, Arizona State University, Phoenix, AZ 85004, USA
| | | | - Alison Kesson
- Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Sydney, Australia
| | - Philip N Britton
- Department of Infectious Diseases and Microbiology, The Children's Hospital at Westmead, Sydney, Australia; Marie Bashir Institute, University of Sydney, Australia
| | - James Newcombe
- Pathology North, Royal North Shore Hospital, St Leonards, Sydney, Australia
| | - William D Rawlinson
- Virology Research Laboratory, Serology and Virology Division (SAViD), NSW Health Pathology, Prince of Wales Hospital, Sydney, NSW 2031, Australia; School of Medical Sciences, Faculty of Medicine, University of New South Wales, Sydney, NSW 2052, Australia; Serology and Virology Division (SAViD), NSW Health Pathology East, Department of Microbiology, Prince of Wales Hospital, Sydney, NSW 2031, Australia; School of Women's and Children's Health, University of New South Wales Medicine, Sydney, NSW 2052, Australia
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31
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Electrostatic interactions at the five-fold axis alter heparin-binding phenotype and drive enterovirus A71 virulence in mice. PLoS Pathog 2019; 15:e1007863. [PMID: 31730673 PMCID: PMC6881073 DOI: 10.1371/journal.ppat.1007863] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 11/27/2019] [Accepted: 09/26/2019] [Indexed: 01/08/2023] Open
Abstract
Enterovirus A71 (EV-A71) causes hand, foot and mouth disease epidemics with neurological complications and fatalities. However, the neuropathogenesis of EV-A71 remains poorly understood. In mice, adaptation and virulence determinants have been mapped to mutations at VP2-149, VP1-145 and VP1-244. We investigate how these amino acids alter heparin-binding phenotype and shapes EV-A71 virulence in one-day old mice. We constructed six viruses with varying residues at VP1-98, VP1-145 (which are both heparin-binding determinants) and VP2-149 (based on the wild type 149K/98E/145Q, termed KEQ) to generate KKQ, KKE, KEE, IEE and IEQ variants. We demonstrated that the weak heparin-binder IEE was highly lethal in mice. The initially strong heparin-binding IEQ variant acquired an additional mutation VP1-K244E, which confers weak heparin-binding phenotype resulting in elevated viremia and increased virus antigens in mice brain, with subsequent high virulence. IEE and IEQ-244E variants inoculated into mice disseminated efficiently and displayed high viremia. Increasing polymerase fidelity and impairing recombination of IEQ attenuated the virulence, suggesting the importance of population diversity in EV-A71 pathogenesis in vivo. Combining in silico docking and deep sequencing approaches, we inferred that virus population diversity is shaped by electrostatic interactions at the five-fold axis of the virus surface. Electrostatic surface charges facilitate virus adaptation by generating poor heparin-binding variants for better in vivo dissemination in mice, likely due to reduced adsorption to heparin-rich peripheral tissues, which ultimately results in increased neurovirulence. The dynamic switching between heparin-binding and weak heparin-binding phenotype in vivo explained the neurovirulence of EV-A71. Enterovirus A71 (EV-A71) is the primary cause of hand, foot and mouth disease, and it can also infect the central nervous system and cause fatal outbreaks in young children. EV-A71 pathogenesis remains elusive. In this study, we demonstrated that EV-A71 variants with strong affinity to heparan sulfate (heparin) have a growth advantage in cell culture, but are disadvantaged in vivo. When inoculated into one-day old mice, strong heparin-binding virus variants are more likely to be adsorbed to peripheral tissues, resulting in impaired ability to disseminate, and are cleared from the bloodstream rapidly. The lower viremia level resulted in no neuroinvasion. In contrast, weak heparin-binding variants show greater levels of viremia, dissemination and subsequent neurovirulence in mice. We also provide evidence that the EV-A71 heparin-binding pattern is mediated by electrostatic surface charges on the virus capsid surface. In mice, EV-A71 undergoes adaptive mutation to acquire greater negative surface charges, thus generating new virulent variants with weak heparin-binding ability which allows greater viral spread. Our study underlines the importance of electrostatic surface charges in shaping EV-A71 virulence.
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32
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Fu X, Wan Z, Li Y, Hu Y, Jin X, Zhang C. National Epidemiology and Evolutionary History of Four Hand, Foot and Mouth Disease-Related Enteroviruses in China from 2008 to 2016. Virol Sin 2019; 35:21-33. [PMID: 31664644 PMCID: PMC7035399 DOI: 10.1007/s12250-019-00169-2] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 08/27/2019] [Indexed: 01/21/2023] Open
Abstract
Hand, foot and mouth disease (HFMD) is a major public health concern in China. The most predominant enteroviruses that cause HFMD have traditionally been attributed to enterovirus A71 (EVA71) and coxsackievirus A16 (CVA16). Since its first large outbreak in 2008, the dominant HFMD pathogens are constantly changing. In 2013 and 2015, CVA6 exceeded both EVA71 and CVA16 to become the leading cause of HFMD in some provinces. However, there still lacks a comprehensive overview on the molecular epidemiology and evolution of HFMD-related enteroviruses at the national level. In this study, we performed systematic epidemiological analyses of HFMD-related enteroviruses using the data of 64 published papers that met the inclusion criteria, and conducted phylogenetic analyses based on 12,080 partial VP1 sequences identified in China before 31st June 2018. We found that EVA71 prevalence has decreased sharply but other enteroviruses have increased rapidly from 2008 to 2016 and that one subtype of each enterovirus is represented during the epidemic. In addition, four genotypes EVA71_C4, CVA16_B1, CVA6_D and CVA10_C are the most predominant enterovirus strains and collectively they cause over 90% of all HFMD cases in China according to the phylogenetic trees using representative partial VP1 sequences. These four major enterovirus genotypes have different geographical distributions, and they may co-circulate with other genotypes and serotypes. These results suggest that more molecular epidemiological studies should be performed on several enteroviruses simultaneously, and such information should have implications for virological surveillance, disease management, vaccine development and policy-making on the prevention and control of HFMD.
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Affiliation(s)
- Xuemin Fu
- Pathogen Discovery and Big Data Center, CAS Key Laboratory of Molecular Virology and Immunology, Institut Pasteur of Shanghai, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai, 200031, China
| | - Zhenzhou Wan
- Medical Laboratory of Taizhou Fourth People's Hospital, Taizhou, 225300, China
| | - Yanpeng Li
- Pathogen Discovery and Big Data Center, CAS Key Laboratory of Molecular Virology and Immunology, Institut Pasteur of Shanghai, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai, 200031, China
| | - Yihong Hu
- Pathogen Discovery and Big Data Center, CAS Key Laboratory of Molecular Virology and Immunology, Institut Pasteur of Shanghai, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai, 200031, China
| | - Xia Jin
- Viral Disease and Vaccine Translational Research Unit, CAS Key Laboratory of Molecular Virology and Immunology, Institut Pasteur of Shanghai, Chinese Academy of Sciences, Shanghai, 200031, China
| | - Chiyu Zhang
- Pathogen Discovery and Big Data Center, CAS Key Laboratory of Molecular Virology and Immunology, Institut Pasteur of Shanghai, Chinese Academy of Sciences, University of Chinese Academy of Sciences, Shanghai, 200031, China.
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33
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Puenpa J, Wanlapakorn N, Vongpunsawad S, Poovorawan Y. The History of Enterovirus A71 Outbreaks and Molecular Epidemiology in the Asia-Pacific Region. J Biomed Sci 2019; 26:75. [PMID: 31627753 PMCID: PMC6798416 DOI: 10.1186/s12929-019-0573-2] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Accepted: 10/01/2019] [Indexed: 01/01/2023] Open
Abstract
Enterovirus A71 (EV-A71) is one of the common causative pathogens for hand foot and mouth disease (HFMD) affecting young children. HFMD outbreak can result in a substantial pediatric hospitalization and burden the healthcare services, especially in less-developed countries. Since the initial epidemic of predominantly EV-A71 in California in 1969, the high prevalence of HFMD in the Asia-pacific region and elsewhere around the world represents a significant morbidity in this age group. With the advent of rapid and accurate diagnostic tools, there has been a dramatic increase in the number of laboratory-confirmed EV-A71 infection over the past two decades. The population, cultural, and socioeconomic diversity among countries in the Asia-Pacific region all influence the transmission and morbidity associated with HFMD. This review summarizes the current state of epidemiology of EV-A71 in Asia-Pacific countries based on the most recent epidemiological data and available information on the prevalence and disease burden. This knowledge is important in guiding the prevention, control and future research on vaccine development of this highly contagious disease of significant socioeconomic implications in public health.
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Affiliation(s)
- Jiratchaya Puenpa
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nasamon Wanlapakorn
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.,Division of Academic Affairs, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Sompong Vongpunsawad
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Yong Poovorawan
- Center of Excellence in Clinical Virology, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
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34
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Yang D, Liu R, Ye L, Hu Q, Rui J, Zhou Y, Zhang H, Zhang X, Zhao B, Chen T. Hand, foot, and mouth disease in Changsha City, China, 2009-2017: a new method to analyse the epidemiological characteristics of the disease. Infect Dis (Lond) 2019; 52:39-44. [PMID: 31596157 DOI: 10.1080/23744235.2019.1675902] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Objectives: By adopting a new method, this study aimed to analyse the epidemiological characteristics of hand, foot, and mouth disease (HFMD) in nine districts and counties (cities) of Changsha City, China, from 2009 to 2017.Methods: The reported HFMD cases were collected in Changsha from 2009 to 2017. The traditional descriptive method and a new method (index system) including six indices (richness index N, Simpson diversity index D, Shannon diversity index H, Berger-Parker dominance index d, Shannon evenness index E, and Morisita-Horn similarity index C) were used to describe the epidemiological characteristics of HFMD in Changsha.Results: There were 214155 HFMD reported in Changsha during the study period. The incidence of the disease was higher in even-numbered years (2010, 2012, 2014, and 2016) than in uneven-numbered years (2009, 2011, 2013, 2015, and 2017), with two peaks in May to June and October to November every year. The age of onset was mainly from 0 to 5 years old, and the death was mainly from 0 to 2 years old. According to occupational classification, districts and counties (cities) had a high degree of similarity of the composition of HFMD, and there was no regional difference.Conclusions: Changsha had a yearly increasing trend of HFMD from 2009 to 2017, and the key population for prevention and control was children aged in 0-5 years old. Seasonal distribution of high incidence and peak incidence were occurred in even-numbered years. The sub-regions of the city shared moderate diversity and high similarity of occupational distribution of HFMD.
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Affiliation(s)
- Dong Yang
- Changsha Center for Disease Control and Prevention, Changsha, People's Republic of China
| | - Ruchun Liu
- Changsha Center for Disease Control and Prevention, Changsha, People's Republic of China
| | - Lan Ye
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, People's Republic of China
| | - Qingqing Hu
- Division of Public Health, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Jia Rui
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, People's Republic of China
| | - Yinzhu Zhou
- Changsha Center for Disease Control and Prevention, Changsha, People's Republic of China
| | - Heng Zhang
- Changsha Center for Disease Control and Prevention, Changsha, People's Republic of China
| | - Xixing Zhang
- Changsha Center for Disease Control and Prevention, Changsha, People's Republic of China
| | - Benhua Zhao
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, People's Republic of China
| | - Tianmu Chen
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, People's Republic of China
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35
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Abstract
Hand, foot and mouth disease (HFMD) has spread widely and leads to high disease burden in many countries. However, relative transmissibility from male to female individuals remains unclear. HFMD surveillance database was built in Shenzhen City from 2013 to 2017. An intersex transmission susceptible-infectious-recovered model was developed to calculate the transmission relative rate among male individuals, among female individuals, from male to female and from female to male. Two indicators, ratio of transmission relative rate (Rβ) and relative transmissibility index (RTI), were developed to assess the relative transmissibility of male vs. female. During the study period, 270 347 HFMD cases were reported in the city, among which 16 were death cases with a fatality of 0.0059%. Reported incidence of total cases, male cases and female cases was 0.0057 (range: 0.0036-0.0058), 0.0052 (range: 0.0032-0.0053) and 0.0044 (range: 0.0026-0.0047), respectively. The difference was statistically significant between male and female (t = 3.046, P = 0.002). Rβ of male vs. female, female vs. female, from female to male vs. female and from male to female vs. female was 7.69, 1.00, 1.74 and 7.13, respectively. RTI of male vs. female, female vs. female, from female to male vs. female and from male to female vs. female was 3.08, 1.00, 1.88 and 1.43, respectively. Transmissibility of HFMD is different between male and female individuals. Male cases seem to be more transmissible than female.
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36
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Kramer R, Sabatier M, Wirth T, Pichon M, Lina B, Schuffenecker I, Josset L. Molecular diversity and biennial circulation of enterovirus D68: a systematic screening study in Lyon, France, 2010 to 2016. ACTA ACUST UNITED AC 2019; 23. [PMID: 30229724 PMCID: PMC6144471 DOI: 10.2807/1560-7917.es.2018.23.37.1700711] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Understanding enterovirus D68 (EV-D68) circulation patterns as well as risk factors for severe respiratory and neurological illness is important for developing preventive strategies. Methods: Between 2010 and 2016, 11,132 respiratory specimens from hospitalised patients in Lyon, France, were screened for EV-D68 by PCR. Phylogenetic relationships of the viral-protein-1 sequences were reconstructed using maximum-likelihood and Bayesian-Markov-Chain-Monte-Carlo approaches. Results: Overall, 171 infections with a biennial pattern were detected, including seven, one, 55, none, 42, one and 65 cases annually during 2010–16. Children (< 16 years-old; n = 150) were mostly affected and 71% (n = 121) of the total patients were under 5 years-old. In 146 patients with medical reviews, 73% (n = 107) presented with acute respiratory distress. Among paediatric patients with medical reviews (n = 133), 55% (n=73) had an asthma/wheezing history, while among adults (n = 13), 11 had underlying diseases. In total, 45 patients had severe infections and 28 patients needed intensive care unit stays. No acute flaccid myelitis (AFM) was detected. We found genotypes A, B1, B2 B3 and D circulating, and no associations between these and clinical presentations. During the study, new genotypes continuously emerged, being replaced over time. We estimated that ancestors of currently circulating genotypes emerged in the late-1990s to 2010. Rises of the EV-D68 effective population size in Lyon coincided with infection upsurges. Phylogenetic analyses showed ongoing diversification of EV-D68 worldwide, coinciding with more infections in recent years and increases of reported AFM paediatric cases. Conclusions: Reinforcement of diagnostic capacities and clinical-based surveillance of EV-D68 infections is needed in Europe to assess the EV-D68 burden.
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Affiliation(s)
- Rolf Kramer
- These authors contributed equally.,European Public Health Microbiology Training Programme (EUPHEM), European Centre for Disease Prevention and Control, Stockholm, Sweden.,Centre National de Référence des Enterovirus et Parechovirus, Laboratoire de Virologie, Institut des Agents Infectieux, HCL, Hôpital de la Croix-Rousse, Lyon, France
| | - Marina Sabatier
- These authors contributed equally.,Centre National de Référence des Enterovirus et Parechovirus, Laboratoire de Virologie, Institut des Agents Infectieux, HCL, Hôpital de la Croix-Rousse, Lyon, France
| | - Thierry Wirth
- Institut Systématique Evolution Biodiversité (ISYEB), EPHE, MNHN, CNRS, Sorbonne Université, Paris, France.,Laboratoire Biologie Intégrative des Populations, Evolution Moléculaire, EPHE, PSL University, Paris, France
| | - Maxime Pichon
- Virpath, CIRI, Université de Lyon, INSERM U1111, CNRS 5308, ENS de Lyon, UCBL, Lyon, France.,Centre National de Référence des Enterovirus et Parechovirus, Laboratoire de Virologie, Institut des Agents Infectieux, HCL, Hôpital de la Croix-Rousse, Lyon, France
| | - Bruno Lina
- Virpath, CIRI, Université de Lyon, INSERM U1111, CNRS 5308, ENS de Lyon, UCBL, Lyon, France.,Centre National de Référence des Enterovirus et Parechovirus, Laboratoire de Virologie, Institut des Agents Infectieux, HCL, Hôpital de la Croix-Rousse, Lyon, France
| | - Isabelle Schuffenecker
- Virpath, CIRI, Université de Lyon, INSERM U1111, CNRS 5308, ENS de Lyon, UCBL, Lyon, France.,Centre National de Référence des Enterovirus et Parechovirus, Laboratoire de Virologie, Institut des Agents Infectieux, HCL, Hôpital de la Croix-Rousse, Lyon, France
| | - Laurence Josset
- Virpath, CIRI, Université de Lyon, INSERM U1111, CNRS 5308, ENS de Lyon, UCBL, Lyon, France.,Centre National de Référence des Enterovirus et Parechovirus, Laboratoire de Virologie, Institut des Agents Infectieux, HCL, Hôpital de la Croix-Rousse, Lyon, France
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37
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Aw‐Yong KL, NikNadia NMN, Tan CW, Sam I, Chan YF. Immune responses against enterovirus A71 infection: Implications for vaccine success. Rev Med Virol 2019; 29:e2073. [DOI: 10.1002/rmv.2073] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Revised: 05/24/2019] [Accepted: 05/31/2019] [Indexed: 12/18/2022]
Affiliation(s)
- Kam Leng Aw‐Yong
- Department of Medical Microbiology, Faculty of MedicineUniversity of Malaya Kuala Lumpur Malaysia
| | - Nik Mohd Nasir NikNadia
- Department of Medical Microbiology, Faculty of MedicineUniversity of Malaya Kuala Lumpur Malaysia
| | - Chee Wah Tan
- Department of Medical Microbiology, Faculty of MedicineUniversity of Malaya Kuala Lumpur Malaysia
| | - I‐Ching Sam
- Department of Medical Microbiology, Faculty of MedicineUniversity of Malaya Kuala Lumpur Malaysia
| | - Yoke Fun Chan
- Department of Medical Microbiology, Faculty of MedicineUniversity of Malaya Kuala Lumpur Malaysia
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38
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Truong PN, Nguyen TV, Nguyen TTT, Stein A. A spatial-temporal statistical analysis of health seasonality: explaining HFMD infections within a children population along the Vietnamese south central coast. BMC Public Health 2019; 19:937. [PMID: 31296198 PMCID: PMC6624959 DOI: 10.1186/s12889-019-7281-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 07/04/2019] [Indexed: 02/06/2023] Open
Abstract
Background Various neglected tropical diseases show spatially changing seasonality at small areas. This phenomenon has received little scientific attention so far. Our study contributes to advancing the understanding of its drivers. This study focuses on the effects of the seasonality of increasing social contacts on the incidence proportions at multiple district level of the childhood hand-foot-mouth disease in Da Nang city, Viet Nam from 2012 to 2016. Methods We decomposed the nonstationary time series of the incidence proportions for the nine spatial-temporal (S-T) strata in the study area, where S indicates the spatial and T the temporal stratum. The long-term trends and the seasonality are presented by the Fourier series. To study the effects of the monthly average ambient temperature and the period of preschooling, we developed a spatial-temporal autoregressive model. Results Seasonality of childhood hand-foot-mouth disease incidence proportions shows two peaks in all spatial strata annually: large peaks synchronously in April and small ones asynchronously during the preschooling period. The peaks of the average temperature are asynchronous with the seasonal peaks of the childhood hand-foot-mouth disease incidence proportions in the period between January and May, with the negative values of the regression coefficients for all spatial strata, respectively: \documentclass[12pt]{minimal}
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\begin{document}$$ {\beta}_{{\mathrm{T}}_11}^{S_1}=-0.18\pm 0.07;{\beta}_{{\mathrm{T}}_11}^{S_2}=-0.25\pm 0.09;{\beta}_{{\mathrm{T}}_11}^{S_3}=-0.14\pm 0.05 $$\end{document}βT11S1=−0.18±0.07;βT11S2=−0.25±0.09;βT11S3=−0.14±0.05. The increasingly cumulative preschooling period and the seasonal component of the incidence proportions are negatively correlated in the period between August and December, with the negative values of the regression coefficients for all temporal strata, respectively: \documentclass[12pt]{minimal}
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\begin{document}$$ {\beta}_{{\mathrm{T}}_32}^{S_1}=-0.40\pm 0.01;{\beta}_{{\mathrm{T}}_32}^{S_2}=-0.29\pm 0.00;{\beta}_{{\mathrm{T}}_32}^{S_3}=-0.25\pm 0.01 $$\end{document}βT32S1=−0.40±0.01;βT32S2=−0.29±0.00;βT32S3=−0.25±0.01. Conclusions The study shows that social contact amongst children under five years of age is the important driving factor of the dynamics of the childhood hand-foot-mouth disease outbreaks in the study area. The preschooling season when children’s contact with each other increases stimulates the geographical variation of the seasonality of childhood hand-foot-mouth disease infections at small areas in the study area.
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Affiliation(s)
- Phuong N Truong
- Faculty of Geo-Information Science and Earth Observation, University of Twente, Enschede, The Netherlands.
| | | | | | - Alfred Stein
- Faculty of Geo-Information Science and Earth Observation, University of Twente, Enschede, The Netherlands
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Owino CO, Chu JJH. Recent advances on the role of host factors during non-poliovirus enteroviral infections. J Biomed Sci 2019; 26:47. [PMID: 31215493 PMCID: PMC6582496 DOI: 10.1186/s12929-019-0540-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2019] [Accepted: 06/11/2019] [Indexed: 02/06/2023] Open
Abstract
Non-polio enteroviruses are emerging viruses known to cause outbreaks of polio-like infections in different parts of the world with several cases already reported in Asia Pacific, Europe and in United States of America. These outbreaks normally result in overstretching of health facilities as well as death in children under the age of five. Most of these infections are usually self-limiting except for the neurological complications associated with human enterovirus A 71 (EV-A71). The infection dynamics of these viruses have not been fully understood, with most inferences made from previous studies conducted with poliovirus.Non-poliovirus enteroviral infections are responsible for major outbreaks of hand, foot and mouth disease (HFMD) often associated with neurological complications and severe respiratory diseases. The myriad of disease presentations observed so far in children calls for an urgent need to fully elucidate the replication processes of these viruses. There are concerted efforts from different research groups to fully map out the role of human host factors in the replication cycle of these viral infections. Understanding the interaction between viral proteins and human host factors will unravel important insights on the lifecycle of this groups of viruses.This review provides the latest update on the interplay between human host factors/processes and non-polio enteroviruses (NPEV). We focus on the interactions involved in viral attachment, entry, internalization, uncoating, replication, virion assembly and eventual egress of the NPEV from the infected cells. We emphasize on the virus- human host interplay and highlight existing knowledge gaps that needs further studies. Understanding the NPEV-human host factors interactions will be key in the design and development of vaccines as well as antivirals against enteroviral infections. Dissecting the role of human host factors during NPEV infection cycle will provide a clear picture of how NPEVs usurp the human cellular processes to establish an efficient infection. This will be a boost to the drug and vaccine development against enteroviruses which will be key in control and eventual elimination of the viral infections.
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Affiliation(s)
- Collins Oduor Owino
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research (A*STAR), Singapore, 138673, Singapore
| | - Justin Jang Hann Chu
- Department of Microbiology and Immunology, National University of Singapore, Singapore, 117597, Singapore.
- Institute of Molecular and Cell Biology, Agency for Science, Technology and Research (A*STAR), Singapore, 138673, Singapore.
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Zhao J, Hu X. The complex transmission seasonality of hand, foot, and mouth disease and its driving factors. BMC Infect Dis 2019; 19:521. [PMID: 31196004 PMCID: PMC6567494 DOI: 10.1186/s12879-019-4153-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Accepted: 05/31/2019] [Indexed: 11/10/2022] Open
Abstract
Background The transmission rate seasonality is an important index for transmission dynamics in many childhood infections, and has been widely studied in industrialized countries. However, it has been neglected in the study of pathogens in China. Methods To understand the transmission dynamics of hand, foot and mouth disease (HFMD), we examined the transmission rate seasonality of HFMD in three provinces, Henan, Anhui and Chongqing, in China, using a dynamical stochastic SIR model. We investigated potential driving factors, including school terms, the Chinese Spring Festival period, meteorological factors and population flux for their effects on the HFMD transmission seasonality using multiple regression models. Results The transmission rate of HFMD had complex seasonality with one large major peak in March and one small peak in autumn. School terms, the Chinese Spring Festival period, population flux and meteorological factors had combined effects on the HFMD transmission seasonality in mainland China. The school terms reflects the seasonal contact rate in Children, while the population flux and the Chinese Spring Festival period reflect the seasonal contact rate in population. They drove HFMD transmission rate seasonality in different time periods of the year in China. Contact rate seasonality in population dominated effects on HFMD transmission in February and March. The dramatic increase in transmission rate during February coincides with the Chinese Spring Festival period and high population flux in this month. The contact rate seasonality in children dominated effects on the transmission in the other months of the year in Chongqing. Meteorological factors can not solely explain the seasonality in HFMD transmission in mainland China; however, they may have combined effects with school terms and the highway passenger traffic on the transmission rate in Anhui during the fall semester. Conclusion The transmission rate of HFMD in three provinces in China had complex seasonality. The Chinese Spring Festival period, population flux and (or) school terms explained the majority of the transmission rate seasonality of HFMD, and they drove HFMD transmission rate seasonality in different time periods of the year. The Chinese Spring Festival period dominantly caused the dramatic increase of the HFMD transmission rate during February. Electronic supplementary material The online version of this article (10.1186/s12879-019-4153-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jijun Zhao
- Institute of Complexity Science, Qingdao University, Qingdao, 266071, China.
| | - Xiangyu Hu
- The Department of Ecology and Evolutionary Biology, University of Arizona, Tucson, AZ, 85721, USA
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Abstract
Since 2014, acute flaccid myelitis (AFM), a long-recognized condition associated with polioviruses, nonpolio enteroviruses, and various other viral and nonviral causes, has been reemerging globally in epidemic form. This unanticipated reemergence is ironic, given that polioviruses, once the major causes of AFM, are now at the very threshold of global eradication and cannot therefore explain any aspect of AFM reemergence. Instead, the new AFM epidemic has been temporally associated with reemergences of nonpolio enteroviruses such as EV-D68, until recently thought to be an obscure virus of extremely low endemicity. This perspective reviews the enigmatic epidemiologic, virologic, and diagnostic aspects of epidemic AFM reemergence; examines current options for clinical management; discusses future research needs; and suggests that the AFM epidemic offers important clues to mechanisms of viral disease emergence.
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Mizuta K, Tanaka S, Komabayashi K, Aoki Y, Itagaki T, Katsushima F, Katsushima Y, Yoshida H, Ito S, Matsuzaki Y, Ikeda T. Phylogenetic and antigenic analyses of coxsackievirus A6 isolates in Yamagata, Japan between 2001 and 2017. Vaccine 2019; 37:1109-1117. [PMID: 30683510 DOI: 10.1016/j.vaccine.2018.12.065] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 12/19/2018] [Accepted: 12/21/2018] [Indexed: 11/27/2022]
Abstract
Although coxsackievirus A6 (CV-A6) is generally recognized as a causative agent of herpangina in children, CV-A6 infections globally emerged as a new and major cause of epidemic hand-foot-and-mouth-diseases (HFMDs) around 2008. To clarify the longitudinal epidemiology of CV-A6, we carried out sequence and phylogenetic analyses for the VP1 and partially for the VP4-3D regions as well as antigenic analysis using 115 CV-A6 isolates and 105 human sera in Yamagata, Japan between 2001 and 2017. Phylogenetic analysis revealed that CV-A6 isolates were clearly divided into two clusters; strains in circulation between 2001 and 2008 and those between 2010 and 2017. Neutralizing antibody titers of two rabbit antisera, which were immunized with Yamagata isolates in 2001 and 2015, respectively, against 28 Yamagata representative strains as well as the prototype Gdula strain were 1:2560-1:5120 and 1:160-1:640, respectively. The neutralizing antibody titers among residents in Yamagata against the above two strains were similar. Our analyses revealed that there were cross-antigenicities among all analyzed CV-A6 strains, although the newly emerged strains were introduced into Yamagata around 2010 and replaced the previous ones. With regard to control measures, these findings suggest that we can prevent CV-A6 infections through the development of a vaccine that effectively induces neutralizing antibodies against CV-A6, irrespective of genetic cluster.
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Affiliation(s)
- Katsumi Mizuta
- Department of Microbiology, Yamagata Prefectural Institute of Public Health, Yamagata 1-6-6, Yamagata 990-0031, Japan.
| | - Shizuka Tanaka
- Department of Microbiology, Yamagata Prefectural Institute of Public Health, Yamagata 1-6-6, Yamagata 990-0031, Japan
| | - Kenichi Komabayashi
- Department of Microbiology, Yamagata Prefectural Institute of Public Health, Yamagata 1-6-6, Yamagata 990-0031, Japan
| | - Yoko Aoki
- Department of Microbiology, Yamagata Prefectural Institute of Public Health, Yamagata 1-6-6, Yamagata 990-0031, Japan
| | | | | | | | - Hiroshi Yoshida
- Department of Pediatrics, Tsuruoka Municipal Shonai Hospital, Yamagata 990-9585, Japan
| | - Sueshi Ito
- Department of Pediatrics, Tsuruoka Municipal Shonai Hospital, Yamagata 990-9585, Japan; Ito Clinic, Department of Pediatrics, Hinode 1-17-8, Tsuruoka, Yamagata 997-0025, Japan
| | - Yoko Matsuzaki
- Department of Infectious Diseases, Yamagata University, Faculty of Medicine, Yamagata 990-9585, Japan
| | - Tatsuya Ikeda
- Department of Microbiology, Yamagata Prefectural Institute of Public Health, Yamagata 1-6-6, Yamagata 990-0031, Japan
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Noisumdaeng P, Korkusol A, Prasertsopon J, Sangsiriwut K, Chokephaibulkit K, Mungaomklang A, Thitithanyanont A, Buathong R, Guntapong R, Puthavathana P. Longitudinal study on enterovirus A71 and coxsackievirus A16 genotype/subgenotype replacements in hand, foot and mouth disease patients in Thailand, 2000-2017. Int J Infect Dis 2019; 80:84-91. [PMID: 30639624 DOI: 10.1016/j.ijid.2018.12.020] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 11/29/2018] [Accepted: 12/15/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Enterovirus A71 (EV-A71) and coxsackievirus A16 (CV-A16) are the major causative agents of hand, foot and mouth disease (HFMD) worldwide, particularly in the Asia-Pacific region. Several strains have emerged, circulated, and faded out over time in recent decades. This study investigated the EV-A71 and CV-A16 circulating strains and replacement of genotypes/subgenotypes in Thailand during the years 2000-2017. METHODS The complete VP1 regions of 92 enteroviruses obtained from 90 HFMD patients, one asymptomatic adult contact case, and one encephalitic case were sequenced and investigated for serotypes, genotypes, and subgenotypes using a phylogenetic analysis. RESULTS The 92 enterovirus isolates were identified as 67 (72.8%) EV-A71 strains comprising subgenotypes B4, B5, C1, C2, C4a, C4b and C5, and 25 (27.2%) CV-A16 strains comprising subgenotypes B1a and B1b. Genotypic/subgenotypic replacements were evidenced during the study period. EV-A71 B5 and C4a have been the major circulating strains in Thailand for more than a decade, and CV-A16 B1a has been circulating for almost two decades. CONCLUSIONS This study provides chronological data on the molecular epidemiology of EV-A71 and CV-A16 subgenotypes in Thailand. Subgenotypic replacement frequently occurred with EV-A71, but not CV-A16. Monitoring for viral genetic and subgenotypic changes is important for molecular diagnosis, vaccine selection, and vaccine development.
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Affiliation(s)
- Pirom Noisumdaeng
- Faculty of Public Health, Thammasat University (Rangsit Center), Khlong Luang, Pathum Thani 12121, Thailand
| | - Achareeya Korkusol
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok-noi, Bangkok 10700, Thailand
| | - Jarunee Prasertsopon
- Center for Research and Innovation, Faculty of Medical Technology, Mahidol University, Nakhon Pathom 73170, Thailand
| | - Kantima Sangsiriwut
- Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok-noi, Bangkok 10700, Thailand
| | - Kulkanya Chokephaibulkit
- Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok-noi, Bangkok 10700, Thailand
| | - Anek Mungaomklang
- Debaratana Nakhon Ratchasima Hospital, Ministry of Public Health, Nakhon Ratchasima 30280, Thailand
| | - Arunee Thitithanyanont
- Department of Microbiology, Faculty of Science, Mahidol University, Bangkok 10400, Thailand
| | - Rome Buathong
- Bureau of Epidemiology, Department of Disease Control, Ministry of Public Health, Nonthaburi 11000, Thailand
| | - Ratigorn Guntapong
- National Institute of Health, Department of Medical Sciences, Ministry of Public Health, Nonthaburi 11000, Thailand
| | - Pilaipan Puthavathana
- Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok-noi, Bangkok 10700, Thailand; Center for Research and Innovation, Faculty of Medical Technology, Mahidol University, Nakhon Pathom 73170, Thailand.
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Affiliation(s)
- Sacha Stelzer-Braid
- Virology Research Laboratory, Prince of Wales Hospital, Sydney, NSW 2031, Australia
- School of Medical Sciences, and School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - William Rawlinson
- Virology Research Laboratory, Prince of Wales Hospital, Sydney, NSW 2031, Australia
- School of Medical Sciences, and School of Women's and Children's Health, Faculty of Medicine, University of New South Wales, Sydney, Australia
- Serology and Virology Division (SAViD), Microbiology NSW Health Pathology Randwick, NSW 2031, Australia
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Yu S, Liao Q, Zhou Y, Hu S, Chen Q, Luo K, Chen Z, Luo L, Huang W, Dai B, He M, Liu F, Qiu Q, Ren L, van Doorn HR, Yu H. Population based hospitalization burden of laboratory-confirmed hand, foot and mouth disease caused by multiple enterovirus serotypes in Southern China. PLoS One 2018; 13:e0203792. [PMID: 30543631 PMCID: PMC6292616 DOI: 10.1371/journal.pone.0203792] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 11/30/2018] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hand, foot and mouth disease (HFMD) is spread widely across Asia, and the hospitalization burden is currently not well understood. Here, we estimated serotype-specific and age-specific hospitalization rates of HFMD in Southern China. METHODS We enrolled pediatric HFMD patients admitted to 3/3 county-level hospitals, and 3/23 township-level hospitals in Anhua county, Hunan (CN). Samples were collected to identify enterovirus serotypes by RT-PCRs between October 2013 and September 2016. Information on other eligible, but un-enrolled, patients were retrospectively collected from the same six hospitals. Monthly numbers of all-cause hospitalizations were collected from each of the 23 township-level hospitals to extrapolate hospitalizations associated with HFMD among these. RESULTS During the three years, an estimated 3,236 pediatric patients were hospitalized with lab-confirmed HFMD, and among these only one case was severe. The mean hospitalization rate was 660 (95% CI: 638-684) per 100,000 person-years for lab-confirmed HFMD, with higher rates among CV-A16 and CV-A6 associated HFMD (213 vs 209 per 100,000 person-years), and lower among EV-A71, CV-A10 and other enterovirus associated HFMD (134, 39 and 66 per 100,000 person-years respectively, p<0.001). Children aged 12-23 months had the highest hospitalization rates (3,594/100,000 person-years), followed by those aged 24-35 months (1,828/100,000 person-years) and 6-11 months (1,572/100,000 person-years). Compared with other serotypes, CV-A6-associated hospitalizations were evident at younger ages. CONCLUSIONS Our study indicates a substantial hospitalization burden associated with non-severe HFMD in a rural county in southern China. Future mitigation policies should take into account the disease burden identified, and optimize interventions for HFMD.
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Affiliation(s)
- Shuanbao Yu
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Qiaohong Liao
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Yonghong Zhou
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Shixiong Hu
- Hunan Provincial Center for Disease Control and Prevention, Changsha, Hunan Province, China
| | - Qi Chen
- Hubei Provincial Center for Disease Control and Prevention, Wuhan, Hubei Province, China
| | - Kaiwei Luo
- Hunan Provincial Center for Disease Control and Prevention, Changsha, Hunan Province, China
| | - Zhenhua Chen
- Chengdu Center for Disease Control and Prevention, Chengdu, Sichuan Province, China
| | - Li Luo
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Wei Huang
- Hunan Provincial Center for Disease Control and Prevention, Changsha, Hunan Province, China
| | - Bingbing Dai
- Anhua County Center for Disease Control and Prevention, Anhua, Hunan Province, China
| | - Min He
- Anhua County Center for Disease Control and Prevention, Anhua, Hunan Province, 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
| | - Qi Qiu
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Lingshuang Ren
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - H. Rogier van Doorn
- Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Hongjie Yu
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
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Hoang MTV, Nguyen TA, Tran TT, Vu TTH, Le NTN, Nguyen THN, Le THN, Nguyen TTH, Nguyen TH, Le NTN, Truong HK, Du TQ, Ha MT, Ho LV, Do CV, Nguyen TN, Nguyen TMT, Sabanathan S, Phan TQ, Nguyen Van VC, Thwaites GE, Wills B, Thwaites CL, Le VT, van Doorn HR. Clinical and aetiological study of hand, foot and mouth disease in southern Vietnam, 2013-2015: Inpatients and outpatients. Int J Infect Dis 2018; 80:1-9. [PMID: 30550944 PMCID: PMC6403263 DOI: 10.1016/j.ijid.2018.12.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 12/02/2018] [Accepted: 12/06/2018] [Indexed: 11/17/2022] Open
Abstract
Multiple serotypes of enterovirus A cause hand, foot and mouth disease in southern Vietnam. Clinical characteristics differed slightly between the different pathogen groups. CV-A6 and CV-A10 emerged in Vietnam in 2013–2015. An unexpected dominance of EV-A71 was found among both inpatients and outpatients.
Background Hand, foot and mouth disease (HFMD) has been associated with large outbreaks among young children in the Asia-Pacific Region since 1997, including cases of severe illness and death. Severe illness is often associated with enterovirus A71 (EV-A71). Vietnam experienced a large sustained outbreak of 200 000 hospitalized cases and over 200 deaths in 2011–12, the large majority occurring in southern Vietnam. Methods A prospective observational study was conducted in the outpatient clinics, infectious diseases wards, and paediatric intensive care units of the three main referral centres for the treatment of HFMD in southern Vietnam. Demographic data, basic laboratory parameters, and clinical data were recorded, and molecular diagnostic tests were performed. Results Between July 2013 and July 2015, a total of 1547 children were enrolled. Four serotypes of enterovirus A (EV-A71, Coxsackievirus (CV) A6, A10, and A16) were responsible for 1005 of 1327 diagnosed cases (75.7%). An unexpected dominance of EV-A71 was found among both inpatients and outpatients, as well as a strong association with severe illness. CV-A6 and CV-A10 emerged in Vietnam during the study period and replaced CV-A16. CV-A10 was associated with different clinical and laboratory characteristics. During admission, 119 children developed a more severe illness. It was found that children with a skin rash showed less progression of severity, but when a rash was present, a macular rash was significantly associated with an increased risk of progression. Conclusions This study represents the most comprehensive descriptive HFMD study from Vietnam to date. Co-circulation and replacement of different serotypes has implications for vaccine development and implementation. These findings from a severely affected country add to our understanding of the presentation, progression, and aetiology of HFMD.
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Affiliation(s)
- Minh Tu Van Hoang
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam; Children's Hospital 2, Ho Chi Minh City, Vietnam.
| | - To Anh Nguyen
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Tan Thanh Tran
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Thi Ty Hang Vu
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | | | | | | | | | | | | | - Tuan Quy Du
- Children's Hospital 1, Ho Chi Minh City, Vietnam
| | - Manh Tuan Ha
- Children's Hospital 2, Ho Chi Minh City, Vietnam
| | - Lu Viet Ho
- Children's Hospital 2, Ho Chi Minh City, Vietnam
| | - Chau Viet Do
- Children's Hospital 2, Ho Chi Minh City, Vietnam
| | | | | | | | - Tu Qui Phan
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam; Hospital of Tropical Diseases, Ho Chi Minh City, Vietnam
| | | | - Guy E 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, UK
| | - Bridget Wills
- 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, UK
| | - C Louise 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, UK
| | - Van Tan Le
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - 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, UK
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Takahashi S, Metcalf CJE, Arima Y, Fujimoto T, Shimizu H, Rogier van Doorn H, Le Van T, Chan YF, Farrar JJ, Oishi K, Grenfell BT. Epidemic dynamics, interactions and predictability of enteroviruses associated with hand, foot and mouth disease in Japan. J R Soc Interface 2018; 15:rsif.2018.0507. [PMID: 30209044 PMCID: PMC6170776 DOI: 10.1098/rsif.2018.0507] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 08/20/2018] [Indexed: 12/28/2022] Open
Abstract
Outbreaks of hand, foot and mouth disease have been documented in Japan since 1963. This disease is primarily caused by the two closely related serotypes of Enterovirus A71 (EV-A71) and Coxsackievirus A16 (CV-A16). Here, we analyse Japanese virologic and syndromic surveillance time-series data from 1982 to 2015. As in some other countries in the Asia Pacific region, EV-A71 in Japan has a 3 year cyclical component, whereas CV-A16 is predominantly annual. We observe empirical signatures of an inhibitory interaction between the serotypes; virologic lines of evidence suggest they may indeed interact immunologically. We fit the time series to mechanistic epidemiological models: as a first-order effect, we find the data consistent with single-serotype susceptible–infected–recovered dynamics. We then extend the modelling to incorporate an inhibitory interaction between serotypes. Our results suggest the existence of a transient cross-protection and possible asymmetry in its strength such that CV-A16 serves as a stronger forcing on EV-A71. Allowing for asymmetry yields accurate out-of-sample predictions and the directionality of this effect is consistent with the virologic literature. Confirmation of these hypothesized interactions would have important implications for understanding enterovirus epidemiology and informing vaccine development. Our results highlight the general implication that even subtle interactions could have qualitative impacts on epidemic dynamics and predictability.
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Affiliation(s)
- Saki Takahashi
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA
| | - C Jessica E Metcalf
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA.,Woodrow Wilson School of Public and International Affairs, Princeton University, Princeton, NJ, USA
| | - Yuzo Arima
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Tsuguto Fujimoto
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Hiroyuki Shimizu
- Department of Virology II, National Institute of Infectious Diseases, Tokyo, Japan
| | - H Rogier van Doorn
- Oxford University Clinical Research Unit-Wellcome Trust Major Overseas Programme, National Hospital for Tropical Diseases, Ha Noi, Viet Nam.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Tan Le Van
- Oxford University Clinical Research Unit-Wellcome Trust Major Overseas Programme, National Hospital for Tropical Diseases, Ha Noi, Viet Nam
| | - Yoke-Fun Chan
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Jeremy J Farrar
- Oxford University Clinical Research Unit-Wellcome Trust Major Overseas Programme, National Hospital for Tropical Diseases, Ha Noi, Viet Nam.,Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Kazunori Oishi
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Bryan T Grenfell
- Department of Ecology and Evolutionary Biology, Princeton University, Princeton, NJ, USA .,Fogarty International Center, National Institutes of Health, Bethesda, MD, USA
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WANG XF, LU J, LIU XX, DAI T. Epidemiological Features of Hand, Foot and Mouth Disease Outbreaks among Chinese Preschool Children: A Meta-analysis. IRANIAN JOURNAL OF PUBLIC HEALTH 2018; 47:1234-1243. [PMID: 30319997 PMCID: PMC6174039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Hand-foot-mouth disease (HFMD) is a widespread communicable disease and has caused large epidemics in many countries. This meta-analysis aimed to analyze and evaluate the epidemiological features of HFMD outbreaks in Chinese preschools. METHODS Literature review was based on PubMed, Chinese National Knowledge Infrastructure (CNKI) and Wanfang databases from 2008 to 2015. The temporal, spatial and demographic parameters were summarized and analyzed. RESULTS Overall, 19 studies with a total of 11269 HFMD cases were selected for data synthesis and analysis. April, May, June and July were detected as the peak months of HFMD outbreaks, with the pooled rate of 21% (95% CI: 12%-34%), 23% (95% CI: 19%-27%), 20% (95% CI: 17%-24%) and 11% (95% CI: 7%-15%). Urban areas were at a higher risk of suffering from HFMD outbreaks than rural areas, with the pooled rate of 65% (95% CI: 48%-78%) and 35% (95% CI: 22%-52%) respectively. The constituent ratio of children aged 37-48 months is the highest, accounting for 46% (95% CI: 39%-53%) of the total cases during HFMD outbreaks. The pooled rate of male cases (60%) was higher than that of female cases (40%). CONCLUSION Month, residence, age, and gender may be early risk factors for potential HFMD outbreaks. Before the advent of peak months from Apr to Jul each year, measures should be taken to prevent the HFMD outbreaks among preschool children in China. Preschools located in urban areas should take priority over special prevention. HFMD surveillance should preferentially focus on children aged 37-48 months, especially boys in preschools.
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Affiliation(s)
- Xiao-Fang WANG
- Division of Preschool Health, Shanghai Normal University, Shanghai, China
| | - Jiao LU
- Dept. of Pediatrics, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai, China
| | - Xiao-Xia LIU
- Dept. of Library, Shanghai Normal University, Shanghai, China
| | - Ting DAI
- Dept. of Public Health, Xuhui Central Hospital, Shanghai, China,Corresponding Author:
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Yang Y, You E, Wu J, Zhang W, Jin J, Zhou M, Jiang C, Huang F. Effects of relative humidity on childhood hand, foot, and mouth disease reinfection in Hefei, China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2018; 630:820-826. [PMID: 29499537 DOI: 10.1016/j.scitotenv.2018.02.262] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/14/2018] [Revised: 02/10/2018] [Accepted: 02/21/2018] [Indexed: 05/04/2023]
Abstract
BACKGROUND In recent years, hand, foot, and mouth disease (HFMD) has become a major public health issue in China, and its reinfection rate has been high. Numerous studies have examined the effects of meteorological factors involved in HFMD infection. However, no study has investigated the effects on HFMD reinfection. The present study analyzed the relationship between relative humidity and HFMD reinfection. METHODS We employed a distributed lag nonlinear model to evaluate the relationship between relative humidity and childhood HFMD reinfection in Hefei, China during 2011-2016. This model controlled confounding factors, including seasonality, long-term trend, day of the week, precipitation, and mean temperature. RESULTS Childhood HFMD reinfection cases occurred mainly from April to July, and the second peak occurred from October to December. A statistically significant association was observed between relative humidity and HFMD reinfection with delayed effects. The adverse effect of high relative humidity (>75%) appeared later than those of low relative humidity (<75%). Moreover, the highest relative risk (RR 1.08, 95% CI 1.04-1.13) occurred when the relative humidity was 100% and had an 8-day lag. Given the differences between gender and age groups, the effects of extremely high relative humidity on females and those aged ≥4years were higher than those of other groups and caused the highest cumulative relative risks at lag 0-9 or 0-10days (Female: RR 2.00, 95% CI 1.23-3.26; Male: RR 1.55, 95% CI 1.04-2.30; Aged ≥4years: RR 2.31, 95% CI 1.27-4.18; Aged <4years: RR 1.51, 95% CI 1.04-2.20). CONCLUSION High and low relative humidity were found to cause the elevated risks of HFMD reinfection, and the highest risk was observed at extremely high relative humidity. Early warning systems should be built for the protection of susceptible populations, particularly females and children aged ≥4years.
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Affiliation(s)
- Yuwei Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Shushan District, Hefei, Anhui 230032, PR China
| | - Enqing You
- Hefei Center for Disease Control and Prevention, 86 Luan Road, Luyang District, Hefei, Anhui 230061, PR China
| | - Jinju Wu
- Hefei Center for Disease Control and Prevention, 86 Luan Road, Luyang District, Hefei, Anhui 230061, PR China
| | - Wenyan Zhang
- Hefei Center for Disease Control and Prevention, 86 Luan Road, Luyang District, Hefei, Anhui 230061, PR China
| | - Jin Jin
- Hefei Center for Disease Control and Prevention, 86 Luan Road, Luyang District, Hefei, Anhui 230061, PR China
| | - Mengmeng Zhou
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Shushan District, Hefei, Anhui 230032, PR China
| | - Chunxiao Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Shushan District, Hefei, Anhui 230032, PR China
| | - Fen Huang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Shushan District, Hefei, Anhui 230032, PR China.
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Zhang C, Chen S, Zhou G, Jin Y, Zhang R, Yang H, Xi Y, Ren J, Duan G. Involvement of the renin-angiotensin system in the progression of severe hand-foot-and-mouth disease. PLoS One 2018; 13:e0197861. [PMID: 29791486 PMCID: PMC5965884 DOI: 10.1371/journal.pone.0197861] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 05/09/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Hand-foot-and-mouth disease (HFMD) is generally considered as a mild exanthematous disease to infants and young children worldwide. HFMD cases are usually mild and self-limiting but for few cases leads to complicated severe clinical outcomes, and even death. Previous studies have indicated that serum Ang II levels in patients with H7N9 infection were related to the severity of infection. However, the mechanisms underlying the pathogenesis of severe HFMD remain unclear. This study was undertaken to clarify the role of the renin-angiotensin system (RAS) in the progression of severe HFMD. METHODS In the present study, 162 children including HFMD patients and healthy controls were recruited. The data was analyzed by time-series fashion. Concentrations of angiotensin II (Ang II) and noradrenaline (NA) in serum of patients were measured with ELISA. We established a mouse model for enterovirus 71 (EV71) infection and determined concentrations of Ang II, NA in tissue lysates at 3, 5 and 7 days post infection (dpi). RESULTS The concentrations of Ang II and NA in serum of the HFMD patients with mild or severe symptoms were significantly higher than that in healthy controls. Additionally, the concentrations of Ang II and NA in serum of severe cases were significantly higher than those mild cases and the increased concentrations of Ang II and NA showed the same time trend during the progression of HFMD in the severe cases. Furthermore, the concentrations of Ang II and NA in target organs of EV71-infected mice including brains, skeletal muscle, and lungs were increased with the progression of EV71 infection in mice. Histopathological alterations were observed in the brains, skeletal muscle and lungs of EV71-infected mice. CONCLUSION Our study suggested that activation of the RAS is implicated in the pathogenesis of severe HFMD.
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Affiliation(s)
- Chao Zhang
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, Henan Province, China
| | - Shuaiyin Chen
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, Henan Province, China
| | - Guangyuan Zhou
- Department of Epidemiology, School of Public Health, Xinxiang Medical University, Henan Province, Xinxiang, China
| | - Yuefei Jin
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, Henan Province, China
| | - Rongguang Zhang
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, Henan Province, China
| | - Haiyan Yang
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, Henan Province, China
| | - Yuanlin Xi
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, Henan Province, China
| | - Jingchao Ren
- Department of Epidemiology, School of Public Health, Xinxiang Medical University, Henan Province, Xinxiang, China
| | - Guangcai Duan
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, Henan Province, China
- * E-mail:
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