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Yang L, Liu T, Tian D, Zhao H, Xia Y, Wang J, Li T, Li Q, Qi L. Non-linear association between daily mean temperature and children's hand foot and mouth disease in Chongqing, China. Sci Rep 2023; 13:20355. [PMID: 37990138 PMCID: PMC10663521 DOI: 10.1038/s41598-023-47858-3] [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: 05/12/2023] [Accepted: 11/19/2023] [Indexed: 11/23/2023] Open
Abstract
Chongqing was seriously affected by hand, foot, and mouth disease (HFMD), but the relationships between daily mean temperature and the incidence of HFMD remain unclear. This study used distributed lag nonlinear model to evaluate the effect of daily mean temperature on the incidence of HFMD in children aged < 5 years in Chongqing. Daily HFMD data from 2012 to 2019 in Chongqing were retrieved from the notifiable infectious disease surveillance system. A total of 413,476 HFMD cases aged < 5 years were reported in Chongqing from 2012 to 2019. The exposure-response curve of daily mean temperature and daily HFMD cases was wavy-shaped. The relative risks (RRs) increased as daily mean temperature below 5.66 °C or above 9.43 °C, with two peaks at 16.10 °C and 26.68 °C. The RRs reached the highest when the daily mean temperature at 26.68 °C on the current day (RR = 1.20, 95% CI 1.09-1.32), followed by the daily mean temperature at 16.10 °C at lag 5 days (RR = 1.07, 95% CI 1.05-1.08). The RRs for girls and daycare children were much higher than those for boys and scattered children, respectively. Taken together, daily mean temperature has strong effect on HFMD in children aged < 5 years old in Chongqing, particularly for girls and daycare children.
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Affiliation(s)
- Lin Yang
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, 400042, China
| | - Tian Liu
- Jingzhou Center for Disease Control and Prevention, Hubei, 434000, China
| | - Dechao Tian
- School of Public Health (Shenzhen), Shenzhen Campus of Sun Yat-Sen University, Shenzhen, 518107, Guangdong, China
| | - Han Zhao
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, 400042, China
| | - Yu Xia
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, 400042, China
| | - Ju Wang
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, 400042, China
| | - Tingting Li
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, 400042, China
| | - Qin Li
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, 400042, China.
| | - Li Qi
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, 400042, China.
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Guo Z, Wang Y, Li Y, Zhou L. Impact of meteorological factors on the incidence of hand-foot-mouth disease in Yangzhou from 2017 to 2022: a time series study. Front Public Health 2023; 11:1278516. [PMID: 37881347 PMCID: PMC10597706 DOI: 10.3389/fpubh.2023.1278516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 09/26/2023] [Indexed: 10/27/2023] Open
Abstract
Background Hand, foot, and mouth disease (HFMD) is a significant public health issue in China, and numerous studies have indicated a close association between HFMD incidence and meteorological factors. This study aims to investigate the relationship between meteorological factors and HFMD in Yangzhou City, Jiangsu Province, China. Methods HFMD case reports and meteorological data from Yangzhou City between 2017 and 2022 were extracted from the National Notifiable Infectious Disease Surveillance System and the Meteorological Data Sharing Service System, respectively. A generalized additive model (GAM) was employed to assess the exposure-response relationship between meteorological factors and HFMD. Subsequently, a distributed lag nonlinear model (DLNM) was used to explore the exposure-lag-effect of meteorological factors on HFMD. Results HFMD in Yangzhou City exhibits obvious seasonality and periodicity. There is an inverted "U" shaped relationship between average temperature and the risk of HFMD, with the maximum lag effect observed at a temperature of 25°C with lag 0 day (RR = 2.07, 95% CI: 1.74-2.47). As the duration of sunshine and relative humidity increase, the risk of HFMD continuously rises, with the maximum lag effect observed at a sunshine duration of 12.4 h with a lag of 14 days (RR = 2.10, 95% CI: 1.17-3.77), and a relative humidity of 28% with a lag of 14 days (RR = 1.21, 95% CI: 1.01-1.64). There is a "U" shaped relationship between average atmospheric pressure and the risk of HFMD, with the maximum effect observed at an atmospheric pressure of 989 hPa with no lag (RR = 1.45, 95% CI: 1.25-1.69). As precipitation increases, the risk of HFMD decreases, with the maximum effect observed at a precipitation of 151 mm with a lag of 14 days (RR = 1.45, 95% CI: 1.19-2.53). Conclusion Meteorological factors including average temperature, average atmospheric pressure, relative humidity, precipitation, and sunshine duration significantly influenced the risk of HFMD in Yangzhou City. Effective prevention measures for HFMD should be implemented, taking into account the local climate conditions.
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Affiliation(s)
- Zaijin Guo
- Clinical Medical College, Yangzhou University, Yangzhou, China
- Northern Jiangsu People’s Hospital, Yangzhou, China
| | - Yin Wang
- Department of Acute Infectious Disease Control and Prevention, Yangzhou Centre for Disease Control and Prevention, Yangzhou, China
| | - Yunshui Li
- Clinical Medical College, Yangzhou University, Yangzhou, China
- Northern Jiangsu People’s Hospital, Yangzhou, China
| | - Luojing Zhou
- Clinical Medical College, Yangzhou University, Yangzhou, China
- Northern Jiangsu People’s Hospital, Yangzhou, China
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Sun J, Li Y, Yang Z, Fang Q, Chen B. Effect of enterovirus 71 vaccination on the epidemiological characteristics and etiology in hospitalized children with hand-foot-and-mouth disease: A retrospective study from a tertiary children's hospital. Medicine (Baltimore) 2022; 101:e30356. [PMID: 36123878 PMCID: PMC9478296 DOI: 10.1097/md.0000000000030356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Enterovirus 71 (EV71) vaccine for hand-foot-and-mouth disease (HFMD) prevention has been available for several years. However, as a new vaccine, the impact of EV71 vaccination on the epidemiology and etiology of HFMD is currently unclear. The purpose of this study was to compare and analyze the changes of epidemiological characteristics and etiology of HFMD patients after the introduction of EV71 vaccine. The data of hospitalized children with HFMD from 2014 to 2020 were collected from the case record department of a tertiary children hospital of Anhui Province. The changes of epidemiological characteristics, time distribution, disease severity and enterovirus serotypes in hospitalized children were analyzed. A total of 7373 cases of HFMD were reported during 2014 to 2020, including 634 (8.6%) severe cases. The number of cases reached the peak in 2016 (n = 1783) and decreased gradually after EV71 vaccination. The results of etiological test showed the positive rate was 80.5%, in which EV71 accounted for 1599 (21.7%) and CV-A16 accounted for 1028 (13.9%) respectively. The number of patients showed a bimodal distribution throughout the year, which were April to June and October to November. The age distribution changed significantly following the introduction of EV71 vaccine. The proportion of 1-year-old group of post-vaccination was significantly higher than that of pre-vaccination (61.9% vs 50.8%, P < .001). The proportion of HFMD caused by EV71 and severe cases decreased significantly after the vaccination (P < .001 for both). While the comparison of epidemiological characteristics and enterovirus serotypes between unvaccinated and vaccinated cases during 2017 to 2020 showed no significant difference. The dominant enterovirus serotypes of hospitalized HFMD changed significantly after the introduction of EV71 vaccine. The proportion of severe cases decreased significantly after the vaccination, but EV71 was still a major pathogen in patients with severe HFMD. More age-appropriate children are recommended to get vaccinated to establish stronger herd immunity in the population.
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Affiliation(s)
- Jing Sun
- Department of Infectious Diseases, Anhui Provincial Children’s Hospital, Hefei, China
| | - Yuanyuan Li
- Department of Infectious Diseases, Anhui Provincial Children’s Hospital, Hefei, China
| | - Zhi Yang
- Department of Infectious Diseases, Anhui Provincial Children’s Hospital, Hefei, China
| | - Qingfeng Fang
- Department of Infectious Diseases, Anhui Provincial Children’s Hospital, Hefei, China
| | - Biquan Chen
- Department of Infectious Diseases, Anhui Provincial Children’s Hospital, Hefei, China
- *Correspondence: Biquan Chen, Department of Infectious Diseases, Anhui Provincial Children’s Hospital, Hefei, China (e-mail: )
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Sheng Y, Liu X, Wang Q, Zhang Y, Huang L, Hu D, Ren P, Hong Q, Kang D. Herbal Granules of Heat-Clearing and Detoxifying for Children with Mild Hand, Foot, and Mouth Disease: A Bayesian Network Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2022; 2022:6818406. [PMID: 35677377 PMCID: PMC9168089 DOI: 10.1155/2022/6818406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 05/09/2022] [Indexed: 02/05/2023]
Abstract
Background Regarding ethical considerations of randomized controlled trials (RCTs) in children, limited evidence for mild hand, foot, and mouth disease (HFMD) is available. Recently, with the increasing but result-conflicting RCTs published around herbal granules of heat-clearing and detoxifying (HGs-HD), a head-to-head comparison is urgently needed to choose a suitable therapy for clinical practice. Materials and Methods This study was conducted according to the preferred reporting items for systematic review and meta-analysis (PRISMA) extension statement for network meta-analysis (NMA). Eight databases (Medline, Embase, and so on) and two trial registry platforms (https://www.clinicaltrials.gov and https://www.chictr.org.cn) were searched from inception to May 26, 2021. The NMA was performed using a random-effect model. The treatment hierarchy was summarized and reported as the surface under the cumulative ranking curve (SUCRA) probability values. The rankings of each HGs-HD at primary outcomes were estimated by the inverse probability weighting (IPW) approach and averaged, which presents the comprehensive improvement effect. Results Forty-five RCTs involving 18 interventions were included that studied 5,652 children with mild HFMD. The best performance probability for improving symptoms were respectively presented in terms of fever (Xiao'er Resuqing granules, XRGs, 94.9%), rash (Xiao'er Jinqiao granules, 83.9%), hospitalization (Xiao'er Chiqiao Qingre granules, XCQGs, 92.7%), vesicles (Jinlianhua granules, 91.0%), appetite (Xiao'er Chiqiao Qingre granules, XCQGs, 86.7%), and ulcers (Kouyanqing granules, KouGs, 88.8%). Furthermore, the top 5 rankings for comprehensive improvement effect were Yanning granules (YNGs, 2.256), XCQGs (2.858), XRGs (3.270), KouGs (7.223), and Houerhuan Xiaoyan granules (HXGs, 7.597). Conclusions This is the first NMA of HGs-HD head-to-head comparisons for children with mild HFMD. Of those, YNGs, XCQGs, XRGs, KouGs, and HXGs could be recommended as potential choices for clinical practice. Of course, the results should be interpreted with caution due to the limited high-quality RCTs.
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Affiliation(s)
- Yongcheng Sheng
- Department of Evidence-Based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Xueting Liu
- Double First-class” Construction Office, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qin Wang
- Department of Evidence-Based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yuhui Zhang
- Department of Evidence-Based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Litao Huang
- Center of Biostatistics, Design, Measurement and Evaluation (CBDME), Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Dan Hu
- Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Pengwei Ren
- Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Qi Hong
- Department of Evidence-Based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Deying Kang
- Department of Evidence-Based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
- Center of Biostatistics, Design, Measurement and Evaluation (CBDME), Department of Clinical Research Management, West China Hospital, Sichuan University, Chengdu, Sichuan, China
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Hu L, Maimaiti H, Zhou L, Gao J, Lu Y. Changing serotypes of hand, foot and mouth disease in Shanghai, 2017-2019. Gut Pathog 2022; 14:12. [PMID: 35313977 PMCID: PMC8935267 DOI: 10.1186/s13099-022-00485-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 03/10/2022] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Hand, foot, and mouth disease (HFMD) is a common reportable infectious disease that is highly contagious among children in China. This study aimed to characterize the epidemics of HFMD and the serotypes of enterovirus (EV) after the introduction of EV-A71 vaccines in Shanghai, a city in Eastern China. RESULTS A total of 2271 HFMD cases were recruited in this study from May 2017 through October 2020. Among these cases, a male-to-female ratio of 1.6:1 was observed, and the cases were mainly in 1-4 years old (63.1%). Children of all ages had a relatively similar time span between the onset of HFMD and the initial medical visit (P = 0.5192). The cases were reported year-round with peaks in the summer (2018 and 2019) and fall (2017), which was consistent with previous epidemics of the reported HFMD cases in the Shanghai municipality. Among the specimens that tested positive for EV (n = 1855), CV-A6 was predominantly detected (71.1%), followed by CV-A16 (14.2%) and EV-A71 (7.0%). Notably, the number of HFMD cases infected with EV-A71 increased in 2019. Furthermore, 9.2% of the cases had comorbidities, mostly convulsion, bronchopneumonia, and pneumonia; however, they were not correlated with the EV serotypes. In addition, 31.2% (709/2271) of the cases were vaccinated with EV-A71 vaccines. The time span differed significantly between the time of vaccination and the onset of the disease across the groups based on whether the onset was before or after vaccination (P < 0.001). CONCLUSIONS CV-A6 is the predominant EV serotype in the epidemic of HFMD in Shanghai; in addition, CV-A16 and EV-A71 may be moderately prevalent. The changing trends in the presence of EV serotypes contributes to the periodicity of the HFMD epidemic. In addition, the minority of HFMD cases may have comorbidities, regardless of the EV serotype. The use of the EV-A71 vaccine has affected the HFMD epidemic. And serotype-specific protection by the EV-A71 vaccine may promote vaccination in children infected with EV-A71 compared to those infected with non-EV-A71 serotypes, which would further change the epidemic scenario of HFMD.
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Affiliation(s)
- Linjie Hu
- Department of Epidemiology, Ministry of Education Key Laboratory of Public Health Safety, School of Public Health, Fudan University, Fosun Tower, 131 Dong An Road, Shanghai, 200032, China
| | - Hairenguli Maimaiti
- Department of Epidemiology, Ministry of Education Key Laboratory of Public Health Safety, School of Public Health, Fudan University, Fosun Tower, 131 Dong An Road, Shanghai, 200032, China
| | - Lu Zhou
- Department of Epidemiology, Ministry of Education Key Laboratory of Public Health Safety, School of Public Health, Fudan University, Fosun Tower, 131 Dong An Road, Shanghai, 200032, China
| | - Jie Gao
- Department of Infection Control, Shanghai Children's Hospital, Shanghai Jiaotong University, 355 Luding Road, Shanghai, 200062, China.
| | - Yihan Lu
- Department of Epidemiology, Ministry of Education Key Laboratory of Public Health Safety, School of Public Health, Fudan University, Fosun Tower, 131 Dong An Road, Shanghai, 200032, China.
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Pan Z, Zhao R, Shen Y, Liu K, Xue W, Liang C, Peng M, Hu P, Chen M, Xu H. Low-frequency, exhausted immune status of CD56 dim NK cells and disordered inflammatory cytokine secretion of CD56 bright NK cells associated with progression of severe HFMD, especially in EV71-infected patients. Int Immunopharmacol 2021; 101:108369. [PMID: 34844872 DOI: 10.1016/j.intimp.2021.108369] [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: 12/30/2020] [Revised: 10/29/2021] [Accepted: 11/09/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND The roles of CD56bright and CD56dim natural killer (NK) subsets in the viral clearance and inflammatory processes of hand, foot, and mouth disease (HFMD) remain undefined. METHODS A total of 39 HCs and 55 patients were enrolled to analyze peripheral CD56bright and CD56dim NK cells according to cell number, surface receptors, cytotoxic activities, and cytokine production. The plasma concentrations of IL-2, IL-6, IL-10, IFN-γ, TNF-α,and MCP-1 were detected using ELSA. RESULTS Peripheral blood NK cells was significantly lower in severe patients than in HCs due to the dramatic loss of CD56dim NK cells with no changes in the cell count of CD56bright NK cells. For mild patients, decreased NKp46 expression coincided with enhanced cytolysis (CD107a, GNLY, and GrB) in CD56dim NK cells and decreased NKG2A expression with enhanced IL-10 production in CD56bright NK cells. In contrast, severe patients showed the dominant expression of NKG2A and decreased expression of NKG2D accompanied by cytotoxic dysfunction in CD56dim NK cells. Imbalanced receptor expression coincided with the increased concentrations of TNF-α in CD56bright NK cells. Moreover, EV71+ patients showed significantly decreased counts of CD56dim NK cells with cytolysis dysfunction, displayed cytokine hypersecretion in CD56bright NK cells, while the EV71- patients displayed significantly higher plasma cytokine concentrations. The changes in the immune function of NK subsets and their subpopulations were closely related to clinical inflammatory parameters. CONCLUSIONS Low-frequency, exhausted immune status of CD56dim NK cells and disordered inflammatory cytokine secretion of CD56bright NK cells were associated with the progression of severe HFMD, especially in EV71-infected patients. This promoted the severity of inflammatory disorders, leading to enhanced disease pathogenesis.
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Affiliation(s)
- Zhaojun Pan
- Department of Infection, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Developmental and Diseases, China International Science and Technology Cooperation Base of Child Development and Critical Diseases, Chongqing Key Laboratory of Pediatrics, No. 136 Zhongshan Road, Yuzhong District, 400014 Chongqing, PR China
| | - Ruiqiu Zhao
- Department of Infection, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Developmental and Diseases, China International Science and Technology Cooperation Base of Child Development and Critical Diseases, Chongqing Key Laboratory of Pediatrics, No. 136 Zhongshan Road, Yuzhong District, 400014 Chongqing, PR China
| | - Yanxi Shen
- Department of Infectious Diseases, Institute for Viral Hepatitis, Key Laboratory of Molecular Biology for Infectious Diseases, Ministry of Education, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400016, PR China
| | - Kai Liu
- Department of Infectious Diseases, Institute for Viral Hepatitis, Key Laboratory of Molecular Biology for Infectious Diseases, Ministry of Education, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400016, PR China
| | - Wei Xue
- Department of Infectious Diseases, Institute for Viral Hepatitis, Key Laboratory of Molecular Biology for Infectious Diseases, Ministry of Education, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400016, PR China
| | - Chengfei Liang
- Department of Infection, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Developmental and Diseases, China International Science and Technology Cooperation Base of Child Development and Critical Diseases, Chongqing Key Laboratory of Pediatrics, No. 136 Zhongshan Road, Yuzhong District, 400014 Chongqing, PR China
| | - Mingli Peng
- Department of Infectious Diseases, Institute for Viral Hepatitis, Key Laboratory of Molecular Biology for Infectious Diseases, Ministry of Education, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400016, PR China
| | - Peng Hu
- Department of Infectious Diseases, Institute for Viral Hepatitis, Key Laboratory of Molecular Biology for Infectious Diseases, Ministry of Education, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400016, PR China
| | - Min Chen
- Department of Infectious Diseases, Institute for Viral Hepatitis, Key Laboratory of Molecular Biology for Infectious Diseases, Ministry of Education, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400016, PR China.
| | - Hongmei Xu
- Department of Infection, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Developmental and Diseases, China International Science and Technology Cooperation Base of Child Development and Critical Diseases, Chongqing Key Laboratory of Pediatrics, No. 136 Zhongshan Road, Yuzhong District, 400014 Chongqing, PR China.
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Javadi M, Nejati A, Yousefi M, Mahmoodi M, Shoja Z, Shahmahmoodi S. First seroepidemiological investigation of human enterovirus 71 in Iran. IRANIAN JOURNAL OF MICROBIOLOGY 2021; 13:502-508. [PMID: 34557279 PMCID: PMC8421584 DOI: 10.18502/ijm.v13i4.6975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background and Objectives: Human Enterovirus 71 (EV-A71) is the causative agent for many dermal to neurological diseases especially polio-like paralysis outbreaks around the world. This study, the first of this kind in Iran, aimed to find neutralizing antibodies against EV-A71 in serum of healthy individuals in different age groups based on neutralization test (NT). Materials and Methods: In this cross-sectional study, 547 serum samples were collected from healthy individuals who were referring for routine checkup tests (aged from under 6 months to over 31 years old) to Imam-Khomeini Hospital in Tehran during January-December 2015. Serum samples were examined by NT in cell culture to detect neutralizing antibodies against EV-A71. In the next step, some of the positive samples were subjected to complete titration to determine the exact titer of anti-EV-A71 antibodies. Results: Of 547 samples, 310 (56.7%) were positive for EV-A71 neutralizing antibody. The presence of the antibody increased with age (p<0.001), and there was a significant statistical relationship between sex and the presence of antibody (p=0.009). Conclusion: Our results demonstrated an apparent but limited circulation of EV-A71 in our society. After the worldwide eradication of poliovirus, EV-A71 which can cause polio-likes syndrome, might be the new challenge for our health care system as regard more in depth research is however needed.
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Affiliation(s)
- Mahsa Javadi
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.,Department of Virology, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
| | - Ahmad Nejati
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Yousefi
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmood Mahmoodi
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Shohreh Shahmahmoodi
- Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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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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Duan X, Chen Z, Li X, Yuan P, Long L. Virus Shedding in Patients With Hand, Foot and Mouth Disease Induced by EV71, CA16 or CA6: Systematic Review and Meta-analysis. Pediatr Infect Dis J 2021; 40:289-294. [PMID: 33181780 DOI: 10.1097/inf.0000000000002985] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND As the highly contagious hand, foot and mouth disease (HFMD) spreads rapidly among children, isolation is the most effective way to control its spread. However, studies on the duration of virus shedding of the HFMD-related enterovirus and a reasonable quarantine period for HFMD patients are inconsistent. METHODS We undertook a systematic review and meta-analysis evaluating the viral shedding of patients with HFMD caused by Enterovirus 71 (EV71) and coxsackievirus A16 (CVA16) and coxsackievirus A6. RESULTS A total of 17 observational studies evaluating 626 participants were included. In the first 5 weeks after onset, the pooled virus positive rate in specimens of EV71-related patients decreased from 0.79 (P < 0.001 for heterogeneity) to 0.38 (P < 0.001 for heterogeneity). The positive rate of CVA16 was reduced from 0.91 (P < 0.001 for heterogeneity) to 0.29 (P < 0.001 for heterogeneity). The positive rates of CVA16 and coxsackievirus A6 were approximately 50% in the third week after onset, while a 50% positive rate appeared in the fourth week in EV71 related cases. CONCLUSIONS We found the positive rates of virus shedding were still high among the patients released from quarantine, and the duration of viral shedding was inconsistent among HFMD patients caused by different serotypes. Our findings provide comprehensive evidence for a possible flexible quarantine period according to the serotype.
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Affiliation(s)
- Xiaoxia Duan
- From the Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu
| | - Zhenhua Chen
- Department of Microbiology Laboratory, Chengdu Municipal Center for Disease Control and Prevention, Sichuan, China
| | - Xianzhi Li
- From the Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu
| | - Ping Yuan
- From the Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu
| | - Lu Long
- From the Department of Epidemiology and Health Statistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu
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Rui J, Luo K, Chen Q, Zhang D, Zhao Q, Zhang Y, Zhai X, Zhao Z, Zhang S, Liao Y, Hu S, Gao L, Lei Z, Wang M, Wang Y, Liu X, Yu S, Xie F, Li J, Liu R, Chiang YC, Zhao B, Su Y, Zhang XS, Chen T. Early warning of hand, foot, and mouth disease transmission: A modeling study in mainland, China. PLoS Negl Trop Dis 2021; 15:e0009233. [PMID: 33760810 PMCID: PMC8021164 DOI: 10.1371/journal.pntd.0009233] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/05/2021] [Accepted: 02/11/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hand, foot, and mouth disease (HFMD) is a global infectious disease; particularly, it has a high disease burden in China. This study was aimed to explore the temporal and spatial distribution of the disease by analyzing its epidemiological characteristics, and to calculate the early warning signals of HFMD by using a logistic differential equation (LDE) model. METHODS This study included datasets of HFMD cases reported in seven regions in Mainland China. The early warning time (week) was calculated using the LDE model with the key parameters estimated by fitting with the data. Two key time points, "epidemic acceleration week (EAW)" and "recommended warning week (RWW)", were calculated to show the early warning time. RESULTS The mean annual incidence of HFMD cases per 100,000 per year was 218, 360, 223, 124, and 359 in Hunan Province, Shenzhen City, Xiamen City, Chuxiong Prefecture, Yunxiao County across the southern regions, respectively and 60 and 34 in Jilin Province and Longde County across the northern regions, respectively. The LDE model fitted well with the reported data (R2 > 0.65, P < 0.001). Distinct temporal patterns were found across geographical regions: two early warning signals emerged in spring and autumn every year across southern regions while one early warning signals in summer every year across northern regions. CONCLUSIONS The disease burden of HFMD in China is still high, with more cases occurring in the southern regions. The early warning of HFMD across the seven regions is heterogeneous. In the northern regions, it has a high incidence during summer and peaks in June every year; in the southern regions, it has two waves every year with the first wave during spring spreading faster than the second wave during autumn. Our findings can help predict and prepare for active periods of HFMD.
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Affiliation(s)
- Jia Rui
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, Fujian Province, People’s Republic of China
| | - Kaiwei Luo
- Hunan Provincial Center for Disease Control and Prevention, Changsha City, Hunan Province, People’s Republic of China
| | - Qiuping Chen
- Université de Montpellier, Montpellier, France; CIRAD, Intertryp, Montpellier, France; IES, Université de Montpellier-CNRS, Montpellier, France
- Medical Insurance Office, Xiang’an Hospital of Xiamen University, Xiamen City, Fujian Province, People’s Republic of China
| | - Dexing Zhang
- Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region, People’s Republic of China
| | - Qinglong Zhao
- Jilin Provincial Center for Disease Control and Prevention, Changchun City, Jilin Province, People’s Republic of China
| | - Yanhong Zhang
- Yunxiao County Center for Disease Control, Zhangzhou City, Fujian Province, People’s Republic of China
| | - Xiongjie Zhai
- Longde County Center for Disease Control, Guyuan City, the Ningxia Hui Autonomous Region, People’s Republic of China
| | - Zeyu Zhao
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, Fujian Province, People’s Republic of China
| | - Siyu Zhang
- Hunan Provincial Center for Disease Control and Prevention, Changsha City, Hunan Province, People’s Republic of China
| | - Yuxue Liao
- Shenzhen Centers for Disease Control and Prevention, Shenzhen City, Guangdong Province, People’s Republic of China
| | - Shixiong Hu
- Hunan Provincial Center for Disease Control and Prevention, Changsha City, Hunan Province, People’s Republic of China
| | - Lidong Gao
- Hunan Provincial Center for Disease Control and Prevention, Changsha City, Hunan Province, People’s Republic of China
| | - Zhao Lei
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, Fujian Province, People’s Republic of China
| | - Mingzhai Wang
- Xiamen City Center for Disease Control and Prevention, Shenzhen City, 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 City, 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 City, Fujian Province, People’s Republic of China
| | - Shanshan Yu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, Fujian Province, People’s Republic of China
| | - Fang Xie
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, Fujian Province, People’s Republic of China
| | - Jia Li
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, Fujian Province, People’s Republic of China
| | - Ruoyun Liu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, Fujian Province, People’s Republic of China
| | - Yi-Chen Chiang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, 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 City, 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 City, Fujian Province, People’s Republic of China
| | | | - Tianmu Chen
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen City, Fujian Province, People’s Republic of China
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11
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Sun M, Yan K, Wang C, Xing J, Duan Z, Jin Y, Cardona CJ, Xing Z. Intrinsic apoptosis and cytokine induction regulated in human tonsillar epithelial cells infected with enterovirus A71. PLoS One 2021; 16:e0245529. [PMID: 33481814 PMCID: PMC7822318 DOI: 10.1371/journal.pone.0245529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 01/04/2021] [Indexed: 11/29/2022] Open
Abstract
Enterovirus A71 (EV-A71) has emerged as a clinically important neurotropic virus following poliovirus eradication. Recent studies have shown that human tonsillar epithelial cell lines (UT-SCC-60A and UT-SCC-60B) were susceptible to EV-A71, suggesting that human tonsillar crypt epithelium could be important in EV-A71 pathogenesis. However, the mechanism about how EV-A71 infects the upper oro-digestive tract remains largely unclear. In this study, we demonstrated that the human tonsillar epithelial cells infected with EV-A71 underwent apoptotic, in which cytochrome c was released from the mitochondria to the cytosol and caspase-9 was activated, while caspase-2 and -8 were not cleaved or activated during the infection. A selective inhibitor of caspase-9, Z-LEHD-FMK, inhibited the cleavage of the executioner caspase-3 and -7, indicating that only mitochondria-mediated intrinsic apoptotic pathway was activated in EV-A71-infected tonsillar epithelial cells. No evidence of pyroptosis or necroptosis was involved in the cell death. EV-A71 infection induced interferon, pro-inflammatory cytokines and chemokines, including IFN-β, IL-6, CCL5, and TNF-α in tonsillar epithelial cells, which may play a critical role in EV-A71-caused herpangina. Our data indicated that the induction of the cytokines was partially regulated by the mitogen-activated protein kinases (MAPKs) signaling pathway. The findings unveiled the host response to EV-A71 and its regulation mechanism, and will further our understanding the significance about the tonsillar crypt epithelium as the initial and primary portal in viral pathogenesis for EV-A71 infection.
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Affiliation(s)
- Menghuai Sun
- Medical School and Jiangsu Provincial Key Laboratory of Medicine, Nanjing University, Nanjing, China
- Nanjing Children’s Hospital, Nanjing Medical University, Nanjing, China
| | - Kunlong Yan
- Nanjing Children’s Hospital, Nanjing Medical University, Nanjing, China
| | - Chunyang Wang
- Clinical Medical College, Xi’an Medical University, Xi’an, China
| | - Jiao Xing
- Nanjing Children’s Hospital, Nanjing Medical University, Nanjing, China
| | - Zhaojun Duan
- National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yu Jin
- Medical School and Jiangsu Provincial Key Laboratory of Medicine, Nanjing University, Nanjing, China
- Nanjing Children’s Hospital, Nanjing Medical University, Nanjing, China
- * E-mail: (YJ); (ZX)
| | - Carol J. Cardona
- Department of Veterinary Biomedical Sciences, College of Veterinary Medicine, University of Minnesota at Twin Cities, St. Paul, Minnesota, United States of America
| | - Zheng Xing
- Medical School and Jiangsu Provincial Key Laboratory of Medicine, Nanjing University, Nanjing, China
- Department of Veterinary Biomedical Sciences, College of Veterinary Medicine, University of Minnesota at Twin Cities, St. Paul, Minnesota, United States of America
- * E-mail: (YJ); (ZX)
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12
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Eshtiaghi P, Weinstein M. Where in the World Did You Get That Rash? Pediatr Rev 2020; 41:184-195. [PMID: 32238547 DOI: 10.1542/pir.2018-0200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Panteha Eshtiaghi
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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13
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Fan S, Liao Y, Jiang G, Jiang L, Wang L, Xu X, Feng M, Yang E, Zhang Y, Cui W, Li Q. Study of integrated protective immunity induced in rhesus macaques by the intradermal administration of a bivalent EV71-CA16 inactivated vaccine. Vaccine 2020; 38:2034-2044. [PMID: 31982260 DOI: 10.1016/j.vaccine.2019.12.057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 11/28/2019] [Accepted: 12/19/2019] [Indexed: 02/07/2023]
Abstract
Enterovirus type 71 (EV71) and coxsackievirus A 16 (CA16) are recognized as the major pathogens responsible for human hand-foot-mouth disease. To develop a bivalent EV71-CA16 vaccine, rhesus macaques immunized with two doses of this vaccine via the intradermal route were challenged with EV71 or CA16, and their clinical symptoms, viral shedding, neutralizing antibodies, IFN-γ-specific ELISpots, and tissue viral load were examined longitudinally. Specific immunity against EV71 and CA16 was observed in the macaques, which exhibited controlled proliferation of the EV71 and CA16 viruses and upregulated expression of immune-related genes compared with the controls. Furthermore, broad protection against EV71 and CA16 challenge without immunopathological effects was observed in all the immunized macaques. These studies suggest that the bivalent EV71-CA16 inactivated vaccine was effective against wild-type EV71 or CA16 viral challenge in rhesus macaques.
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Affiliation(s)
- Shengtao Fan
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming 650118, China
| | - Yun Liao
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming 650118, China
| | - Guorun Jiang
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming 650118, China
| | - Li Jiang
- Aimei Convac BioPharm (Jiangsu) Co., Ltd., Taizhou 225300, Jiangsu, China
| | - Lichun Wang
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming 650118, China
| | - Xingli Xu
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming 650118, China
| | - Min Feng
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming 650118, China
| | - Erxia Yang
- Aimei Convac BioPharm (Jiangsu) Co., Ltd., Taizhou 225300, Jiangsu, China
| | - Ying Zhang
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming 650118, China
| | - Wei Cui
- Aimei Convac BioPharm (Jiangsu) Co., Ltd., Taizhou 225300, Jiangsu, China
| | - Qihan Li
- Institute of Medical Biology, Chinese Academy of Medical Sciences & Peking Union Medical College, Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Kunming 650118, China.
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14
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Ju Y, Tan Z, Huang H, Chen M, Tan Y, Zhang C, Wang J, Wang H, Chen M. Clinical and epidemiological characteristics of Coxsackievirus A6- and Enterovirus 71-associated clinical stage 2 and 3 severe hand, foot, and mouth disease in Guangxi, Southern China, 2017. J Infect 2020; 80:121-142. [DOI: 10.1016/j.jinf.2019.09.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 09/26/2019] [Accepted: 09/28/2019] [Indexed: 11/16/2022]
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15
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Miao L, Liu Y, Luo P, Mao S, Liu J, Lu S. Association between platelet count and the risk and progression of hand, foot, and mouth disease among children. Clinics (Sao Paulo) 2020; 75:e1619. [PMID: 32428116 PMCID: PMC7213664 DOI: 10.6061/clinics/2020/e1619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 02/05/2020] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE We aimed to evaluate the association between platelet (PLT) count and the risk and progression of hand, foot, and mouth disease (HFMD). METHODS In total, 122 HFMD patients and 40 healthy controls were enrolled in the study. The differences between variables among the different subgroups were compared. Logistic regression analyses were performed to assess the relationship between various parameters and HFMD risk/progression. Sensitivity analysis was conducted by detecting the trend of the association between PLT count quartiles and HFMD risk/progression. A generalized additive model was used to identify the nonlinear relationship between PLT count and HFMD risk/progression. The relationship between gender and PLT count as well as the risk/progression of HFMD was detected using a stratified logistic regression model. RESULTS Significant differences were observed in terms of age, male/female ratio, white blood cell (WBC) count, and PLT count between patients with stage I-II, III-IV HFMD and healthy controls. Moreover, the alanine aminotransferase and magnesium levels between patients with stage I-II and III-IV HFMD significantly differed. Moreover, a significant difference was noted in the male/female ratio among the different PLT groups. The group with a low PLT count had a lower risk of HFMD progression than the group with a high PLT count (Q4) (p=0.039). Lower age, male gender, and WBC count were found to be associated with HFMD risk. Meanwhile, PLT count was correlated to HFMD progression. The sensitivity analysis yielded a similar result using the minimally adjusted model (p for trend=0.037), and minimal changes were observed using the crude and fully adjusted model (p for trend=0.054; 0.090). A significant nonlinear relationship was observed between PLT count and HFMD progression after adjusting for age, gender, and WBC (p=0.039). CONCLUSIONS PLT was independently associated with HFMD progression in a nonlinear manner.
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Affiliation(s)
- Li Miao
- Department of Pediatrics, The First Affiliated Hospital of Kangda College of Nanjing Medical University /, The First People's Hospital of Lianyungang, Lianyungang, China
- Department of Pediatric Nephrology, Lianyungang Children's Hospital, Lianyungang, China
| | - Yongjuan Liu
- Department of Central Laboratory, The First Affiliated Hospital of Kangda College of Nanjing Medical University /, The First People's Hospital of Lianyungang, Lianyungang, China
| | - Peiliang Luo
- Department of Pediatrics, The First Affiliated Hospital of Kangda College of Nanjing Medical University /, The First People's Hospital of Lianyungang, Lianyungang, China
| | - Song Mao
- Department of Pediatrics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jiansheng Liu
- Department of Pediatrics, The First Affiliated Hospital of Kangda College of Nanjing Medical University /, The First People's Hospital of Lianyungang, Lianyungang, China
- Department of Pediatric Nephrology, Lianyungang Children's Hospital, Lianyungang, China
- Corresponding author. E-mail:
| | - Siguang Lu
- Department of Pediatrics, The First Affiliated Hospital of Kangda College of Nanjing Medical University /, The First People's Hospital of Lianyungang, Lianyungang, China
- Department of Pediatric Nephrology, Lianyungang Children's Hospital, Lianyungang, China
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The Clinical and Epidemiological Study of Children with Hand, Foot, and Mouth Disease in Hunan, China from 2013 to 2017. Sci Rep 2019; 9:11662. [PMID: 31406192 PMCID: PMC6690890 DOI: 10.1038/s41598-019-48259-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 07/29/2019] [Indexed: 02/05/2023] Open
Abstract
Hand, foot, and mouth disease (HFMD) is endemic in the Pacific region, especially in mainland China. The case-fatality ratio of HFMD is increasing steadily. Knowledge of the changing epidemiology of HFMD in different regions is necessary for implementing appropriate intervention strategies. In this study, we describe the clinical and epidemiological characteristics of HFMD in Hunan Children’s Hospital between 2013 and 2017. A total of 7203 patients with HFMD were admitted, with complication and mortality rates of 35.62% and 0.78%, respectively. The total number of children with HFMD, proportion of severely ill children, and HFMD mortality rate were the highest in 2014. The number of cases caused by EV-A71 and CV-A16 decreased continuously, while the number of cases caused by ‘other enteroviruses’ increased yearly since 2014, suggesting that other enteric viruses will gradually replace EV-A71 and CV-A16 as the main pathogenic HFMD agents. Furthermore, EV-A71 and mixed infections accounted for the high case fatality rates in children with severe HFMD, among whom EV-A71 infection resulted in the highest complication and mortality rates; the mild form of the disease was dominated by ‘other enteroviruses’. In conclusion, the changing etiological pattern highlights the need to improve pathogen surveillance and vaccine strategies for HFMD control.
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17
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He Y, Feng Z, Wang W, Chen Y, Cheng J, Meng J, Yang H, Wang Y, Yao X, Feng Q, Chen L, Zhang H, Wang MHT, Zee BCY, Wang X, He ML. Global cytokine/chemokine profile identifies potential progression prediction indicators in hand-foot-and-mouth disease patients with Enterovirus A71 infections. Cytokine 2019; 123:154765. [PMID: 31255913 DOI: 10.1016/j.cyto.2019.154765] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 05/27/2019] [Accepted: 06/18/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVE New clinical indicators are urgently needed for predicting the progression and complications of hand-foot-and-mouth disease (HFMD) caused by EV-A71 infections. MATERIALS AND METHODS Serum specimens from 132 EV-A71 HFMD patients and 73 health children were collected during 2012-2014 in Shenzhen, China. The specific cytokines/chemokines were detected with a 274-human cytokine antibody array, followed by a 38-inflammation cytokine array, and further validated by ELISA. RESULTS Cytokines varied in different severity of EV-A71 HFMD patients. The ROC curve analysis revealed 5 serum cytokines with high sensitivity and specificity in predicting the disease progression. Eotaxin, IL-8 and IP-10 have showed high AUC values (0.90-0.95) for discrimination between the health controls and the patient group. The three cytokines showed high sensitivity (80-91%) and specificity (88-95%). MMP-8 had a high sensitivity and specificity to predict mild HFMD (100%, 100%). IL-1b and leptin discriminated the severe/critical group from the mild group (79% and 69% in sensitivity, 73% and 63% in specificity). CONCLUSIONS Eotaxin, IP-10 and IL-8 could be potential indicators for predicting HFMD progression with EV-A71 infection. MMP-8 is a specific indicator for mild infection, while IL-1b and leptin display potential for predicting the severity and criticality.
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Affiliation(s)
- Yaqing He
- Major Infectious Disease Control Key Laboratory, The Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong Province, China
| | - Zhuoying Feng
- Department of Biomedical Science, The City University of Hong Kong, China
| | - Wei Wang
- Department of Biomedical Science, The City University of Hong Kong, China
| | - Ying Chen
- Department of Biomedical Science, The City University of Hong Kong, China
| | - Jinquan Cheng
- Major Infectious Disease Control Key Laboratory, The Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong Province, China
| | - Jun Meng
- Major Infectious Disease Control Key Laboratory, The Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong Province, China
| | - Hong Yang
- Major Infectious Disease Control Key Laboratory, The Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong Province, China
| | - Yujie Wang
- The Zhenzhou Hospital of Traditional Chinese Medicine, Zhenzhou, Henan Province, China
| | - Xiangjie Yao
- Major Infectious Disease Control Key Laboratory, The Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong Province, China
| | - Qianjin Feng
- The Cancer Institute, Zhongshan People's Hospital, Zhongshan, Guangdong Province, China
| | - Long Chen
- Major Infectious Disease Control Key Laboratory, The Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong Province, China
| | - Hailong Zhang
- Major Infectious Disease Control Key Laboratory, The Shenzhen Center for Disease Control and Prevention, Shenzhen, Guangdong Province, China
| | - Maggie H T Wang
- The Cancer Institute, Zhongshan People's Hospital, Zhongshan, Guangdong Province, China; Division of Biostatistics, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; The CUHK Shenzhen Research Institute, Shenzhen, China
| | - Benny C Y Zee
- The Cancer Institute, Zhongshan People's Hospital, Zhongshan, Guangdong Province, China; Division of Biostatistics, JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; The CUHK Shenzhen Research Institute, Shenzhen, China
| | - Xin Wang
- The CityU Shenzhen Research Institute, Shenzhen, Guangdong Province, China
| | - Ming-Liang He
- Department of Biomedical Science, The City University of Hong Kong, China; The CityU Shenzhen Research Institute, Shenzhen, Guangdong Province, China.
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Co-Circulation of Echovirus 6 and 30 with Coxsackievirus A6 Among Children with Hand, Foot, and Mouth Disease in Ahvaz, Southwest Iran. ARCHIVES OF CLINICAL INFECTIOUS DISEASES 2019. [DOI: 10.5812/archcid.83522] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Liu XF, Sun XM, Sun XW, Yang YQ, Huang CH, Wen H. Epidemiological study on hand, foot and mouth disease in Tongzhou District, Beijing, 2013-2017. J Int Med Res 2019; 47:2615-2625. [PMID: 31099288 PMCID: PMC6567722 DOI: 10.1177/0300060519841974] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Objective To study the epidemiological characteristics of hand, foot and mouth disease (HFMD) in Tongzhou District, Beijing between 2013 and 2017. Methods Data on HFMD infections from 1 January 2013 to 31 December 2017 were collected from the Notifiable Infectious Diseases Reporting Information System and analysed. Serotyping of enteroviruses from samples from patients with HFMD was undertaken using reverse transcription–polymerase chain reaction. Results A total of 15 341 patients with HFMD were reported and 32 patients (0.2%) were classified as having severe HFMD. The annual mean incidence rate of HFMD was 219.3/100 000 of the general population. The incidence and case-severity rates of HFMD generally decreased between 2013 and 2017. In the floating migrant population, the incidence and cases-severity rates of HFMD were significantly higher than in the local population. The peak incidence and severity-case rates were at 2 years of age and > 90% of patients were ≤5 years. Enterovirus A71 and Coxsackievirus A16 were the predominant pathogens in 2013–2017. Conclusions During the 5-year period 2013–2017, the incidence rate and case-severity rate of HFMD generally decreased in Tongzhou District, Beijing. The floating migrant population and children ≤5 years of age were at the highest risk of HFMD.
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Affiliation(s)
- Xiao-Feng Liu
- 1 Administrative Office, Beijing Centre for Disease Prevention and Control, Dongcheng District, Beijing, China
| | - Xiu-Mei Sun
- 2 Business Management Office, Tongzhou District Centre for Disease Prevention and Control, Tongzhou District, Beijing, China
| | - Xiao-Wei Sun
- 2 Business Management Office, Tongzhou District Centre for Disease Prevention and Control, Tongzhou District, Beijing, China
| | - Yu-Qing Yang
- 2 Business Management Office, Tongzhou District Centre for Disease Prevention and Control, Tongzhou District, Beijing, China
| | - Cong-Hui Huang
- 2 Business Management Office, Tongzhou District Centre for Disease Prevention and Control, Tongzhou District, Beijing, China
| | - Han Wen
- 2 Business Management Office, Tongzhou District Centre for Disease Prevention and Control, Tongzhou District, Beijing, China
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MRI reveals segmental distribution of enterovirus lesions in the central nervous system: a probable clinical evidence of retrograde axonal transport of EV-A71. J Neurovirol 2019; 25:354-362. [DOI: 10.1007/s13365-019-00724-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 12/08/2018] [Accepted: 01/08/2019] [Indexed: 11/29/2022]
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The untranslated regions of EV-A71 contribute to its pathogenicity and virulence. Virus Res 2019; 263:55-63. [PMID: 30611822 DOI: 10.1016/j.virusres.2018.12.019] [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: 10/15/2018] [Revised: 12/28/2018] [Accepted: 12/30/2018] [Indexed: 01/23/2023]
Abstract
Enterovirus A71 (EV-A71) is known for its manifestation as hand foot and mouth disease (HFMD), which has caused countless large-scale epidemic outbreaks throughout the world. However, the molecular pathogenesis of EV-A71 infection is still elusive. Previous studies found that the biological characteristics of a mild EV-A71 strain (SDLY1) and a severe EV-A71 strain (SDLY107) are significantly different, and sequence analysis showed that there are several differences in nucleotide sites of UTRs (88 nt, 123 nt, 143 nt, 154 nt, 187 nt, 241 nt, 243 nt, 253 nt, 291 nt, 438 nt, 440 nt, 571 nt, 579 nt, 602 nt, 658 nt, 664 nt, 690 nt, 696 nt, 7328 nt, 7335 nt, 7367 nt, and 7395 nt). The aim of this study was to determine whether these amino sites in UTRs are associated with the pathogenesis of EV-A71 and are responsible for different clinical manifestations. Based on the reverse genetics technology, we rescued two chimeric viruses SDLY107(1-5'UTR) and SDLY107(1-3'UTR) by replacing 5'UTR/3'UTR gene fragments of an infectious cDNA clone. Replication kinetics and cytotoxicity assays showed that the virulence of the two chimeric strains significantly changed in vitro. The viral loads of the two chimeric strains in infected ICR mice were reduced and pathological damage in the brains, lungs, intestinal tissues, and muscles were lightened. Our findings suggest that some nucleotide sites in UTRs may have a function in the pathogenicity and virulence of EV-A71.
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Matsushima Y, Shimizu T, Doi I, Mizukoshi F, Nagasawa K, Ryo A, Shimizu H, Kobayashi M, Funatogawa K, Nagata N, Ishikawa M, Komane A, Okabe N, Mori Y, Takeda M, Kimura H. A method for detecting rash and fever illness-associated viruses using multiplex reverse transcription polymerase chain reaction. Microbiol Immunol 2018; 61:337-344. [PMID: 28710778 DOI: 10.1111/1348-0421.12502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 07/07/2017] [Accepted: 07/12/2017] [Indexed: 02/02/2023]
Abstract
In this study, a new multiplex RT-PCR method for detecting various viral genes in patients with rash and fever illnesses (RFIs) was constructed. New primer sets were designed for detection of herpes simplex viruses 1 and 2 (HSV1 and 2), and Epstein-Barr virus (EBV). The newly designed and previously reported primer sets were used to detect 13 types of RFI-associated viruses by multiplex RT-PCR assay systems. Moreover, to eliminate non-specific PCR products, a double-stranded specific DNase was used to digest double-stranded DNA derived from the templates in clinical specimens. RFI-associated viruses were detected in 77.0% of the patients (97/126 cases) by the presented method, multiple viruses being identified in 27.8% of the described cases (35/126 cases). Detected viruses and clinical diagnoses were compatible in 32.5% of the patients (41/126 cases). Sensitivity limits for these viruses were estimated to be 101 -103 copies/assay. Furthermore, non-specific PCR products were eliminated by a double-stranded specific DNase with no influence on sensitivity. These results suggest that this method can detect various RFI-associated viruses in clinical specimens with high sensitivity and specificity.
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Affiliation(s)
- Yuki Matsushima
- Division of Virology, Kawasaki City Institute for Public Health, 3-25-13 Tonomachi, Kawasaki-ku, Kawasaki-shi, Kanagawa 210-0821, Japan
| | - Tomomi Shimizu
- Division of Virology, Kawasaki City Institute for Public Health, 3-25-13 Tonomachi, Kawasaki-ku, Kawasaki-shi, Kanagawa 210-0821, Japan
| | - Ikuko Doi
- Ibaraki Prefectural Institute of Public Health, 993-2 Kasaharacho, Mito-shi, Ibaraki 310-0852, Japan
| | - Fuminori Mizukoshi
- Tochigi Prefectural Institute of Public Health and Environmental Science, 2145-13 Shimookamotocho, Utsunomiya-shi, Tochigi 329-1196, Japan
| | - Koo Nagasawa
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 4-7-1 Gakuen, Musashimurayama-shi, Tokyo 208-0011, Japan
| | - Akihide Ryo
- Department of Microbiology, Yokohama City University School of Medicine, 3-9 Fuku-ura, Kanazawa-ku, Yokohama-shi, Kanagawa 236-0004, Japan
| | - Hideaki Shimizu
- Division of Virology, Kawasaki City Institute for Public Health, 3-25-13 Tonomachi, Kawasaki-ku, Kawasaki-shi, Kanagawa 210-0821, Japan
| | - Masae Kobayashi
- Ibaraki Prefectural Institute of Public Health, 993-2 Kasaharacho, Mito-shi, Ibaraki 310-0852, Japan
| | - Keiji Funatogawa
- Tochigi Prefectural Institute of Public Health and Environmental Science, 2145-13 Shimookamotocho, Utsunomiya-shi, Tochigi 329-1196, Japan
| | - Noriko Nagata
- Ibaraki Prefectural Institute of Public Health, 993-2 Kasaharacho, Mito-shi, Ibaraki 310-0852, Japan
| | - Mariko Ishikawa
- Division of Virology, Kawasaki City Institute for Public Health, 3-25-13 Tonomachi, Kawasaki-ku, Kawasaki-shi, Kanagawa 210-0821, Japan
| | - Ayako Komane
- Division of Virology, Kawasaki City Institute for Public Health, 3-25-13 Tonomachi, Kawasaki-ku, Kawasaki-shi, Kanagawa 210-0821, Japan
| | - Nobuhiko Okabe
- Division of Virology, Kawasaki City Institute for Public Health, 3-25-13 Tonomachi, Kawasaki-ku, Kawasaki-shi, Kanagawa 210-0821, Japan
| | - Yoshio Mori
- Department of Virology III, National Institute of Infectious Diseases, 4-7-1 Gakuen, Musashimurayama-shi, Tokyo 208-0011, Japan
| | - Makoto Takeda
- Department of Virology III, National Institute of Infectious Diseases, 4-7-1 Gakuen, Musashimurayama-shi, Tokyo 208-0011, Japan
| | - Hirokazu Kimura
- Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 4-7-1 Gakuen, Musashimurayama-shi, Tokyo 208-0011, Japan.,Department of Microbiology, Yokohama City University School of Medicine, 3-9 Fuku-ura, Kanazawa-ku, Yokohama-shi, Kanagawa 236-0004, Japan
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Kılınç F, Akbaş A. Clinical and Demographic Analysis of Patients with Hand, Foot and Mouth Disease Diagnosis. ANKARA MEDICAL JOURNAL 2018. [DOI: 10.17098/amj.409044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Clinical features for 89 deaths of hand, foot and mouth disease in Guangxi, China, 2014. Int J Infect Dis 2017; 64:15-19. [DOI: 10.1016/j.ijid.2017.08.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 08/23/2017] [Accepted: 08/26/2017] [Indexed: 12/18/2022] Open
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Epidemiology of 45,616 suspect cases of Hand, Foot and Mouth Disease in Chongqing, China, 2011-2015. Sci Rep 2017; 7:45630. [PMID: 28422128 PMCID: PMC5395817 DOI: 10.1038/srep45630] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2016] [Accepted: 03/01/2017] [Indexed: 12/19/2022] Open
Abstract
Epidemiology and etiology of hand, foot, and mouth disease (HFMD) based on large sample size or evaluation of detection for more enterovirus serotypes are not well investigated in Chongqing of China. 45,616 suspect HFMD patients were prospectively enrolled among whom 21,615 were laboratory confirmed HFMD cases over a 5-year period (January 2011 to December 2015). Their epidemiological, clinical, and laboratory data were extracted and stratified by month, age, sex, disease severity, and enterovirus serotype. Subsequently 292 non-EV-A71/CV-A16 HFMD confirmed cases were randomly selected in three consecutive outbreaks to detect CV-A6 and CV-A10, using RT-PCR. Results showed that the HFMD epidemic peaked in early summer and autumn. The median age of onset was 2.45 years with a male-to-female ratio of 1.54:1, and with children under 5 years of age accounting for 92.54% of all confirmed cases. EV-A71 and CV-A16 infection accounted for only 36.05% (7793/21615) of total confirmed cases while EV-A71 accounted for 59.64% (232/389) of severe cases. Importantly, the proportion of EV-A71 infection generally increased with age which showed rapid growth in severe cases. CV-A6 and CV-A10 were tested positive in Chongqing, but CV-A6 had greater positive rates of 62.33% while CV-A10 had 4.79% in non-EV-A71/CV-A16 HFMD confirmed cases.
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Cheng BN, Jin YL, Chen BQ, Zhu LY, Xu ZC, Shen T. Serum cholinesterase: a potential assistant biomarker for hand, foot, and mouth disease caused by enterovirus 71 infection. Infect Dis Poverty 2016; 5:27. [PMID: 27025584 PMCID: PMC4812613 DOI: 10.1186/s40249-016-0124-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Accepted: 03/24/2016] [Indexed: 01/21/2023] Open
Abstract
Background Hand, foot, and mouth disease (HFMD) caused by enterovirus 71 (EV71) is a potentially life-threatening infectious disease that commonly occurs in children. Diagnosis of HFMD caused by EV71 largely depends on clinical manifestations and rare serological biomarkers used to identify children suffering from HFMD. Serum cholinesterase (SChE) activity has frequently been reported as a potential biomarker for solid central nervous system tumors, chronic heart failure, and liver cirrhosis. However, its potential value in the diagnosis of neurotropic virus infections, such as HFMD caused by EV71, remains to be determined. Findings In our study, 220 children hospitalized with HFMD caused by EV71, 34 inpatients infected with coxsackievirus A16 (CVA16), and 43 undefined enterovirus-infected HFMD inpatients were recruited at the Anhui Provincial Children’s Hospital between January 2011 and December 2012. SChE activity was measured. The non-parametric Mann–Whitney U test showed that SChE activity in children diagnosed with HFMD caused by EV71 was significantly higher than in healthy controls (p < 0.001), as well as in children with upper respiratory tract infections (p = 0.011), bronchopneumonia (p < 0.001), septicemia (p < 0.001), amygdalitis (p < 0.001), and appendicitis (p < 0.001). In addition, higher SChE activity was observed in male inpatients with HFMD caused by EV71 (47.7 % positivity) compared to female inpatients (26.1 % positivity) (chi-square test, p = 0.002). In our study, no significant differences in SChE levels were observed among different ages (up to 120 months) (r = -0.112, p > 0.05). An important finding was that SChE activity declined in the recovery phase of HFMD caused by EV71 compared to the acute phase (p < 0.001). Conclusions Elevated SChE activity was observed in patients with severe HFMD caused by EV71. Therefore, SChE might be a potential assistant biomarker for the diagnosis of HFMD caused by EV71 in children. Electronic supplementary material The online version of this article (doi:10.1186/s40249-016-0124-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Bang-Ning Cheng
- Clinical Laboratory Center, Anhui Provincial Children's Hospital, Hefei, 230051, China
| | - Yu-Lian Jin
- Department of Infectious Diseases, Anhui Provincial Children's Hospital, Hefei, 230051, China
| | - Bi-Quan Chen
- Department of Infectious Diseases, Anhui Provincial Children's Hospital, Hefei, 230051, China
| | - Li-Yan Zhu
- Department of Microbiology and Infectious Disease Center, School of Basic Medical Sciences, Peking University, Beijing, 100191, China
| | - Zi-Cheng Xu
- Clinical Laboratory Center, Anhui Provincial Children's Hospital, Hefei, 230051, China
| | - Tao Shen
- Clinical Laboratory Center, Anhui Provincial Children's Hospital, Hefei, 230051, China. .,Department of Microbiology and Infectious Disease Center, School of Basic Medical Sciences, Peking University, Beijing, 100191, China.
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