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Cheng L, Zhong S, Xu X, Li J, Xie F, Lin Y, Zhang D. Chinese parents' intention to vaccinate their 0-5-year-old children with the EV-71 vaccine against hand, foot, and mouth disease and willingness-to-pay. Front Public Health 2024; 12:1336687. [PMID: 38525345 PMCID: PMC10958786 DOI: 10.3389/fpubh.2024.1336687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Accepted: 01/31/2024] [Indexed: 03/26/2024] Open
Abstract
Background This study aimed to determine the intention and willingness-to-pay (WTP) of Chinese parents/guardians to vaccinate their children with the EV-71 vaccine. Knowledge levels about hand, foot, and mouth disease (HFMD) and the EV-71 vaccine were also investigated. Methods A cross-sectional, self-administered online survey was conducted between November 2022 and March 2023. A stratified multi-stage random sampling method was used to recruit parents/guardians of children aged 0-5 years in southeastern China. Results A total of 3,626 complete responses were received. The mean knowledge score of HFMD was 9.99 (±4.23) out of a total of 14 points. The majority of the participants reported a somewhat willing intent (58.8%), followed by an extremely willing intent (28.9%). Participants who did not consider the EV-71 vaccine expensive (OR = 2.94, 95%CI 2.45-3.53) perceived that the EV-71 vaccine is effective (OR = 2.73, 95%CI 1.52-4.90), and a high knowledge level of HFMD (OR = 1.90, 95%CI 1.57-2.29) had the highest significant odds of having an extremely willing intent to vaccinate their children with the EV-71 vaccine. The median (interquartile range [IQR]) of WTP for the EV-71 vaccine was CNY¥200/USD$28 (IQR CNY¥100-400/USD$14-56). The highest marginal WTP for the vaccine was mainly influenced by the perceived high cost of the vaccine. Those participants who did not consider the EV-71 vaccine expensive had more than 10 times higher odds of vaccinating their children (OR = 10.86, 95%CI 8.49-13.88). Perceived susceptibility, perceived benefits, and perceived barriers were also significant influencing factors in the highest marginal WTP. Conclusion The findings demonstrate the importance of improving health promotion and reducing the barriers to EV-71 vaccination. Therefore, it is important to improve health promotion and reduce the barriers to EV-71 vaccination.
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Affiliation(s)
- Lu Cheng
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Sumei Zhong
- Vaccine Clinical Trial Center, Fujian Provincial Center for Disease Control and Prevention, Fuzhou, Fujian, China
| | - Xiaonan Xu
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Junrong Li
- Vaccine Clinical Trial Center, Fujian Provincial Center for Disease Control and Prevention, Fuzhou, Fujian, China
| | - Fangqin Xie
- Vaccine Clinical Trial Center, Fujian Provincial Center for Disease Control and Prevention, Fuzhou, Fujian, China
| | - Yulan Lin
- Department of Epidemiology and Health Statistics, School of Public Health, Fujian Medical University, Fuzhou, Fujian, China
| | - Dongjuan Zhang
- Vaccine Clinical Trial Center, Fujian Provincial Center for Disease Control and Prevention, Fuzhou, Fujian, China
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Pei J, Liu RL, Yang ZH, Du YX, Qian SS, Meng SL, Guo J, Zhang B, Shen S. Identification of Critical Amino Acids of Coxsackievirus A10 Associated with Cell Tropism and Viral RNA Release during Uncoating. Viruses 2023; 15:2114. [PMID: 37896891 PMCID: PMC10611408 DOI: 10.3390/v15102114] [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: 09/19/2023] [Revised: 10/07/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023] Open
Abstract
Coxsackievirus A10 (CV-A10) is a prevailing causative agent of hand-foot-mouth disease, necessitating the isolation and adaptation of appropriate strains in cells allowed for human vaccine development. In this study, amino acid sequences of CV-A10 strains with different cell tropism on RD and Vero cells were compared. Various amino acids on the structural and non-structural proteins related to cell tropism were identified. The reverse genetic systems of several CV-A10 strains with RD+/Vero- and RD+/Vero+ cell tropism were developed, and a set of CV-A10 recombinants were produced. The binding, entry, uncoating, and proliferation steps in the life cycle of these viruses were evaluated. P1 replacement of CV-A10 strains with different cell tropism revealed the pivotal role of the structural proteins in cell tropism. Further, seven amino acid substitutions in VP2 and VP1 were introduced to further investigate their roles played in cell tropism. These mutations cooperated in the growth of CV-A10 in Vero cells. Particularly, the valine to isoleucine mutation at the position VP1-236 (V1236I) was found to significantly restrict viral uncoating in Vero cells. Co-immunoprecipitation assays showed that the release of viral RNA from the KREMEN1 receptor-binding virions was restricted in r0195-V1236I compared with the parental strain r0195 (a RD+/Vero+ strain). Overall, this study highlights the dominant effect of structural proteins in CV-A10 adaption in Vero cells and the importance of V1236 in viral uncoating, providing a foundation for the mechanism study of CV-A10 cell tropism, and facilitating the development of vaccine candidates.
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Affiliation(s)
- Jie Pei
- Wuhan Institute of Biological Products Co., Ltd., Wuhan 430207, China; (J.P.); (R.-L.L.); (Z.-H.Y.); (Y.-X.D.); (S.-S.Q.); (S.-L.M.); (J.G.)
| | - Rui-Lun Liu
- Wuhan Institute of Biological Products Co., Ltd., Wuhan 430207, China; (J.P.); (R.-L.L.); (Z.-H.Y.); (Y.-X.D.); (S.-S.Q.); (S.-L.M.); (J.G.)
| | - Zhi-Hui Yang
- Wuhan Institute of Biological Products Co., Ltd., Wuhan 430207, China; (J.P.); (R.-L.L.); (Z.-H.Y.); (Y.-X.D.); (S.-S.Q.); (S.-L.M.); (J.G.)
| | - Ya-Xin Du
- Wuhan Institute of Biological Products Co., Ltd., Wuhan 430207, China; (J.P.); (R.-L.L.); (Z.-H.Y.); (Y.-X.D.); (S.-S.Q.); (S.-L.M.); (J.G.)
| | - Sha-Sha Qian
- Wuhan Institute of Biological Products Co., Ltd., Wuhan 430207, China; (J.P.); (R.-L.L.); (Z.-H.Y.); (Y.-X.D.); (S.-S.Q.); (S.-L.M.); (J.G.)
| | - Sheng-Li Meng
- Wuhan Institute of Biological Products Co., Ltd., Wuhan 430207, China; (J.P.); (R.-L.L.); (Z.-H.Y.); (Y.-X.D.); (S.-S.Q.); (S.-L.M.); (J.G.)
| | - Jing Guo
- Wuhan Institute of Biological Products Co., Ltd., Wuhan 430207, China; (J.P.); (R.-L.L.); (Z.-H.Y.); (Y.-X.D.); (S.-S.Q.); (S.-L.M.); (J.G.)
| | - Bo Zhang
- Key Laboratory of Virology, Wuhan Institute of Virology, Chinese Academy of Sciences, Wuhan 430071, China;
| | - Shuo Shen
- Wuhan Institute of Biological Products Co., Ltd., Wuhan 430207, China; (J.P.); (R.-L.L.); (Z.-H.Y.); (Y.-X.D.); (S.-S.Q.); (S.-L.M.); (J.G.)
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Guo Z, Wang Y, Li Y, Zhou L. Impact of meteorological factors on the incidence of hand-foot-mouth disease in Yangzhou from 2017 to 2022: a time series study. Front Public Health 2023; 11:1278516. [PMID: 37881347 PMCID: PMC10597706 DOI: 10.3389/fpubh.2023.1278516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 09/26/2023] [Indexed: 10/27/2023] Open
Abstract
Background Hand, foot, and mouth disease (HFMD) is a significant public health issue in China, and numerous studies have indicated a close association between HFMD incidence and meteorological factors. This study aims to investigate the relationship between meteorological factors and HFMD in Yangzhou City, Jiangsu Province, China. Methods HFMD case reports and meteorological data from Yangzhou City between 2017 and 2022 were extracted from the National Notifiable Infectious Disease Surveillance System and the Meteorological Data Sharing Service System, respectively. A generalized additive model (GAM) was employed to assess the exposure-response relationship between meteorological factors and HFMD. Subsequently, a distributed lag nonlinear model (DLNM) was used to explore the exposure-lag-effect of meteorological factors on HFMD. Results HFMD in Yangzhou City exhibits obvious seasonality and periodicity. There is an inverted "U" shaped relationship between average temperature and the risk of HFMD, with the maximum lag effect observed at a temperature of 25°C with lag 0 day (RR = 2.07, 95% CI: 1.74-2.47). As the duration of sunshine and relative humidity increase, the risk of HFMD continuously rises, with the maximum lag effect observed at a sunshine duration of 12.4 h with a lag of 14 days (RR = 2.10, 95% CI: 1.17-3.77), and a relative humidity of 28% with a lag of 14 days (RR = 1.21, 95% CI: 1.01-1.64). There is a "U" shaped relationship between average atmospheric pressure and the risk of HFMD, with the maximum effect observed at an atmospheric pressure of 989 hPa with no lag (RR = 1.45, 95% CI: 1.25-1.69). As precipitation increases, the risk of HFMD decreases, with the maximum effect observed at a precipitation of 151 mm with a lag of 14 days (RR = 1.45, 95% CI: 1.19-2.53). Conclusion Meteorological factors including average temperature, average atmospheric pressure, relative humidity, precipitation, and sunshine duration significantly influenced the risk of HFMD in Yangzhou City. Effective prevention measures for HFMD should be implemented, taking into account the local climate conditions.
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Affiliation(s)
- Zaijin Guo
- Clinical Medical College, Yangzhou University, Yangzhou, China
- Northern Jiangsu People’s Hospital, Yangzhou, China
| | - Yin Wang
- Department of Acute Infectious Disease Control and Prevention, Yangzhou Centre for Disease Control and Prevention, Yangzhou, China
| | - Yunshui Li
- Clinical Medical College, Yangzhou University, Yangzhou, China
- Northern Jiangsu People’s Hospital, Yangzhou, China
| | - Luojing Zhou
- Clinical Medical College, Yangzhou University, Yangzhou, China
- Northern Jiangsu People’s Hospital, Yangzhou, China
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Factors related to the mortality risk of severe hand, foot, and mouth diseases (HFMD): a 5-year hospital-based survey in Guangxi, Southern China. BMC Infect Dis 2023; 23:144. [PMID: 36890462 PMCID: PMC9993373 DOI: 10.1186/s12879-023-08109-y] [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: 08/18/2022] [Accepted: 02/21/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND To understand the factors influencing clinical outcomes of severe hand, foot, and mouth diseases (HFMD), and to provide scientific evidence for reducing the mortality risk of severe HFMD. METHODS From 2014 to 2018, children diagnosed with severe HFMD cases in Guangxi, China, were enrolled in this hospital-based study. The epidemiological data obtained through face-to-face interviews with the parents and guardians. Univariate and multivariate logistics regression models were used to analyze the factors influencing the clinical outcomes of severe HFMD. The impact of the EV-A71 vaccination on inpatient mortality was analyzed by a comparison approach. RESULTS A total of 1565 severe HFMD cases were enrolled in this survey, including 1474 (94.19%) survival cases and 91 (5.81%) death cases. The multivariate logistic analysis demonstrated that HFMD history of playmates in the last three months, first visit to the village hospital, time from the first visit to admission less than two days, no correct diagnosis for HFMD at the first visit, and having no rash symptoms were the independent risk factors for severe HFMD cases (all p < 0.05). While EV-A71 vaccination was a protective factor (p < 0.05). The EV-A71 vaccination group versus the non-vaccination group showed 2.23% of death in the vaccination group and 7.24% of death in the non-vaccination group. The EV-A71 vaccination protected 70.80% of the death of severe HFMD cases, with an effective index of 4.79. CONCLUSIONS The mortality risk of severe HFMD in Guangxi was related to playmates had HFMD history in last 3 months, hospital grade, EV-A71 vaccination, patients visit hospital previously, and rash symptom. EV-A71 vaccination can significantly reduce mortality among severe HFMD. The findings are of great significance for the effective prevention and control of HFMD in Guangxi, southern China.
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Chen Z, Ye SY. Research progress on antiviral constituents in traditional Chinese medicines and their mechanisms of action. PHARMACEUTICAL BIOLOGY 2022; 60:1063-1076. [PMID: 35634712 PMCID: PMC9154771 DOI: 10.1080/13880209.2022.2074053] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 04/22/2022] [Accepted: 04/30/2022] [Indexed: 06/15/2023]
Abstract
CONTEXT Viruses have the characteristics of rapid transmission and high mortality. At present, western medicines still lack an ideal antiviral. As natural products, many traditional Chinese medicines (TCM) have certain inhibitory effects on viruses, which has become the hotspot of medical research in recent years. OBJECTIVE The antiviral active ingredients and mechanisms of TCM against viral diseases was studied in combination with the pathogenesis of viral diseases and antiviral effects. MATERIALS AND METHODS English and Chinese literature from 1999 to 2021 was collected from databases including Web of Science, PubMed, Elsevier, Chinese Pharmacopoeia 2020 (CP), and CNKI (Chinese). Traditional Chinese medicines (TCM), active ingredients, antiviral, mechanism of action, and anti-inflammatory effect were used as the key words. RESULTS The antiviral activity of TCM is clarified to put forward a strategy for discovering active compounds against viruses, and provide reference for screening antivirus drugs from TCM. TCM can not only directly kill viruses and inhibit the proliferation of viruses in cells, but also prevent viruses from infecting cells and causing cytophilia. It can also regulate the human immune system, enhance human immunity, and play an indirect antiviral role. DISCUSSION AND CONCLUSION Based on the experimental study and antiviral mechanism of TCM, this paper can provide analytical evidence that supports the effectiveness of TCM in treating virus infections, as well as their mechanisms against viruses. It could be helpful to provide reference for the research and development of innovative TCMs with multiple components, multiple targets and low toxicity.
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Affiliation(s)
- Zhi Chen
- Pharmaceutical College, Shandong University of TCM, Jinan, People’s Republic of China
| | - Si-yong Ye
- Department of Pharmacy, Jinan Second People's Hospital, Jinan, People’s Republic of China
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Fang H, Chen C, Fang Y, He X, Hou Z, Jiang M, Jiang Y, Li S, Liu Y, Sui B, Sun Q, Wu J, Xu T, Yang J, Yin Z, Ying X, Yuan B, Zheng H, Zheng Y. A guideline for economic evaluations of vaccines and immunization programs in China. Hum Vaccin Immunother 2022; 18:2132802. [PMID: 36287462 PMCID: PMC9746533 DOI: 10.1080/21645515.2022.2132802] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
This study aimed to develop a consensus framework for economic evaluations of vaccines as a national guideline in China. Some unique and important aspects were particularly emphasized. Nineteen Chinese experts in the field of health economics and immunization decision-making were nominated to select and discuss relevant aspects of vaccine economic evaluations in China. A workshop attended by external experts was held to summarize unique and important aspects and formulate consensus recommendations. There were ten unique and/or important aspects identified for economic evaluations of vaccines in China, including study perspectives, comparator strategies, analysis types, model choices, costing approaches, utility measures, discounting, uncertainty, equity, and evaluation purposes. Background information and expert recommendations were provided for each aspect. Economic evaluations of vaccines should play an important role in China's immunization policy-making. This guideline can help improve the quality of economic evaluations as a good practice consensus.
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Affiliation(s)
- Hai Fang
- China Center for Health Development Studies, Peking University, Beijing, China,Institute for Global Health and Development, Peking University, Beijing, China,CONTACT Hai Fang China Center for Health Development Studies, Peking University, Beijing, China
| | - Chen Chen
- School of Public Health, Wuhan University, Wuhan, Hubei Province, China
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Xiaoning He
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
| | - Zhiyuan Hou
- School of Public Health, Fudan University, Shanghai, China
| | - Minghuan Jiang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi’an Jiaotong University, Xi’an, Shaanxi Province, China
| | - Yawen Jiang
- School of Public Health (Shenzhen), Sun Yat-Sen University, Shenzhen, Guangdong Province, China
| | - Shunping Li
- School of Public Health, Shandong University, Jinan, Shandong Province, China
| | - Yang Liu
- Centre for Mathematical Modelling of Infectious Diseases, London School of Hygiene and Tropical Medicine, London, UK,Department of Infectious Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Binyan Sui
- School of Social Development and Public Policy, Beijing Normal University, Beijing, China
| | - Qiang Sun
- School of Public Health, Shandong University, Jinan, Shandong Province, China
| | - Jing Wu
- School of Pharmaceutical Science and Technology, Tianjin University, Tianjin, China
| | - Tingting Xu
- School of Public Health, Capital Medical University, Beijing, China
| | - Juan Yang
- School of Public Health, Fudan University, Shanghai, China
| | - Zundong Yin
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xiaohua Ying
- School of Public Health, Fudan University, Shanghai, China
| | - Beibei Yuan
- China Center for Health Development Studies, Peking University, Beijing, China
| | - Hui Zheng
- National Immunization Program, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yaming Zheng
- Division of Infectious Diseases, Chinese Center for Disease Control and Prevention, Beijing, China
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Gao Q, Liu Z, Xiang J, Tong M, Zhang Y, Wang S, Zhang Y, Lu L, Jiang B, Bi P. Forecast and early warning of hand, foot, and mouth disease based on meteorological factors: Evidence from a multicity study of 11 meteorological geographical divisions in mainland China. ENVIRONMENTAL RESEARCH 2021; 192:110301. [PMID: 33069698 DOI: 10.1016/j.envres.2020.110301] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/24/2020] [Accepted: 10/05/2020] [Indexed: 05/14/2023]
Abstract
BACKGROUND Hand, foot, and mouth disease (HFMD) is a significant public health issue in China. Early warning and forecasting are one of the most cost-effective ways for HFMD control and prevention. However, relevant research is limited, especially in China with a large population and diverse climatic characteristics. This study aims to identify local specific HFMD epidemic thresholds and construct a weather-based early warning model for HFMD control and prevention across China. METHODS Monthly notified HFMD cases and meteorological data for 22 cities selected from different climate zones from 2014 to 2018 were extracted from the National Notifiable Disease Surveillance System and the Meteorological Data Sharing Service System, respectively. A generalized additive model (GAM) based on meteorological factors was conducted to forecast HFMD epidemics. The receiver operator characteristic curve (ROC) was generated to determine the value of optimal warning threshold. RESULTS The developed model was solid in forecasting the epidemic of HFMD with all R square (R2) in the 22 cities above 85%, and mean absolute percentage error (MAPE) less than 1%. The warning thresholds varied by cities with the highest threshold observed in Shenzhen (n = 7195) and the lowest threshold in Liaoyang (n = 12). The areas under the curve (AUC) was greater than 0.9 for all regions, indicating a satisfied discriminating ability in epidemics detection. CONCLUSIONS The weather-based HFMD forecasting and early warning model we developed for different climate zones provides needed information on occurrence time and size of HFMD epidemics. An effective early warning system for HFMD could provide sufficient time for local authorities to implement timely interventions to minimize the HFMD morbidity and mortality.
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Affiliation(s)
- Qi Gao
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, People's Republic of China; Shandong University Climate Change and Health Center, Jinan, Shandong Province, People's Republic of China
| | - Zhidong Liu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, People's Republic of China; Shandong University Climate Change and Health Center, Jinan, Shandong Province, People's Republic of China
| | - Jianjun Xiang
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia; School of Public Health, Fujian Medical University, Fuzhou, 350108, People's Republic of China
| | - Michael Tong
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Ying Zhang
- School of Public Health, China Studies Centre, The University of Sydney, New South Wales, Australia
| | - Shuzi Wang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, People's Republic of China; Shandong University Climate Change and Health Center, Jinan, Shandong Province, People's Republic of China
| | - Yiwen Zhang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, People's Republic of China; Shandong University Climate Change and Health Center, Jinan, Shandong Province, People's Republic of China
| | - Liang Lu
- Shandong University Climate Change and Health Center, Jinan, Shandong Province, People's Republic of China; State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, People's Republic of China
| | - Baofa Jiang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, People's Republic of China; Shandong University Climate Change and Health Center, Jinan, Shandong Province, People's Republic of China.
| | - Peng Bi
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
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Head JR, Collender PA, Lewnard JA, Skaff NK, Li L, Cheng Q, Baker JM, Li C, Chen D, Ohringer A, Liang S, Yang C, Hubbard A, Lopman B, Remais JV. Early Evidence of Inactivated Enterovirus 71 Vaccine Impact Against Hand, Foot, and Mouth Disease in a Major Center of Ongoing Transmission in China, 2011-2018: A Longitudinal Surveillance Study. Clin Infect Dis 2020; 71:3088-3095. [PMID: 31879754 PMCID: PMC7819528 DOI: 10.1093/cid/ciz1188] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 12/11/2019] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Enterovirus 71 (EV71) is a major causative agent of hand, foot, and mouth disease (HFMD), associated with severe manifestations of the disease. Pediatric immunization with inactivated EV71 vaccine was initiated in 2016 in the Asia-Pacific region, including China. We analyzed a time series of HFMD cases attributable to EV71, coxsackievirus A16 (CA16), and other enteroviruses in Chengdu, a major transmission center in China, to assess early impacts of immunization. METHODS Reported HFMD cases were obtained from China's notifiable disease surveillance system. We compared observed postvaccination incidence rates during 2017-2018 with counterfactual predictions made from a negative binomial regression and a random forest model fitted to prevaccine years (2011-2015). We fit a change point model to the full time series to evaluate whether the trend of EV71 HFMD changed following vaccination. RESULTS Between 2011 and 2018, 279 352 HFMD cases were reported in the study region. The average incidence rate of EV71 HFMD in 2017-2018 was 60% (95% prediction interval [PI], 41%-72%) lower than predicted in the absence of immunization, corresponding to an estimated 6911 (95% PI, 3246-11 542) EV71 cases averted over 2 years. There were 52% (95% PI, 42%-60%) fewer severe HFMD cases than predicted. However, the incidence rate of non-CA16 and non-EV71 HFMD was elevated in 2018. We identified a significant decline in the trend of EV71 HFMD 4 months into the postvaccine period. CONCLUSIONS We provide the first real-world evidence that programmatic vaccination against EV71 is effective against childhood HFMD and present an approach to detect early vaccine impact or intended consequences from surveillance data.
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Affiliation(s)
- Jennifer R Head
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Philip A Collender
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Joseph A Lewnard
- Division of Epidemiology, School of Public Health, University of California, Berkeley, Berkeley, California, USA
- Center for Computational Biology, College of Engineering, University of California, Berkeley, Berkeley, California, USA
| | - Nicholas K Skaff
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Ling Li
- Institute for Public Health Information, Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Qu Cheng
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Julia M Baker
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Charles Li
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Dehao Chen
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Alison Ohringer
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Song Liang
- Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida, Gainesville, Florida, USA
| | - Changhong Yang
- Institute for Public Health Information, Sichuan Center for Disease Control and Prevention, Chengdu, China
| | - Alan Hubbard
- Division of Biostatistics, School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - Benjamin Lopman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Justin V Remais
- Division of Environmental Health Sciences, School of Public Health, University of California, Berkeley, Berkeley, California, USA
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9
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Han Y, Chen Z, Zheng K, Li X, Kong J, Duan X, Xiao X, Guo B, Luan R, Long L. Epidemiology of Hand, Foot, and Mouth Disease Before and After the Introduction of Enterovirus 71 Vaccines in Chengdu, China, 2009-2018. Pediatr Infect Dis J 2020; 39:969-978. [PMID: 32433221 DOI: 10.1097/inf.0000000000002745] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Hand, foot, and mouth disease (HFMD) has posed a serious threat to children's health. Three inactivated monovalent enterovirus 71 (EV71) vaccines are proved to be highly efficacious in phase III clinical trials and are now available in China. METHODS We analyzed the citywide surveillance data on HFMD cases in Chengdu during 2009-2018, and estimated cumulative first-dose EV71 vaccination coverage among children eligible to EV71 vaccination after August 2016 in Chengdu. Time series susceptible-infected-recovered model was developed to analyze basic reproduction number and herd immunity threshold of HFMD. Overall and serotype-specific HFMD incidences and severity risks were compared before and after the EV71 vaccination. RESULTS Among 3 laboratory-identified serotype categories, i.e. EV71, coxsackievirus A16 (CV-A16), and other enteroviruses, the major serotype attributed to HFMD has been changing across years. The cumulative first-dose EV71 vaccination coverage rate was estimated as 60.8% during the study period in Chengdu. By contrast, herd immunity threshold for EV71-related HFMD was 94.0%. After introduction of EV71 vaccines, the overall incidence of HFMD increased 60.8%, mainly driven by 173.7% and 11.8% increased in HFMD caused by other enteroviruses and CV-A16, respectively, which offset a significant reduction in the incidence of HFMD caused by EV71. The overall case-severity risk decreased from 1.4% to 0.3%, with significantly declined presented in all serotype categories. CONCLUSIONS The incidence and severity of EV71-related HFMD decreased following implementation of EV71 vaccination. Developing multivalent vaccines and strengthening laboratory-based surveillance could further decline burden of HFMD.
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Affiliation(s)
- Yutong Han
- Department of Epidemiology and Biostatitics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Sichuan, China
| | - Zhenhua Chen
- Department of Epidemiology and Biostatitics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Sichuan, China
| | - Ke Zheng
- Department of Immunization Planning, Chengdu Municipal Center for Disease Control and Prevention, Sichuan, China
| | - Xianzhi Li
- Department of Epidemiology and Biostatitics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Sichuan, China
| | - Jinwang Kong
- Department of Epidemiology and Biostatitics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Sichuan, China
| | - Xiaoxia Duan
- Department of Epidemiology and Biostatitics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Sichuan, China
| | - Xiong Xiao
- Department of Epidemiology and Biostatitics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Sichuan, China
| | - Bing Guo
- Department of Epidemiology and Biostatitics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Sichuan, China
| | - Rongsheng Luan
- Department of Epidemiology and Biostatitics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Sichuan, China
| | - Lu Long
- Department of Epidemiology and Biostatitics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Sichuan, China
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10
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Du Z, Huang Y, Bloom MS, Zhang Z, Yang Z, Lu J, Xu J, Hao Y. Assessing the vaccine effectiveness for hand, foot, and mouth disease in Guangzhou, China: a time-series analysis. Hum Vaccin Immunother 2020; 17:217-223. [PMID: 32530733 DOI: 10.1080/21645515.2020.1763076] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objective: Hand, foot, and mouth disease (HFMD) is an important public health issue in China. Although efficacy has been demonstrated by randomized controlled trials, the evidence for effectiveness of the monovalent Enterovirus 71 (EV71) vaccine against HFMD remains unknown. This study aimed to assess the vaccine effectiveness for HFMD in Guangzhou, China. Methods: Routinely collected vaccination and HFMD surveillance data were captured from the China Information System for Disease Control and Prevention. We estimated the EV71 vaccine effectiveness using spatial ecologic and time-series analysis approaches. Results: A total of 174,002 HFMD cases under 5 years of age were reported to the Guangzhou, China surveillance system from January 2016 to December 2018. A total of 408,664 children completed a two-dose EV71 vaccination series. In an ecologic analysis, a two-dose EV71 vaccination rate above the median conferred lower HFMD risk relative to a vaccination rate below the median (ratio ratio = 0.955, 95% confidence interval (CI): 0.949, 0.962; P < .001). In the time-series approach, 0.9% fewer HFMD cases were associated with a 1% increase in the two-dose EV71 vaccination rate, but without statistical significance (P = .094). However, we detected statistically significant protective associations for HFMD among children 3 years of age (0.9% fewer HFMD cases with a 1% increased vaccination rate; P = .046), and for EV71 (1.4%; P = .012) and "other viruses" (1.3%; P = .002), although not for Coxsackievirus A16 (CVA16). Conclusion: Our findings, based on real-world data, provide evidence of EV71 vaccine effectiveness for preventing EV71 and "other" viruses associated with HFMD. An expanded program of EV71 vaccination is urgently needed.
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Affiliation(s)
- Zhicheng Du
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University , Guangzhou, China
| | - Yong Huang
- Department of Immunization Programme Planning, Guangzhou Center for Disease Control and Prevention , Guangzhou, China
| | - Michael S Bloom
- Departments of Environmental Health Sciences and Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York , Albany, New York, USA
| | - Zhoubin Zhang
- Department of Communicable Disease Control and Prevention, Guangzhou Center for Disease Control and Prevention , Guangzhou, China
| | - Zhicong Yang
- Department of Communicable Disease Control and Prevention, Guangzhou Center for Disease Control and Prevention , Guangzhou, China
| | - Jianyun Lu
- Department of Communicable Disease Control and Prevention, Guangzhou Center for Disease Control and Prevention , Guangzhou, China
| | - Jianxiong Xu
- Department of Immunization Programme Planning, Guangzhou Center for Disease Control and Prevention , Guangzhou, China
| | - Yuantao Hao
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University , Guangzhou, China
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11
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Wang Y, Meng F, Li J, Li G, Hu J, Cao J, Yu Q, Liang Q, Zhu F. Willingness of parents to vaccinate their 6-60-month-old children with EV71 vaccines: a cross-sectional study in rural areas of northern Jiangsu Province. Hum Vaccin Immunother 2020; 16:1579-1585. [PMID: 32209003 DOI: 10.1080/21645515.2020.1737465] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Enterovirus 71 (EV71) is the dominant pathogen in severe and fatal hand-foot-mouth disease (HFMD) cases. Since 2015, three inactivated EV71 vaccines have been approved in China. The vaccination coverage of the EV71 vaccine has been relatively low, especially in rural areas. A cross-sectional survey from July 19 to August 22, 2018, was conducted in three rural counties of northern Jiangsu Province among parents of children aged 6-60 months. We adopted a pretested validated questionnaire to assess knowledge, awareness, and attitude of HFMD and EV71 vaccines among respondents and used univariate and multivariate binary logistic analyses to explore potential factors associated with the acceptance of EV71 vaccines. Of the 1,112 parents who participated, 87.8% were willing to vaccinate their children with EV71 vaccines. Parents over 40 y old were less likely to have their children vaccinated [adjusted odds ratio (aOR) = 2.12, 95% confidence interval (CI): 1.13-3.97]. Parents who lived in Ganyu (aOR = 0.50, 95% CI: 0.31-0.79) or Xinyi county (aOR = 0.33, 95% CI: 0.20-0.53), had a university or higher degree (aOR = 0.26, 95% CI: 0.11-0.64), had good knowledge of EV71 vaccines (aOR = 0.81, 95% CI: 0.67-0.98), perceived their children's disease susceptibility, and worried about the severity of HFMD had a higher willingness to vaccinate their children. Most parents were willing to vaccinate their children against EV71-related HFMD. Parental age, location, education level, knowledge of EV71 vaccines, concern about susceptibility, and severity of HFMD were all factors that influenced willingness to vaccinate.
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Affiliation(s)
- Yuanyuan Wang
- School of Public Health, Nanjing Medical University , Nanjing, PR China
| | - Fanyu Meng
- Vaccine Clinical Evaluation Department, Jiangsu Provincial Center for Disease Control and Prevention , Nanjing, PR China
| | - Jingxin Li
- Vaccine Clinical Evaluation Department, Jiangsu Provincial Center for Disease Control and Prevention , Nanjing, PR China
| | - Guifan Li
- Department of Registration, Beijing Minhai Biotechnology Co. Ltd ., Beijing, PR China
| | - Jialei Hu
- Vaccine Clinical Evaluation Department, Jiangsu Provincial Center for Disease Control and Prevention , Nanjing, PR China
| | - Jiaqian Cao
- School of Public Health, Nanjing Medical University , Nanjing, PR China
| | - Qiufan Yu
- School of Public Health, Southeast University , Nanjing, PR China
| | - Qi Liang
- Vaccine Clinical Evaluation Department, Jiangsu Provincial Center for Disease Control and Prevention , Nanjing, PR China
| | - Fengcai Zhu
- School of Public Health, Nanjing Medical University , Nanjing, PR China.,Vaccine Clinical Evaluation Department, Jiangsu Provincial Center for Disease Control and Prevention , Nanjing, PR China.,Center for Global Health, Nanjing Medical University , Nanjing, PR China
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12
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Liu D, Leung K, Jit M, Yu H, Yang J, Liao Q, Liu F, Zheng Y, Wu JT. Cost-effectiveness of bivalent versus monovalent vaccines against hand, foot and mouth disease. Clin Microbiol Infect 2020; 26:373-380. [PMID: 31279839 PMCID: PMC6942242 DOI: 10.1016/j.cmi.2019.06.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 06/20/2019] [Accepted: 06/22/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Enterovirus 71 (EV71) and coxsackievirus A16 (CA16) were responsible for 43.3% (235 123/543 243) and 24.8% (134 607/543 243) of all laboratory-confirmed hand, foot and mouth disease (HFMD) cases during 2010-2015 in China. Three monovalent EV71 vaccines have been licensed in China while bivalent EV71/CA16 vaccines are under development. A comparative cost-effectiveness analysis of bivalent EV71/CA16 versus monovalent EV71 vaccination would be useful for informing the additional value of bivalent HFMD vaccines in China. METHODS We used a static model parameterized with the national HFMD surveillance data during 2010-2013, virological HFMD surveillance records from all 31 provinces in mainland China during 2010-2013 and caregiver survey data of costs and health quality of life during 2012-2013. We estimated the threshold vaccine cost (TVC), defined as the maximum additional cost that could be paid for a cost-effective bivalent EV71/CA16 vaccine over a monovalent EV71 vaccine, as the outcome. The base case analysis was performed from a societal perspective. Several sensitivity analyses were conducted by varying assumptions governing HFMD risk, costs, discounting and vaccine efficacy. RESULTS In the base case, choosing the bivalent EV71/CA16 over monovalent EV71 vaccination would be cost-effective only if the additional cost of the bivalent EV71/CA16 compared with the monovalent EV71 vaccine is less than €4.7 (95% CI 4.2-5.2). Compared with the TVC in the base case, TVC increased by up to €8.9 if all the test-negative cases were CA16-HFMD; decreased by €1.1 with an annual discount rate of 6% and exclusion of the productivity loss; and increased by €0.14 and €0.3 with every 1% increase in bivalent vaccine efficacy against CA16-HFMD and differential vaccine efficacy against EV71-HFMD, respectively. CONCLUSIONS Bivalent EV71/CA16 vaccines can be cost-effective compared with monovalent EV71 vaccines, if suitably priced. Our study provides further evidence for determining the optimal use of HFMD vaccines in routine paediatric vaccination programme in China.
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Affiliation(s)
- D Liu
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - K Leung
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - M Jit
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China; Modelling and Economics Unit, Public Health England, London, UK; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - H Yu
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - J Yang
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Q Liao
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - F Liu
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Y Zheng
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - J T Wu
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
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13
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Hao J, Yang Z, Yang W, Huang S, Tian L, Zhu Z, Lu Y, Xiang H, Liu S. Impact of Ambient Temperature and Relative Humidity on the Incidence of Hand-Foot-Mouth Disease in Wuhan, China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:117358. [PMID: 31936369 DOI: 10.1016/j.atmosenv.2020.117358] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 01/02/2020] [Accepted: 01/07/2020] [Indexed: 05/19/2023]
Abstract
Background: Few studies have previously explored the relationship between hand, foot, and mouth disease (HFMD) and meteorological factors with the effect modification of air pollution, and these studies had inconsistent findings. We therefore applied a time-series analysis assessing the effects of temperature and humidity on the incidence of HFMD in Wuhan, China to deepen our understanding of the relationship between meteorological factors and the risk of HFMD. Methods: Daily HFMD cases were retrieved from Hubei Provincial Center for Disease Control and Prevention from 1 February 2013 to 31 January 2017. Daily meteorological data including 24 h average temperature, relative humidity, wind velocity, and atmospheric pressure were obtained from Hubei Meteorological Bureau. Data on Air pollution was collected from 10 national air-monitoring stations in Wuhan city. We adopted a distributed lag non-linear model (DLNM) combined with Poisson regression and time-series analysis to estimate the effects of temperature and relative humidity on the incidence HFMD. Results: We found that the association between temperature and HFMD incidence was non-linear, exhibiting an approximate "M" shape with two peaks occurring at 2.3 °C (RR = 1.760, 95% CI: 1.218-2.542) and 27.9 °C (RR = 1.945, 95% CI: 1.570-2.408), respectively. We observed an inverted "V" shape between relative humidity and HFMD. The risk of HFMD reached a maximum value at a relative humidity of 89.2% (RR = 1.553, 95% CI: 1.322-1.824). The largest delayed cumulative effects occurred at lag 6 for temperature and lag 13 for relative humidity. Conclusions: The non-linear relationship between meteorological factors and the incidence of HFMD on different lag days could be used in the early targeted warning system of infectious diseases, reducing the possible outbreaks and burdens of HFMD among sensitive populations.
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Affiliation(s)
- Jiayuan Hao
- Department of Global Health, School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan 430071, China
- Global Health Institute, Wuhan University, 115# Donghu Road, Wuhan 430071, China
| | - Zhiyi Yang
- Department of Global Health, School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan 430071, China
- Global Health Institute, Wuhan University, 115# Donghu Road, Wuhan 430071, China
| | - Wenwen Yang
- Hubei Provincial Center for Disease control and Prevention, Wuhan 430079, China
| | - Shuqiong Huang
- Hubei Provincial Center for Disease control and Prevention, Wuhan 430079, China
| | - Liqiao Tian
- State Key Laboratory of Information Engineering in Surveying, Mapping and Remote Sensing, Wuhan University, Wuhan 430079, China
| | - Zhongmin Zhu
- State Key Laboratory of Information Engineering in Surveying, Mapping and Remote Sensing, Wuhan University, Wuhan 430079, China
- College of Information Science and Engineering, Wuchang Shouyi University, Wuhan 430064, China
| | - Yuanan Lu
- Environmental Health Laboratory, Department of Public Health Sciences, University of Hawaii at Manoa, 1960 East-West Rd, Biomed Bldg, D105, Honolulu, HI 96822, USA
| | - Hao Xiang
- Department of Global Health, School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan 430071, China
- Global Health Institute, Wuhan University, 115# Donghu Road, Wuhan 430071, China
| | - Suyang Liu
- Department of Global Health, School of Health Sciences, Wuhan University, 115# Donghu Road, Wuhan 430071, China
- Global Health Institute, Wuhan University, 115# Donghu Road, Wuhan 430071, China
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14
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Sun Y, Feng L, Li J, Xu H, Mei X, Feng L, Sun H, Gao J, Zhang X. miR-545 promoted enterovirus 71 replication via directly targeting phosphatase and tensin homolog and tumor necrosis factor receptor-associated factor 6. J Cell Physiol 2019; 234:15686-15697. [PMID: 30697739 DOI: 10.1002/jcp.28222] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 01/10/2019] [Accepted: 01/15/2019] [Indexed: 01/24/2023]
Abstract
Enterovirus 71 (EV71) is a small, nonenveloped icosahedral RNA virus and is the predominant causative pathogen of hand-foot-and-mouth disease. Recently, microRNAs (miRNAs) are reported to play important roles in the pathogenesis of EV71 replication. This study investigated the role of miR-545 in the EV71 replication and explored the underlying molecular mechanisms. We showed that miR-545 was upregulated in the EV71-infected human embryonic kidney (HEK) 293 cells and rhabdomyosarcoma (RD) cells. Overexpression of miR-545 promoted the viral replication of EV71 and attenuated the inhibitory effects of EV71 on cell viability in HEK293 and RD cells; while knockdown of miR-545 significantly suppressed the EV71 replication in these two cell lines. Bioinformatics analysis and luciferase reporter assay showed that miR-545 directly targeted the 3'untranslated region of phosphatase and tensin homolog (PTEN) and tumor necrosis factor receptor-associated factor 6 (TRAF6) in HEK293 cells. Furthermore, miR-545 negatively regulated the messenger RNA (mRNA) and protein expression of PTEN and TRAF6. The mRNA and protein expression of PTEN and TRAF6 was also suppressed by EV71 infection, which was attenuated by miR-545 knockdown in HEK293 cells. Overexpression of PTEN and TRAF6 both suppressed the EV71 replication in HKE293 cells, and also attenuated the enhanced effects of miR-545 overexpression on the EV71 replication in HEK293 cells. Collectively, our study for the first time showed that miR-545 had an enhanced effect on the EV71 replication in HEK293 and RD cells. Further mechanistic results indicated that miR-545 promoted EV71 replication at least partly via targeting PTEN and TRAF6.
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Affiliation(s)
- Ying Sun
- Basic Medicine College, Henan University of Chinese Medicine, Zhengzhou, Henan, China.,Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, Henan, China.,Collaborative Innovation Center for Respiratory Disease Diagnosis and Treatment & Chinese Medicine Development of Henan Province, Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Long Feng
- Basic Medicine College, Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Jiansheng Li
- Henan Key Laboratory of Chinese Medicine for Respiratory Disease, Henan University of Chinese Medicine, Zhengzhou, Henan, China.,Collaborative Innovation Center for Respiratory Disease Diagnosis and Treatment & Chinese Medicine Development of Henan Province, Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Huaming Xu
- Basic Medicine College, Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Xue Mei
- Basic Medicine College, Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Lingyan Feng
- Medical College, Jianghan University, Wuhan, Hubei, China
| | - Huijuan Sun
- Basic Medicine College, Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Jianfeng Gao
- Basic Medicine College, Henan University of Chinese Medicine, Zhengzhou, Henan, China
| | - Xiaoli Zhang
- Basic Medicine College, Henan University of Chinese Medicine, Zhengzhou, Henan, China
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15
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Chen S, Liu X, Wu Y, Xu G, Zhang X, Mei S, Zhang Z, O'Meara M, O'Gara MC, Tan X, Li L. The application of meteorological data and search index data in improving the prediction of HFMD: A study of two cities in Guangdong Province, China. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 652:1013-1021. [PMID: 30380469 DOI: 10.1016/j.scitotenv.2018.10.304] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2018] [Revised: 10/22/2018] [Accepted: 10/22/2018] [Indexed: 02/05/2023]
Abstract
Hand, foot and mouth disease (HFMD) is a public health issue in China, and its incidence in Guangdong Province is higher than the national average. Previous studies have found climatic factors have an influential role in the transmission of HFMD. Internet search technology has been shown to predict some infectious disease epidemics and is a potential resource in tracking epidemics in countries where the use of Internet search index data is prevalent. This study aims to improve the prediction of HFMD in two Chinese cities, Shantou and Shenzhen in Guangdong Province, applying both meteorological data and Baidu search indices to create a HFMD forecasting model. To this end, the relationship between meteorological factors and HFMD was found to be linear in both cities, while the relationship between search engine data and HFMD was not consistent. The results of our study suggest that using both Internet search and meteorological data can improve the prediction of HFMD incidence. Using comparative analysis of both cities, we posit that improved quality search indices enhance prediction of HFMD.
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Affiliation(s)
- Shaoxing Chen
- Injury Prevention Research Center, Shantou University Medical College, Shantou, Guangdong 515041, China; Department of Community monitoring, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Xiaojian Liu
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China.
| | - Yongsheng Wu
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China.
| | - Guangxing Xu
- Shantou Center for Disease Control and Prevention, Shantou, China
| | - Xubin Zhang
- Shantou Center for Disease Control and Prevention, Shantou, China
| | - Shujiang Mei
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China.
| | - Zhen Zhang
- Shenzhen Center for Disease Control and Prevention, Shenzhen, China.
| | - Michael O'Meara
- Department of Information Technology, Shantou University Medical College, Shantou, Guangdong 515041, China.
| | - Mary Clare O'Gara
- Department of Nursing, Shantou University Medical College, Shantou, Guangdong 515041, China.
| | - Xuerui Tan
- Department of Cardiology, The First Affiliated Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Liping Li
- Injury Prevention Research Center, Shantou University Medical College, Shantou, Guangdong 515041, China.
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16
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Xu L, Shi Y, Rainey JJ, Zhang Z, Zhang H, Zhao J, Li Y, Rao H, Li Y, Liao Q, Ma Y. Epidemiological features and spatial clusters of hand, foot, and mouth disease in Qinghai Province, China, 2009-2015. BMC Infect Dis 2018; 18:624. [PMID: 30518329 PMCID: PMC6280489 DOI: 10.1186/s12879-018-3509-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Accepted: 11/08/2018] [Indexed: 01/26/2023] Open
Abstract
Background Hand, Foot, and Mouth Disease (HFMD) is most frequently caused by Enterovirus71 (EV-A71) or Coxsackie virus A16 (CV-A16), infants and young children are at greatest risk. Describing the epidemiology of HFMD can help develop and better target interventions, including the use of pediatric EV-A71 vaccination. Methods We obtained data from the national surveillance system for HFMD cases with onset dates from 2009 to 2015. We defined probable cases as patient with skin papular or vesicular rashes on the hands, feet, mouth, or buttocks and confirmed cases as patients with the above symptoms along with laboratory-based enterovirus detection. We generated overall and age-specific annual incidence rates and described the temporal variability and seasonality of HFMD in Qinghai Province. We identified spatial clustering of HFMD incidence at the county level using the Local Indicator of Spatial Associationand an alpha level of 0.05. Results During the study period, 14,480 HFMD probable or confirmed cases were reported in Qinghai Province. Of the 2158 (14.9%) with laboratory confirmation, 924 (42.6%) were caused by CV-A16 and 830 (38.2%) were caused by EV-A71. The majority (89%) of all case-patients were ≤ 5 years of age and male (61.5%). The overall mean annual HFMD incidence rate was 36.4 cases per 100,000 populations, while the incidence rate for children ≤5 years of age was 379.5 cases per 100,000. Case reports peaked during the months of May through July. HFMD was predominantly caused by EV-A71, except in 2010 and 2014 when CV-A16 was the predominant causative agent. High incidence rates of HFMD were clustered (Moran’s I = 0.59, P < 0.05) in the eastern region of the province. Conclusion HFMD remains an important cause of childhood disease in Qinghai Province, occurring in an acyclical pattern of increased incidence, primarily due to CV-A16 circulation every three years. Incidence is also seasonal and tends to spatially cluster in the eastern region of the province. Since approximately 40% of confirmed HFMD cases were due to EV-A71, EV-A71 vaccination is likely to have a positive impact on the HFMD disease burden. Routine analysis of local surveillance data is crucial for describing disease occurrence and changes in etiology. Electronic supplementary material The online version of this article (10.1186/s12879-018-3509-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lili Xu
- Institute for Infectious Disease Control and Prevention, Qinghai Provincial Center for Disease Control and Prevention, Xining, Qinghai, China
| | - Yan Shi
- Institute for Infectious Disease Control and Prevention, Qinghai Provincial Center for Disease Control and Prevention, Xining, Qinghai, China
| | - Jeanette J Rainey
- International Emerging Infections Program, Division of Global Health Protection, United States Centers for Disease Control and Prevention, Beijing, China.,Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, USA
| | - Zhijie Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Huayi Zhang
- Institute for Infectious Disease Control and Prevention, Qinghai Provincial Center for Disease Control and Prevention, Xining, Qinghai, China
| | - Jinhua Zhao
- Institute for Infectious Disease Control and Prevention, Qinghai Provincial Center for Disease Control and Prevention, Xining, Qinghai, China
| | - Yonghong Li
- Institute for Infectious Disease Control and Prevention, Qinghai Provincial Center for Disease Control and Prevention, Xining, Qinghai, China
| | - Huaxiang Rao
- Institute for Infectious Disease Control and Prevention, Qinghai Provincial Center for Disease Control and Prevention, Xining, Qinghai, China
| | - Yanming Li
- Institute for Infectious Disease Control and Prevention, Qinghai Provincial Center for Disease Control and Prevention, Xining, Qinghai, China
| | - Qiaohong Liao
- Department of Epidemiology and Biostatistics, School of Public Health, Fudan University, Shanghai, China. .,Division of Infectious Disease, Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China.
| | - Yongcheng Ma
- Institute for Infectious Disease Control and Prevention, Qinghai Provincial Center for Disease Control and Prevention, Xining, Qinghai, China.
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17
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Zhang H, Wang X, Wang Y, Pei X, Wang C, Niu Y, Xu P, Peng Y. Substituted 3-benzylcoumarins 13 and 14 suppress enterovirus A71 replication by impairing viral 2A pro dependent IRES-driven translation. Antiviral Res 2018; 160:10-16. [PMID: 30315876 DOI: 10.1016/j.antiviral.2018.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 08/22/2018] [Accepted: 10/09/2018] [Indexed: 02/07/2023]
Abstract
Activation of the ERK signaling cascade in host cells has been demonstrated to be essential for enterovirus A71 (EV-A71) replication. Our previous study showed that MEK kinase, which specially activated downstream ERK kinase, is an important and potential target against EV-A71. Furthermore, we reported that a series of substituted 3-benzylcoumarins designed and synthesized as well as verified for inhibiting the MEK-ERK cascade were found to be effective on anti-EV-A71. In this study, we further demonstrated that two substituted 3-benzylcoumarins designated as 13 and 14 were more effective anti-MEK/ERK activity, less cytotoxicity and stronger antiviral effect represented by inhibition of viral-induced CPE, the expression of viral proteins and the replication of the viral genome, as well as the production of progeny virions, compared to those of U0126, an available MEK inhibitor, and sorafenib, a multiple-targeted kinase inhibitor in clinical use. Moreover, we explored that the likely mechanism of action of these two test compounds were to block EV-A71 2A dependent IRES-driven activity essential for successful viral replication. Hence, our results suggest that two substituted 3-benzylcoumarins 13 and 14 could be candidates as potential anti-EV-A71 agents.
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Affiliation(s)
- Hao Zhang
- Department of Microbiology & Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100083, China
| | - Xin Wang
- Department of Microbiology & Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100083, China
| | - Yuya Wang
- Department of Microbiology & Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100083, China
| | - Xinyi Pei
- Department of Microbiology & Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100083, China
| | - Chao Wang
- State Key Laboratory of Natural and Biomimetic Drugs, Department of Medicinal Chemistry, School of Pharmaceutical Science, Peking University Health Science Center, Beijing 100083, China
| | - Yan Niu
- State Key Laboratory of Natural and Biomimetic Drugs, Department of Medicinal Chemistry, School of Pharmaceutical Science, Peking University Health Science Center, Beijing 100083, China
| | - Ping Xu
- State Key Laboratory of Natural and Biomimetic Drugs, Department of Medicinal Chemistry, School of Pharmaceutical Science, Peking University Health Science Center, Beijing 100083, China
| | - Yihong Peng
- Department of Microbiology & Infectious Disease Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100083, China.
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Abstract
PURPOSE OF REVIEW The focus of this review is on enterovirus (EV)-associated acute flaccid paralysis (AFP) due to spinal cord anterior horn cell disease. Emphasis is placed on the epidemiology, pathogenesis, diagnosis, treatment, and outcome of AFP caused by polioviruses, vaccine-derived polioviruses, EV-D68, and EV-A71. RECENT FINDINGS Since the launch of The Global Polio Eradication Initiative in 1988, the worldwide incidence of polio has been reduced by 99.9%, with small numbers of poliomyelitis cases being reported only in Afghanistan, Pakistan, and Nigeria. With the planned phaseout of oral polio vaccine, vaccine-associated poliomyelitis is also expected to be eliminated. In their place, other EVs, chiefly EV-D68 and EV-A71, have emerged as the principal causes of AFP. There is evidence that the emergence of EV-D68 as a cause of severe respiratory disease and AFP was due to recent genetic virus evolution. Antiviral medications targeting EV-D68, EV-A71, and other EVs will likely be available in the near future. An effective EV-A71 vaccine has been developed, and preliminary investigations suggest an EV-D68 vaccine could be on the horizon. The eradication of poliomyelitis and vaccine-associated poliomyelitis is near, after which other EVs, presently EV-D68 and EV-A71, will be the principle viral causes of AFP. Moving forward, it is essential that EV outbreaks, in particular those associated with neurologic complications, be investigated carefully and the causal strains identified, so that treatment and prevention efforts can be rapidly developed and implemented.
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Affiliation(s)
- Ari Bitnun
- Division of Infectious Diseases, The Hospital for Sick Children and Department of Pediatrics, University of Toronto, Toronto, ON, M5G 1X8, Canada.
| | - E Ann Yeh
- Division of Neurology, The Hospital for Sick Children and Department of Pediatrics, Division of Neurosciences and Mental Health, SickKids Research Institute, University of Toronto, Toronto, Canada
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Li T, Wang H, Lu Y, Li Q, Chen C, Wang D, Li M, Li Y, Lu J, Chen Z, Ma Y, Liu W, Ma M, Wu D, Lu J, Yang Z. Willingness and influential factors of parents to vaccinate their children with novel inactivated enterovirus 71 vaccines in Guangzhou, China. Vaccine 2018; 36:3772-3778. [DOI: 10.1016/j.vaccine.2018.05.054] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 05/09/2018] [Accepted: 05/10/2018] [Indexed: 01/08/2023]
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