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Ren FR, Abodurezhake Y, Cui Z, Zhang M, Wang YY, Zhang XR, Lu YQ. Effects of Meteorological Factors and Atmospheric Pollution on Hand, Foot, and Mouth Disease in Urumqi Region. Front Public Health 2022; 10:913169. [PMID: 35812470 PMCID: PMC9257078 DOI: 10.3389/fpubh.2022.913169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
Background Hand, foot, and mouth disease (HFMD) is a febrile rash infection caused by enteroviruses, spreading mainly via the respiratory tract and close contact. In the past two decades, HFMD has been prevalent mainly in Asia, including China and South Korea, causing a huge disease burden and putting the lives and health of children at risk. Therefore, a further study of the factors influencing HFMD incidences has far-reaching implications. In existing studies, the environmental factors affecting such incidences are mainly divided into two categories: meteorological and air. Among these studies, the former are the majority of studies on HFMD. Some scholars have studied both factors at the same, but the number is not large and the findings are quite different. Methods We collect monthly cases of HFMD in children, meteorological factors and atmospheric pollution in Urumqi from 2014 to 2020. Trend plots are used to understand the approximate trends between meteorological factors, atmospheric pollution and the number of HFMD cases. The association between meteorological factors, atmospheric pollution and the incidence of HFMD in the Urumqi region of northwest China is then investigated using multiple regression models. Results A total of 16,168 cases in children are included in this study. According to trend plots, the incidence of HFMD shows a clear seasonal pattern, with O3 (ug/m3) and temperature (°C) showing approximately the same trend as the number of HFMD cases, while AQI, PM2.5 (ug/m3), PM10 (ug/m3) and NO2 (ug/m3) all show approximately opposite trends to the number of HFMD cases. Based on multiple regression results, O3 (P = 0.001) and average station pressure (P = 0.037) are significantly and negatively associated with HFMD incidences, while SO2 (P = 0.102), average dew point temperature (P = 0.072), hail (P = 0.077), and thunder (P = 0.14) have weak significant relationships with them.
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Affiliation(s)
- Fang-rong Ren
- College of Economics and Management, Nanjing Forestry University, Nanjing, China
| | | | - Zhe Cui
- Economics and Management School, Nantong University, Nantong, China
| | - Miao Zhang
- Economics and Management School, Nantong University, Nantong, China
| | - Yu-yu Wang
- Economics and Management School, Nantong University, Nantong, China
| | - Xue-rong Zhang
- Economics and Management School, Nantong University, Nantong, China
| | - Yao-qin Lu
- Department of Infectious Disease Control, Urumqi Center for Disease Control and Prevention, Ürümqi, China
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Li P, Rui J, Niu Y, Xie F, Wang Y, Li Z, Liu C, Yu S, Huang J, Luo L, Deng B, Liu W, Yang T, Li Q, Chen T. Analysis of HFMD Transmissibility Among the Whole Population and Age Groups in a Large City of China. Front Public Health 2022; 10:850369. [PMID: 35480581 PMCID: PMC9035867 DOI: 10.3389/fpubh.2022.850369] [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: 01/07/2022] [Accepted: 03/02/2022] [Indexed: 11/29/2022] Open
Abstract
Background Hand-Foot-and-Mouth-Disease (HFMD) has been widely spread in Asia, and has result in a high disease burden for children in many countries. However, the dissemination characteristics intergroup and between different age groups are still not clear. In this study, we aim to analyze the differences in the transmissibility of HFMD, in the whole population and among age groups in Shenzhen city, by utilizing mathematical models. Methods A database that reports HFMD cases in Shenzhen city from January 2010 to December 2017 was collected. In the first stage, a Susceptive-Infected-Recovered (SIR) model was built to fit data of Shenzhen city and its districts, and Reff was used to assess transmissibility in each district. In the second stage, a cross-age groups SIR model was constructed to calculate the difference in transmissibility of reported cases among three age groups of EV71 virus: 0–3 years, 3–5 years, and over 5 years which was denoted as age group 1, 2, and 3, respectively. Results From 2010 to 2017, 345,807 cases of HFMD were reported in Shenzhen city, with peak incidence in spring and autumn in Shenzhen city and most of its districts each year. Analysis of the EV71 incidence data by age group revealed that age Group 1 have the highest incidence (3.13 ×10−7–2.31 ×10−4) while age group 3 had the lowest incidence (0–3.54 ×10−5). The differences in weekly incidence of EV71 between age groups were statistically significant (t12 = 7.563, P < 0.0001; t23 = 12.420, P < 0.0001; t13 = 16.996, P < 0.0001). The R2 of the SIR model Shenzhen city population-wide HFMD fit for each region was >0.5, and P < 0.001. Reff values were >1 for the vast majority of time and regions, indicating that the HFMD virus has the ability to spread in Shenzhen city over the long-term. Differences in Reff values between regions were judged by using analysis of variance (ANOVA) (F = 0.541, P = 0.744). SiIiRi-SjIjRj models between age groups had R2 over 0.7 for all age groups and P <0.001. The Reff values between groups show that the 0–2 years old group had the strongest transmissibility (median: 2.881, range: 0.017–9.897), followed by the over 5 years old group (median: 1.758, range: 1.005–5.279), while the 3–5 years old group (median: 1.300, range: 0.005–1.005) had the weakest transmissibility of the three groups. Intra-group transmissibility was strongest in the 0–2 years age group (median: 1.787, range: 0–9.146), followed by Group 1 to Group 2 (median: 0.287, range: 0–1.988) and finally Group 1 to Group 3 (median: 0.287, range: 0–1.988). Conclusion The incidence rate of HFMD is high in Shenzhen city. In the data on the incidence of EV71 in each age group, the highest incidence was in the 0–2 years age group, and the lowest incidence was in the over 5 years age group. The differences in weekly incidence rate of EV71 among age groups were statistically significant. Children with the age of 0–2 years had the highest transmissibility.
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Affiliation(s)
- Peihua Li
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Jia Rui
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Yan Niu
- Chinese Center for Disease Control and Prevention, Public Health Emergency Center, Beijing, China
| | - Fang Xie
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Yifang Wang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Zhuoyang Li
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Chan Liu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Shanshan Yu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Jiefeng Huang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Li Luo
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Bin Deng
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Weikang Liu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Tianlong Yang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Qun Li
- Chinese Center for Disease Control and Prevention, Public Health Emergency Center, Beijing, China
- Qun Li
| | - Tianmu Chen
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
- *Correspondence: Tianmu Chen ;
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Li P, Huang Y, Zhu D, Yang S, Hu D. Risk Factors for Severe Hand-Foot-Mouth Disease in China: A Systematic Review and Meta-Analysis. Front Pediatr 2021; 9:716039. [PMID: 34858899 PMCID: PMC8631475 DOI: 10.3389/fped.2021.716039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Accepted: 10/13/2021] [Indexed: 12/22/2022] Open
Abstract
Background: This study aimed to identify potential risk factors for severe hand-foot-mouth disease (HFMD). Methods: The PubMed, Embase, the Cochrane Library, Sinomed, WanFang, CNKI, and VIP databases were searched (up to August 2021). Results: Twenty-nine studies (9,241 and 927,355 patients with severe HFMD and controls, respectively; all from China) were included. EV71 was associated with higher odds of severe HFMD compared with other agents (OR = 4.44, 95%CI: 3.12-6.33, p < 0.001). Being home-raised (OR = 1.99, 95%CI: 1.59-2.50, p < 0.001), higher number of children in the family (OR = 2.09, 95%CI: 1.93-2.27, p < 0.001), poor hand hygiene (OR = 2.74, 95%CI: 1.78-4.23, p < 0.001), and no breastfeeding (OR = 2.01, 95%CI: 1.45-2.79, p < 0.001) were risk factors for severe HFMD. First consulting to a district-level or above hospital (OR = 0.34, 95%CI: 0.25-0.45, p < 0.001) and diagnosis of HFMD at baseline (OR = 0.17, 95%CI: 0.13-0.24, p < 0.001) were protective factors against severe HFMD. Fever, long fever duration, vomiting, lethargy, leukocytosis, tic, and convulsions were each associated with severe HFMD (all p < 0.05), while rash was not. Conclusions: EV71, lifestyle habits, frequent hospital visits, and symptoms are risk factors for severe HFMD in children in China, while early diagnosis and admission to higher-level hospitals are protective factors.
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Affiliation(s)
- Peiqing Li
- Department of Pediatric Emergency, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yuge Huang
- Pediatric Intensive Care Unit, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Danping Zhu
- Department of Pediatric Emergency, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Sida Yang
- Department of Pediatric Neurology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Dandan Hu
- Children's Health Section, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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Su Y, Han J, Li J, Ren Z, Huang L, Xu B, Wei Q. Resistance of poliovirus 1 and enterovirus A71 against alcohol and other disinfectants. J Virol Methods 2021; 298:114292. [PMID: 34536486 DOI: 10.1016/j.jviromet.2021.114292] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Revised: 09/12/2021] [Accepted: 09/13/2021] [Indexed: 10/20/2022]
Abstract
Poliovirus 1 (PV 1) is the standard virus used in tests to support claims of virucidal property in commercial hand sanitizers and disinfectants in China. Classified within the same genus as poliovirus, enterovirus A71 (EV A71), which causes hand-foot-mouth disease among children, has caused numerous outbreaks in China and other countries. Hand hygiene and surface cleaning are critical to prevent and control this disease and many other infectious diseases. This study compared the efficacies of 17 self-made alcohol-based hand sanitizers and 10 commercially available disinfectants (4 high-level, 4 intermediate-level, 2 low-level) against these two viruses. The results showed that by itself, ethanol needed to reach a concentration of 75 % to meet the inactivation requirement of 4-log reduction in average TCID50 against PV 1. Nine out of 13 laboratory-formulated alcohol-based hand sanitizers reached the 4-log inactivation requirement against PV 1 after 4.5 min, while the remaining four sanitizers did not. Unexpectedly, none of the tested ethanol-based sanitizers inactivated EV A71 by 4-log. For the commercially available disinfectants, all four high-level and one intermediate-level disinfectants passed the inactivation requirements against both PV 1 and EV A71, while two intermediate-level disinfectants met the inactivation requirement against PV 1 but failed against EV A71. The last intermediate-level and both low-level disinfectants did not meet the requirement for either PV 1 or EV A71. Therefore, PV 1 is more susceptible to inactivation by many common alcohol-based and non-alcohol-based disinfectants than EV A71. Therefore, the adoption of EV A71 as the standard test virus would elevate the disinfectant requirement standard and provide better protection for the public. Based on these results, seven new alcohol-based hand sanitizer recipes were formulated and found to be effective against both PV 1 and EV A71, with two candidates reaching the required 4-log virus reduction efficacy within 1 min.
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Affiliation(s)
- Yuxin Su
- Center for Disease Prevention and Control of People's Liberation Army, Beijing, China
| | - Jie Han
- Center for Disease Prevention and Control of People's Liberation Army, Beijing, China
| | - Jie Li
- Center for Disease Prevention and Control of Mentougou District, Beijing, China
| | - Zhe Ren
- Center for Disease Prevention and Control of People's Liberation Army, Beijing, China
| | - Liuyu Huang
- Center for Disease Prevention and Control of People's Liberation Army, Beijing, China
| | - Binjie Xu
- Guangzhou Kingtest Technology, Co. Ltd., Guangzhou, Guangdong, China
| | - Qiuhua Wei
- Center for Disease Prevention and Control of People's Liberation Army, Beijing, China.
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Fu M, Bai J, Gao S, Chang Z, Zhou X, Long JE. Construction and characterization of an infectious cDNA clone of enterovirus 71: a rapid method for rescuing infectious virus based on stable cells expressing T7 polymerase. Arch Virol 2021; 166:627-632. [PMID: 33423081 DOI: 10.1007/s00705-020-04940-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 11/12/2020] [Indexed: 11/26/2022]
Abstract
Enterovirus 71 (EV71) is a causative agent of hand, foot and, mouth disease (HFMD) in young children. It is valuable for virologists to develop a fast method to rescue infectious virus from a viral cDNA clone. Here, we report a method for rapid rescue of infectious EV71 by using cells expressing T7 polymerase. The full-length EV71 genome was amplified in one step by long-distance PCR with a T7 promoter at the 5' end, and the T7 polymerase gene was cloned into a lentivirus vector for construction of a stable cell line expressing T7 polymerase. The infectious virus was rapidly and efficiently rescued by single transfection of cells with the infectious cDNA clone. Further experiments showed that the rescued virus had characteristics similar to those of the parental virus. This method circumvented the difficulty in performing in vitro transcription of a long linear DNA to obtain high-quality RNA. The construction of the viral cDNA clone and the fast rescue of the infectious virus will greatly benefit future investigations.
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Affiliation(s)
- Meixian Fu
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), School of Basic Medical Sciences, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Jinjin Bai
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), School of Basic Medical Sciences, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Shuang Gao
- Department of Medical Microbiology and Parasitology, School of Basic Medical Sciences, Shanghai Medical College, Fudan University, 138 Yixueyuan R., Shanghai, 200032, China
| | - Zhangmei Chang
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), School of Basic Medical Sciences, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Xin Zhou
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), School of Basic Medical Sciences, Shanghai Medical College, Fudan University, Shanghai, 200032, China
| | - Jian-Er Long
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), School of Basic Medical Sciences, Shanghai Medical College, Fudan University, Shanghai, 200032, China.
- Department of Medical Microbiology and Parasitology, School of Basic Medical Sciences, Shanghai Medical College, Fudan University, 138 Yixueyuan R., Shanghai, 200032, China.
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6
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Bai J, Chen X, Liu Q, Zhou X, Long JE. Characteristics of enterovirus 71-induced cell death and genome scanning to identify viral genes involved in virus-induced cell apoptosis. Virus Res 2019; 265:104-114. [DOI: 10.1016/j.virusres.2019.03.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 02/19/2019] [Accepted: 03/21/2019] [Indexed: 12/13/2022]
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7
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Xiao K, Duan L, Peng Y, Wu M, Mai G, Yan Z, Chen S, Lu Y. Epidemiologic features of enterovirus associated with hand, foot and mouth disease in 2013 and 2014 in Shenzhen, China. Sci Rep 2019; 9:3856. [PMID: 30846756 PMCID: PMC6405776 DOI: 10.1038/s41598-019-40402-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Accepted: 02/12/2019] [Indexed: 02/05/2023] Open
Abstract
Hand, foot and mouth disease (HFMD) is responsible for a heavy economic and social burden in the Asia-Pacific region. Previous studies have shown that coxsackievirus A6 (CVA6) and coxsackievirus A10 (CVA10) have become the predominant agents of HFMD in mainland China in recent years, replacing enterovirus 71 (EV71) and coxsackievirus A16 (CVA16), although it is unclear if this is consistent throughout China. In this study, samples from 253 HFMD cases were collected in Shenzhen, China, from May 2013 through April 2014 to identify the etiological agent of HFMD. In total, 64.8% (164/253) of HFMD cases were enterovirus positive, in which 81.1% (133/164) were determined to be CVA6. The phylogenetic tree of the partial viral protein 1 sequence showed that the CVA6 isolates were divided into four clusters (Clusters A to D), and cluster D was further divided into four sub-clusters (Clusters D1 to D4). The 133 CVA6 samples isolated in our study were classified into cluster D4, in which the first identified sequence was isolated in Shenzhen in 2008. This study demonstrated that the CVA6 cluster D4, which is predominantly circulating in HFMD in mainland China, may have originated from a local strain identified in 2008 in Shenzhen.
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Affiliation(s)
- Kelin Xiao
- International institute of Infection and Immunity, Shantou University Medical College, Shantou, 515041, China
- Central Laboratory, Maternal-Fetal Medicine Institute, Baoan Maternal and Child Health Hospital, Jinan University, Shenzhen, 518102, China
| | - Lian Duan
- Shenzhen liver diseases institute, Shenzhen Third People's Hospital, Shenzhen, 518112, China
| | - Yun Peng
- Shenzhen liver diseases institute, Shenzhen Third People's Hospital, Shenzhen, 518112, China
| | - Maocai Wu
- Shenzhen liver diseases institute, Shenzhen Third People's Hospital, Shenzhen, 518112, China
| | - Guangxing Mai
- Central Laboratory, Maternal-Fetal Medicine Institute, Baoan Maternal and Child Health Hospital, Jinan University, Shenzhen, 518102, China
| | - Zehao Yan
- Central Laboratory, Maternal-Fetal Medicine Institute, Baoan Maternal and Child Health Hospital, Jinan University, Shenzhen, 518102, China
| | - Shuiwen Chen
- Department of pediatrics, Baoan Maternal and Child Health Hospital, Jinan University, Shenzhen, 518102, China.
| | - Yihan Lu
- Department of Epidemiology, The Key Laboratory of Public Health Safety of Minister of Education, School of Public Health, Fudan University, Shanghai, 200032, China.
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Li J, Li Y, Zhang S, Ma H, Liu X, Liang Z, Zhang W, Jing H, Du Y, Yang Y, Huo D, Chen L, Wang Q. Analysis of an Imported Subgenotype C2 Strain of Human Enterovirus 71 in Beijing, China, 2015. Front Microbiol 2018; 9:2337. [PMID: 30323801 PMCID: PMC6172327 DOI: 10.3389/fmicb.2018.02337] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2017] [Accepted: 09/12/2018] [Indexed: 11/21/2022] Open
Abstract
Background: Subgenotype C4 of enterovirus 71 (EV71) is the predominant agent of Hand Foot and Mouth disease (HFMD) circulating in the mainland of China. For the first time, a subgenotype C2 of EV71 named SY30-2 was isolated from a HFMD case in Beijing, China. Since it is uncertain whether antibodies raised against subgenotype C4 of EV71 can protect C2 EV71, it is important to monitor and check the presence of cross-reactive antibodies against new EV71 subgenotypes. To find out the causes for the different NtAb, this study is to investigate the relationships between amino acid residue variations and cross-reactive antibodies against EV71 subgenotypes C2 and C4. Methods: Nucleotide and amino acid sequences from full-length genome sequence of SY30-2 were compared to EV71 reference strains. A microneutralization test was used to detect neutralizing antibody (NTAb) in the sera of subgenotype C4 of EV71 infected cases against SY30-2 and FY17 (a C4 isolate). The 3D structure of the viral capsid protein of SY30-2 was constructed. Results: Genome sequence and similarity plot analyses showed that SY30-2 shared the highest identity with subgenotype C2 of EV71 strains in every fragment of the genome. While the microneutralization test result showed that children infected with subgenotype C4 of EV71 had higher NTAb titers against FY17 than SY30-2 (p < 0.001). The amino acid sequence comparison revealed that four amino acid residues VP1-22, VP1-31, VP1-249 and VP3-93 were highly conserved in subgenotype C4 of EV71 compared with the corresponding amino acid residues on subgenotype C2 of EV71 (p < 0.05). Furthermore, the 3D-structure of viral capsid protein showed that VP1-22, VP1-31 and VP3-93 were located on the surface of virion. Conclusion: This is the first report of an EV71 subgenotype C2 isolated from HFMD in Beijing, China. Only a few antigenic variations on subgenotype C2 of EV71 could have led to a great decrease in NTAb titer. Thus, imported new genotypes and subgenotypes of EV71 should be closely monitored. The efficacy of available vaccines against new viruses should be evaluated as well.
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Affiliation(s)
- Jie Li
- Beijing Center for Disease Prevention and Control, Beijing, China.,Beijing Center for Preventive Medicine Research, Beijing, China.,Beijing Shunyi Center for Disease Prevention and Control, Beijing, China
| | - Yindong Li
- Beijing Shunyi Center for Disease Prevention and Control, Beijing, China
| | - Songjian Zhang
- Beijing Shunyi Center for Disease Prevention and Control, Beijing, China
| | - Hongmei Ma
- Beijing Shunyi Center for Disease Prevention and Control, Beijing, China
| | - XiaoXiao Liu
- Beijing Xi Cheng Center for Disease Prevention and Control, Beijing, China
| | - Zhichao Liang
- Beijing Center for Disease Prevention and Control, Beijing, China.,Beijing Center for Preventive Medicine Research, Beijing, China
| | - Wenzeng Zhang
- Beijing Shunyi Center for Disease Prevention and Control, Beijing, China
| | - Hongbo Jing
- Beijing Shunyi Center for Disease Prevention and Control, Beijing, China
| | - Yiwei Du
- Beijing Center for Disease Prevention and Control, Beijing, China.,Beijing Center for Preventive Medicine Research, Beijing, China
| | - Yang Yang
- Beijing Center for Disease Prevention and Control, Beijing, China.,Beijing Center for Preventive Medicine Research, Beijing, China
| | - Da Huo
- Beijing Center for Disease Prevention and Control, Beijing, China.,Beijing Center for Preventive Medicine Research, Beijing, China
| | - Lijuan Chen
- Beijing Center for Disease Prevention and Control, Beijing, China.,Beijing Center for Preventive Medicine Research, Beijing, China
| | - Quanyi Wang
- Beijing Center for Disease Prevention and Control, Beijing, China.,Beijing Center for Preventive Medicine Research, Beijing, China
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Zhu R, Cheng T, Yin Z, Liu D, Xu L, Li Y, Wang W, Liu J, Que Y, Ye X, Tang Q, Zhao Q, Ge S, He S, Xia N. Serological survey of neutralizing antibodies to eight major enteroviruses among healthy population. Emerg Microbes Infect 2018; 7:2. [PMID: 29323107 PMCID: PMC5837151 DOI: 10.1038/s41426-017-0003-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 10/03/2017] [Accepted: 11/06/2017] [Indexed: 12/13/2022]
Abstract
Human enteroviruses (EVs) are the most common causative agents infecting human, causing many harmful diseases, such as hand, foot, and mouth disease (HFMD), herpangina (HA), myocarditis, encephalitis, and aseptic meningitis. EV-related diseases pose a serious worldwide threat to public health. To gain comprehensive insight into the seroepidemiology of major prevalent EVs in humans, we firstly performed a serological survey for neutralizing antibodies (nAbs) against Enterovirus A71 (EV-A71), Coxsackie virus A16 (CV-A16), Coxsackie virus A6 (CV-A6), Coxsackie virus A10 (CV-A10), Coxsackie virus B3 (CV-B3), Coxsackie virus B5 (CV-B5), Echovirus 25 (ECHO25), and Echovirus 30 (ECHO30) among the healthy population in Xiamen City in 2016, using micro-neutralization assay. A total of 515 subjects aged 5 months to 83 years were recruited by stratified random sampling. Most major human EVs are widely circulated in Xiamen City and usually infect infants and children. The overall seroprevalence of these eight EVs were ranged from 14.4% to 42.7%, and most of them increased with age and subsequently reached a plateau. The co-existence of nAbs against various EVs are common among people ≥ 7 years of age, due to the alternate infections or co-infections with different serotypes of EVs, while most children were negative for nAb against EVs, especially those < 1 year of age. This is the first report detailing the seroepidemiology of eight prevalent EVs in the same population, which provides scientific data supporting further studies on the improvement of EV-related disease prevention and control.
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Affiliation(s)
- Rui Zhu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Life Sciences, School of Public Health, Xiamen University, Xiamen, 361102, China
| | - Tong Cheng
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Life Sciences, School of Public Health, Xiamen University, Xiamen, 361102, China
| | - Zhichao Yin
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Life Sciences, School of Public Health, Xiamen University, Xiamen, 361102, China
| | - Dongxiao Liu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Life Sciences, School of Public Health, Xiamen University, Xiamen, 361102, China
| | - Longfa Xu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Life Sciences, School of Public Health, Xiamen University, Xiamen, 361102, China
| | - Yongchao Li
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Life Sciences, School of Public Health, Xiamen University, Xiamen, 361102, China
| | - Wei Wang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Life Sciences, School of Public Health, Xiamen University, Xiamen, 361102, China
| | - Jian Liu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Life Sciences, School of Public Health, Xiamen University, Xiamen, 361102, China
| | - Yuqiong Que
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Life Sciences, School of Public Health, Xiamen University, Xiamen, 361102, China
| | - Xiangzhong Ye
- Beijing Wantai Biological Pharmacy Enterprise, Beijing, 102206, China
| | - Qiyi Tang
- Department of Microbiology, Howard University College of Medicine, Washington, DC, 20059, USA
| | - Qinjian Zhao
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Life Sciences, School of Public Health, Xiamen University, Xiamen, 361102, China
| | - Shengxiang Ge
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Life Sciences, School of Public Health, Xiamen University, Xiamen, 361102, China
| | - Shuizhen He
- Xiamen Center for Disease Control and Prevention, Xiamen, 361012, China.
| | - Ningshao Xia
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Life Sciences, School of Public Health, Xiamen University, Xiamen, 361102, China.
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10
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Chang Z, Wang Y, Bian L, Liu Q, Long JE. Enterovirus 71 antagonizes the antiviral activity of host STAT3 and IL-6R with partial dependence on virus-induced miR-124. J Gen Virol 2017; 98:3008-3025. [PMID: 29120300 DOI: 10.1099/jgv.0.000967] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Enterovirus 71 (EV71) has caused major outbreaks of hand, foot and mouth disease. EV71 infections increase the production of many host cytokines and pro-inflammatory factors, including interleukin (IL)-6, IL-10 and COX-2. Some of these molecules could stimulate the signal transducer and activator of transcription 3 (STAT3), which plays a key role in regulating host immune responses and several viral diseases. However, the role of STAT3 in EV71 infection remains unknown. This study found that the phosphorylation levels of STAT3 (pY705-STAT3) are closely related to EV71 infection. Further experiments revealed that STAT3 exerts an anti-EV71 activity. However, the antiviral activity of STAT3 is partially antagonized by EV71-induced miR-124, which directly targets STAT3 mRNA. Similarly, IL-6R, the α-subunit of the IL-6 receptor complex, exhibits anti-EV71 activity and is directly targeted by the virus-induced miR-124. These results indicate that EV71 can evade host IL-6R- and STAT3-mediated antiviral activities by EV71-induced miR-124. This suggests that controlling miR-124 and the downstream targets, IL-6R and STAT3, might benefit the antiviral treatment of EV71 infection.
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Affiliation(s)
- Zhangmei Chang
- Key Laboratory of Medical Molecular Virology of Ministries of Education and Health, Shanghai Medical College of Fudan University, Shanghai 200032, PR China
| | - Yan Wang
- Department of Medical Microbiology and Parasitology, Laboratory of Medical Microbiology, Shanghai Medical College of Fudan University, 138 Yixueyuan Road, Shanghai 200032, PR China
| | - Liang Bian
- Department of Medical Microbiology and Parasitology, Laboratory of Medical Microbiology, Shanghai Medical College of Fudan University, 138 Yixueyuan Road, Shanghai 200032, PR China
| | - Qingqing Liu
- Key Laboratory of Medical Molecular Virology of Ministries of Education and Health, Shanghai Medical College of Fudan University, Shanghai 200032, PR China
| | - Jian-Er Long
- Key Laboratory of Medical Molecular Virology of Ministries of Education and Health, Shanghai Medical College of Fudan University, Shanghai 200032, PR China.,Department of Medical Microbiology and Parasitology, Laboratory of Medical Microbiology, Shanghai Medical College of Fudan University, 138 Yixueyuan Road, Shanghai 200032, PR China
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11
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Zhao D, Sun B, Sun S, Fu B, Liu C, Liu D, Chu Y, Ma Y, Bai L, Wu Y, Zhou Y, Su W, Hou A, Cai L, Xu F, Kong W, Jiang C. Characterization of human enterovirus71 virus-like particles used for vaccine antigens. PLoS One 2017; 12:e0181182. [PMID: 28732070 PMCID: PMC5521781 DOI: 10.1371/journal.pone.0181182] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 06/27/2017] [Indexed: 12/11/2022] Open
Abstract
Human enterovirus 71 (EV71) is a major causative pathogen of hand, foot and mouth disease (HFMD) and has caused outbreaks with significant mortality among young children in the Asia-Pacific region in recent years. Towards developing a vaccine for this disease, we have expressed and purified EV71 virus-like particles (VLPs), which resemble the authentic virus in appearance, capsid structure and protein sequence, from insect cells (Sf9) using a multistep chromatography process. We demonstrated intracellular localization of the VLPs in host cells by in situ immunogold detection, electron microscopy and immunofluorescence. Characteristics of these EV71 VLPs were studied using a variety of immunological and physicochemical techniques, which aimed to reveal that the purified EV71 VLPs have good morphology and structure consistent with natural EV71 empty capsids. Results of the amino acid analysis, SDS-PAGE, Western blotting and high-performance liquid chromatography confirmed the high purity of the EV71 VLPs. However the sedimentation coefficient of the VLPs showed that they were smaller than that of secreted EV71 VLPs purified by discontinuous cesium chloride density gradients, they were similar to the empty capsids of natural EV71 virions reported previously. Combined with the previous study that EV71 VLPs purified by a multistep chromatography process were able to elicit strong humoral immune responses in mice, our results further supported the conclusion that our EV71 VLPs had well-preserved molecular and structural characteristics. The EV71 VLPs produced from the baculovirus expression system and purified by a multistep chromatography process displayed key structural and immunological features, which would contribute to their efficacy as a HFMD vaccine.
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MESH Headings
- Amino Acid Sequence
- Animals
- Blotting, Western
- Chromatography, High Pressure Liquid
- Dynamic Light Scattering
- Electrophoresis, Polyacrylamide Gel
- Enterovirus A, Human/genetics
- Enterovirus A, Human/immunology
- Immunohistochemistry
- Mass Spectrometry
- Microscopy, Atomic Force
- Microscopy, Confocal
- Microscopy, Electron, Transmission
- Sf9 Cells
- Vaccines, Virus-Like Particle/chemistry
- Vaccines, Virus-Like Particle/genetics
- Vaccines, Virus-Like Particle/immunology
- Vaccines, Virus-Like Particle/ultrastructure
- Viral Vaccines/chemistry
- Viral Vaccines/immunology
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Affiliation(s)
- Dandan Zhao
- National Engineering Laboratory for AIDS Vaccine, School of Life Sciences, Jilin University, Changchun, China
- School of Life Sciences, Jilin Agricultural University, Changchun, China
| | - Bo Sun
- National Engineering Laboratory for AIDS Vaccine, School of Life Sciences, Jilin University, Changchun, China
| | - Shiyang Sun
- National Engineering Laboratory for AIDS Vaccine, School of Life Sciences, Jilin University, Changchun, China
| | - Bin Fu
- Beijing Proteome Research Center, Beijing, China
| | - Chuntian Liu
- National Engineering Laboratory for AIDS Vaccine, School of Life Sciences, Jilin University, Changchun, China
| | - Dawei Liu
- Changchun BCHT Biotechnology Company, Changchun, China
| | - Yanfei Chu
- Changchun BCHT Biotechnology Company, Changchun, China
| | - Youlei Ma
- Changchun BCHT Biotechnology Company, Changchun, China
| | - Lu Bai
- Changchun BCHT Biotechnology Company, Changchun, China
| | - Yongge Wu
- National Engineering Laboratory for AIDS Vaccine, School of Life Sciences, Jilin University, Changchun, China
| | - Yan Zhou
- National Engineering Laboratory for AIDS Vaccine, School of Life Sciences, Jilin University, Changchun, China
| | - Weiheng Su
- National Engineering Laboratory for AIDS Vaccine, School of Life Sciences, Jilin University, Changchun, China
| | - Ali Hou
- National Engineering Laboratory for AIDS Vaccine, School of Life Sciences, Jilin University, Changchun, China
| | - Linjun Cai
- National Engineering Laboratory for AIDS Vaccine, School of Life Sciences, Jilin University, Changchun, China
| | - Fei Xu
- National Engineering Laboratory for AIDS Vaccine, School of Life Sciences, Jilin University, Changchun, China
| | - Wei Kong
- National Engineering Laboratory for AIDS Vaccine, School of Life Sciences, Jilin University, Changchun, China
- * E-mail: (WK); (CJ)
| | - Chunlai Jiang
- National Engineering Laboratory for AIDS Vaccine, School of Life Sciences, Jilin University, Changchun, China
- * E-mail: (WK); (CJ)
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12
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Wu Y, Zhu R, Xu L, Li Y, Li S, Yu H, Li S, Zhu H, Cheng T, Xia N. A novel combined vaccine based on monochimeric VLP co-displaying multiple conserved epitopes against enterovirus 71 and varicella-zoster virus. Vaccine 2017; 35:2728-2735. [PMID: 28408118 DOI: 10.1016/j.vaccine.2017.03.065] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 03/16/2017] [Accepted: 03/18/2017] [Indexed: 12/14/2022]
Abstract
Chicken pox and hand, foot and mouth disease (HFMD) are two major infectious diseases that mainly affect infants and children, causing significant morbidity annually. Varicella-zoster virus (VZV) and enterovirus 71 (EV71), respectively, are the principal epidemic pathogens causing these two diseases. To investigate the possibility of developing a novel combined vaccine to prevent chicken pox and HFMD, we constructed three chimeric virus-like particles (VLPs) (termed HBc-V/1/2, HBc-2/V/1 and HBc-1/2/V) based on the hepatitis B core antigen (HBc) carrier that display epitopes derived from VZV-gE, EV71-VP1, and EV71-VP2 in a varied tandem manner. The chimeric HBc can self-assemble into VLPs with these three epitopes displayed on the surface of particles. Epitope-specific antibody characterization suggested that HBc-V/1/2 elicits a balanced antibody response toward these three epitopes, and no immune interference was observed between the three epitopes. Importantly, the anti-HBc-V/1/2 sera could simultaneously neutralize VZV and EV71 and cross-neutralize coxsackievirus A16 (CVA16), another major pathogen causing HFMD. Moreover, the anti-HBc-V/1/2 sera protected neonatal mice from lethal challenge of EV71 and CVA16. Collectively, our study not only demonstrated that HBc-V/1/2 is a promising candidate combined vaccine for HFMD and Chicken pox but also provides a novel strategy for the design of combined vaccines.
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MESH Headings
- Animals
- Antibodies, Neutralizing/blood
- Antibodies, Viral/blood
- Chickenpox/prevention & control
- Drug Carriers
- Enterovirus A, Human/genetics
- Enterovirus A, Human/immunology
- Epitopes/genetics
- Epitopes/immunology
- Female
- Hand, Foot and Mouth Disease/prevention & control
- Hepatitis B Core Antigens/genetics
- Herpesvirus 3, Human/genetics
- Herpesvirus 3, Human/immunology
- Mice, Inbred BALB C
- Vaccines, Combined/administration & dosage
- Vaccines, Combined/genetics
- Vaccines, Combined/immunology
- Vaccines, Synthetic/administration & dosage
- Vaccines, Synthetic/genetics
- Vaccines, Synthetic/immunology
- Vaccines, Virus-Like Particle/administration & dosage
- Vaccines, Virus-Like Particle/genetics
- Vaccines, Virus-Like Particle/immunology
- Viral Vaccines/administration & dosage
- Viral Vaccines/genetics
- Viral Vaccines/immunology
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Affiliation(s)
- Yangtao Wu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Sciences, Xiamen University, Xiamen, China
| | - Rui Zhu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Sciences, Xiamen University, Xiamen, China
| | - Longfa Xu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Sciences, Xiamen University, Xiamen, China
| | - Yongchao Li
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Sciences, Xiamen University, Xiamen, China
| | - Shuxuan Li
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Sciences, Xiamen University, Xiamen, China
| | - Hai Yu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Sciences, Xiamen University, Xiamen, China
| | - Shaowei Li
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Sciences, Xiamen University, Xiamen, China
| | - Hua Zhu
- Department of Microbiology and Molecular Genetics, New Jersey Medical School, Rutgers University, Newark, USA
| | - Tong Cheng
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Sciences, Xiamen University, Xiamen, China.
| | - Ningshao Xia
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, National Institute of Diagnostics and Vaccine Development in Infectious Diseases, School of Life Sciences, Xiamen University, Xiamen, China
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13
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Shen J, Zhao C, Cao P, Shi P, Cao L, Zhu Q. Relationship between serologic response and clinical symptoms in children with enterovirus 71-infected hand-foot-mouth disease. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2016; 8:11608-14. [PMID: 26617898 PMCID: PMC4637714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 08/19/2015] [Indexed: 01/17/2023]
Abstract
This study aimed to explore the correlation between clinical symptoms, including rash and fever, and serum antibody reaction to enterovirus 71 (EV71) infection in children hospitalized due to hand-foot-mouth disease (HFMD). From May 2014 to July 2014, a total of 547 children hospitalized due to HFMD in Children's Hospital of Fudan University were enrolled retrospectively. RNA levels of EV71 and CA16 in fecal, serum, and cerebrospinal fluid specimens were measured using quantitative real-time RT-PCR, and EV71-IgM antibody in the serum was detected using immune colloidal gold assays. Of the 547 fecal specimens, 296 were EV71 RNA positive, 109 were CA16 RNA positive, and 8 were positive for both EV71 RNA and CA16 RNA. The total positive rate for either EV71 or CA16 in feces was 72.58% (397/547). Additionally, 544 serum specimens were collected, and 409 were EV71-IgM positive (75.18%). The duration of rash and fever was found to be correlated to the positive rate of serum EV71-IgM, and the positive rate of serum EV71-IgM plus EV71 RNA in feces. The positive rates of serum EV71-IgM and serum EV71-IgM plus EV71 RNA in fecal collected at day 3 of fever were 79.7% and 52.8%, respectively. In conclusion, EV71 and CA16 were found to be the major pathogens responsible for the epidemics of HFMD in children during May to July 2014 in Shanghai, China. There is a close relationship between the positive rate of serum EV71-IgM and the duration of fever and rash.
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Affiliation(s)
- Jun Shen
- Department of Infectious Disease, Children's Hospital of Fudan University Shanghai, China
| | - Chao Zhao
- Key laboratory of medical molecular virology, Fudan University Shanghai, China
| | - Ping Cao
- Department of Infectious Disease, Children's Hospital of Fudan University Shanghai, China
| | - Peng Shi
- Information Center, Children's Hospital of Fudan University Shanghai, China
| | - Lingfeng Cao
- Virology Laboratory, Children's Hospital of Fudan University Shanghai, China
| | - Qirong Zhu
- Department of Infectious Disease, Children's Hospital of Fudan University Shanghai, China
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14
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Zhang W, Huang B, She C, Liu Y, Tong H, Wang F, Wu K. An epidemic analysis of hand, foot, and mouth disease in Zunyi, China between 2012 and 2014. Saudi Med J 2016; 36:593-8. [PMID: 25935181 PMCID: PMC4436757 DOI: 10.15537/smj.2015.5.10859] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To re-evaluate the epidemiology of hand, foot, and mouth disease (HFMD) in a non-vaccinated population in Zunyi, China. METHODS We used laboratory-based data from the Third Affiliated Hospital of Zunyi Medical College, Zunyi, China to assess the epidemiology of the HFMD caused by enteroviruses between January 2012 and November 2014. Real-time polymerase chain reaction was used to determine human enteroviruses from a total of 12313 probable cases enrolled in this retrospective study. All analyses were stratified by enterovirus serotype, gender, and age. RESULTS Virological results were available for 12313 cases of probable HFMD. A total of 5750 cases were positive for viral detection, and the positive rates of infection caused by other enteroviruses was 46.7%, EV71 9%, and CVA16 4.7%. During the study period there was a substantial increase in the occurrence of HFMD. Most of the HFMD patients (87.4%) were aged 0-59 months (median 24; range 0-59). Males showed a higher HFMD prevalence rate (62.4%) than females (37.6%). CONCLUSION Enterovirus infection remains an important public health problem and other entroviruses are emerging as the major causative agent of the HFMD in Zunyi, China.
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Affiliation(s)
- Weiwei Zhang
- Department of Pediatric Health Care, The Third Affiliated Hospital of Zunyi Medical College, Zunyi, China. E-mail.
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15
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Koh WM, Bogich T, Siegel K, Jin J, Chong EY, Tan CY, Chen MIC, Horby P, Cook AR. The Epidemiology of Hand, Foot and Mouth Disease in Asia: A Systematic Review and Analysis. Pediatr Infect Dis J 2016; 35:e285-300. [PMID: 27273688 PMCID: PMC5130063 DOI: 10.1097/inf.0000000000001242] [Citation(s) in RCA: 159] [Impact Index Per Article: 19.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/22/2016] [Indexed: 12/22/2022]
Abstract
CONTEXT Hand, foot and mouth disease (HFMD) is a widespread pediatric disease caused primarily by human enterovirus 71 (EV-A71) and Coxsackievirus A16 (CV-A16). OBJECTIVE This study reports a systematic review of the epidemiology of HFMD in Asia. DATA SOURCES PubMed, Web of Science and Google Scholar were searched up to December 2014. STUDY SELECTION Two reviewers independently assessed studies for epidemiologic and serologic information about prevalence and incidence of HFMD against predetermined inclusion/exclusion criteria. DATA EXTRACTION Two reviewers extracted answers for 8 specific research questions on HFMD epidemiology. The results are checked by 3 others. RESULTS HFMD is found to be seasonal in temperate Asia with a summer peak and in subtropical Asia with spring and fall peaks, but not in tropical Asia; evidence of a climatic role was identified for temperate Japan. Risk factors for HFMD include hygiene, age, gender and social contacts, but most studies were underpowered to adjust rigorously for confounding variables. Both community-level and school-level transmission have been implicated, but their relative importance for HFMD is inconclusive. Epidemiologic indices are poorly understood: No supporting quantitative evidence was found for the incubation period of EV-A71; the symptomatic rate of EV-A71/Coxsackievirus A16 infection was from 10% to 71% in 4 studies; while the basic reproduction number was between 1.1 and 5.5 in 3 studies. The uncertainty in these estimates inhibits their use for further analysis. LIMITATIONS Diversity of study designs complicates attempts to identify features of HFMD epidemiology. CONCLUSIONS Knowledge on HFMD remains insufficient to guide interventions such as the incorporation of an EV-A71 vaccine in pediatric vaccination schedules. Research is urgently needed to fill these gaps.
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Affiliation(s)
- Wee Ming Koh
- From the Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Standard Analytics, New York, New York; Rollins School of Public Health, Emory University, Atlanta, Georgia; Duke-NUS Graduate Medical School, Singapore; Communicable Disease Centre, Tan Tock Seng Hospital, Singapore; Nuffield Department of Medicine, University of Oxford, United Kingdom; and Yale-NUS College, National University of Singapore, Singapore
| | - Tiffany Bogich
- From the Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Standard Analytics, New York, New York; Rollins School of Public Health, Emory University, Atlanta, Georgia; Duke-NUS Graduate Medical School, Singapore; Communicable Disease Centre, Tan Tock Seng Hospital, Singapore; Nuffield Department of Medicine, University of Oxford, United Kingdom; and Yale-NUS College, National University of Singapore, Singapore
| | - Karen Siegel
- From the Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Standard Analytics, New York, New York; Rollins School of Public Health, Emory University, Atlanta, Georgia; Duke-NUS Graduate Medical School, Singapore; Communicable Disease Centre, Tan Tock Seng Hospital, Singapore; Nuffield Department of Medicine, University of Oxford, United Kingdom; and Yale-NUS College, National University of Singapore, Singapore
| | - Jing Jin
- From the Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Standard Analytics, New York, New York; Rollins School of Public Health, Emory University, Atlanta, Georgia; Duke-NUS Graduate Medical School, Singapore; Communicable Disease Centre, Tan Tock Seng Hospital, Singapore; Nuffield Department of Medicine, University of Oxford, United Kingdom; and Yale-NUS College, National University of Singapore, Singapore
| | - Elizabeth Y. Chong
- From the Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Standard Analytics, New York, New York; Rollins School of Public Health, Emory University, Atlanta, Georgia; Duke-NUS Graduate Medical School, Singapore; Communicable Disease Centre, Tan Tock Seng Hospital, Singapore; Nuffield Department of Medicine, University of Oxford, United Kingdom; and Yale-NUS College, National University of Singapore, Singapore
| | - Chong Yew Tan
- From the Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Standard Analytics, New York, New York; Rollins School of Public Health, Emory University, Atlanta, Georgia; Duke-NUS Graduate Medical School, Singapore; Communicable Disease Centre, Tan Tock Seng Hospital, Singapore; Nuffield Department of Medicine, University of Oxford, United Kingdom; and Yale-NUS College, National University of Singapore, Singapore
| | - Mark IC Chen
- From the Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Standard Analytics, New York, New York; Rollins School of Public Health, Emory University, Atlanta, Georgia; Duke-NUS Graduate Medical School, Singapore; Communicable Disease Centre, Tan Tock Seng Hospital, Singapore; Nuffield Department of Medicine, University of Oxford, United Kingdom; and Yale-NUS College, National University of Singapore, Singapore
| | - Peter Horby
- From the Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Standard Analytics, New York, New York; Rollins School of Public Health, Emory University, Atlanta, Georgia; Duke-NUS Graduate Medical School, Singapore; Communicable Disease Centre, Tan Tock Seng Hospital, Singapore; Nuffield Department of Medicine, University of Oxford, United Kingdom; and Yale-NUS College, National University of Singapore, Singapore
| | - Alex R. Cook
- From the Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Standard Analytics, New York, New York; Rollins School of Public Health, Emory University, Atlanta, Georgia; Duke-NUS Graduate Medical School, Singapore; Communicable Disease Centre, Tan Tock Seng Hospital, Singapore; Nuffield Department of Medicine, University of Oxford, United Kingdom; and Yale-NUS College, National University of Singapore, Singapore
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16
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Ma Z, Zha J, Yang J, Zhang X, Zhang X, Hu J, Yang H, Dong H, Ding W, Yang M. Epidemiological and genetic analysis of hand-foot-mouth disease by enterovirus A71 in Taizhou, P. R. China, between 2010 and 2013. J Med Virol 2016; 89:782-790. [PMID: 27671219 DOI: 10.1002/jmv.24697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2016] [Indexed: 11/06/2022]
Abstract
Out of a population of 1,098 enteroviruses (EVs)-positive hand, foot, and mouth disease (HFMD) specimens, 352 were screened positive for EV-A71-accounting for 32.1% of all EV-positive specimens. This percentage denotes EV-A71 as the second major serotype of enteroviruse among HFMD suffers in Taizhou. An epidemic outbreak of EV-A71 among HFMD children was found in Taizhou in the second quarter of 2012. Phylogeny analysis based on the VP1 complete sequences leads us to find a sub-clade (designated TZ1-1) of EV-A71 circulating in Taizhou, whose emergence might be correlated with the epidemic outbreak. This correlation was further supported by the followed two analyses (namely skyline plot of population history and birth-death SIR simulation of epidemic history). And more importantly, at a positively selected site of VP1 caspid, a mutation of N31D was found to be a synapomorphy of TZ1-1 and its occurrence might be correlated with the epidemic outbreak. J. Med. Virol. 89:782-790, 2017. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Zhilong Ma
- Taizhou Center for Disease Control and Prevention, Taizhou, Jiangsu Province, P. R. China
| | - Jie Zha
- Taizhou Center for Disease Control and Prevention, Taizhou, Jiangsu Province, P. R. China
| | - Jianguo Yang
- Taizhou Center for Disease Control and Prevention, Taizhou, Jiangsu Province, P. R. China
| | - Xuemei Zhang
- Taizhou Center for Disease Control and Prevention, Taizhou, Jiangsu Province, P. R. China
| | - Xiang Zhang
- Taizhou Center for Disease Control and Prevention, Taizhou, Jiangsu Province, P. R. China
| | - Jinmei Hu
- Taizhou Center for Disease Control and Prevention, Taizhou, Jiangsu Province, P. R. China
| | - Haiyu Yang
- Taizhou Center for Disease Control and Prevention, Taizhou, Jiangsu Province, P. R. China
| | - Hongyan Dong
- Taizhou Center for Disease Control and Prevention, Taizhou, Jiangsu Province, P. R. China
| | - Wen Ding
- Taizhou Center for Disease Control and Prevention, Taizhou, Jiangsu Province, P. R. China
| | - Maodan Yang
- Taizhou Center for Disease Control and Prevention, Taizhou, Jiangsu Province, P. R. China
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17
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Coxsackievirus A16 induced neurological disorders in young gerbils which could serve as a new animal model for vaccine evaluation. Sci Rep 2016; 6:34299. [PMID: 27667023 PMCID: PMC5035925 DOI: 10.1038/srep34299] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 09/09/2016] [Indexed: 11/09/2022] Open
Abstract
Coxsackievirus A16 (CA16) is one of the major pathogens associated with human hand, foot, and mouth disease (HFMD) in the Asia-pacific region. Although CA16 infections are generally mild, severe neurological manifestations or even death has been reported. Studies on CA16 pathogenesis and vaccine development are severely hampered because the small animal models that are currently available show major limitations. In this study, gerbils (Meriones unguiculatus) were investigated for their suitability as an animal model to study CA16 pathogenesis and vaccine development. Our results showed that gerbils up to the age of 21 days were fully susceptible to CA16 and all died within five days post-infection. CA16 showed a tropism towards the skeletal muscle, spinal cord and brainstem of gerbils, and severe lesions, including necrosis, were observed. In addition, an inactivated CA16 whole-virus vaccine administrated to gerbils was able to provide full protection to the gerbils against lethal doses of CA16 strains. These results demonstrate that gerbils are a suitable animal model to study CA16 infection and vaccine development.
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18
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Zhou HT, Guo YH, Chen MJ, Pan YX, Xue L, Wang B, Tao SH, Yu N. Changes in enterovirus serotype constituent ratios altered the clinical features of infected children in Guangdong Province, China, from 2010 to 2013. BMC Infect Dis 2016; 16:399. [PMID: 27506778 PMCID: PMC4977723 DOI: 10.1186/s12879-016-1690-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Accepted: 06/21/2016] [Indexed: 11/17/2022] Open
Abstract
Background Enterovirus (EV)-related hand, foot, and mouth disease/herpangina (HFMD/HA) has been prevalent in Guangdong Province, China, since 2010. Methods Clinical data for EV-related HFMD/HA inpatients admitted to the Department of Paediatrics of Zhujiang Hospital from 2010 to 2013 were retrospectively reviewed. The corresponding EV serotypes were also determined by reverse transcription-polymerase chain reaction or BLAST analysis of the sequenced partial lengths of the viral protein1/5′-untranslated region. Results A total of 867 eligible inpatients admitted during 2010–2013 were included in the study. Of these, the serotype of the responsible EV was successfully identified in 824 cases. The incidence of enterovirus 71 (EV71) infection amongst pediatric HFMD/HA inpatients decreased dramatically from 55.5 % in 2010 to 8.1 % in 2013, with a similar decrease recorded for coxsackievirus A16 (CVA16). However, the incidence of non-EV71/CVA16 infection increased from 30.0 % in 2010 to 83.8 % in 2013. We noted that the types of infection caused by different EV serotypes varied: EV71 was responsible for 100 % of the paralysis cases (26/26), 84.6 % of the deaths (11/13), and 84.1 % of cases with severe central nervous system involvement (SCNSI) (74/88); echovirus contributed to 16.4 % of the deaths (2/13) and 4.4 % of the SCNSI cases; and coxsackievirus accounted for only 2.2 % of the SCNSI cases (2/90). The clinical features of HFMD/HA cases varied greatly during the time period examined, with drastic changes in the hospitalization rates (45.1, 63.7, 36.4, and 19.1 % for 2010, 2011, 2012, and 21013, respectively), mortality rates (2.3, 0.9, 2.5, and 0.0 %, respectively), paralysis (5.1, 1.2, 5.4, and 0.0 %, respectively), SCNSI (16.8, 7.1, 12.7, and 2.2 %, respectively), and acute respiratory infection (21.1, 22.0, 45.9, and 59.0 %, respectively). Conclusions The incidences of infection caused by different EV serotypes, along with the clinical features of HFMD/HA cases, changed drastically in Guangdong Province, China, from 2010 to 2013, with the biggest changes observed in 2013. The changed constituent ratios of the different EV serotypes might therefore be responsible for the differences in the observed clinical features of HFMD/HA during this period. Electronic supplementary material The online version of this article (doi:10.1186/s12879-016-1690-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hong-Tao Zhou
- Laboratory of Emerging Infectious Diseases and Division of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, No. 253 Gong ye da dao zhong, Guangzhou, 510282, People's Republic of China. .,Department of Clinical Laboratory, Hainan Provincial People's Hospital, No. 19 Xiuhua road, Haikou, 570311, People's Republic of China.
| | - Yong-Hui Guo
- Laboratory of Emerging Infectious Diseases and Division of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, No. 253 Gong ye da dao zhong, Guangzhou, 510282, People's Republic of China
| | - Man-Jun Chen
- Laboratory of Emerging Infectious Diseases and Division of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, No. 253 Gong ye da dao zhong, Guangzhou, 510282, People's Republic of China
| | - Yu-Xian Pan
- Laboratory of Emerging Infectious Diseases and Division of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, No. 253 Gong ye da dao zhong, Guangzhou, 510282, People's Republic of China
| | - Lin Xue
- Laboratory of Emerging Infectious Diseases and Division of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, No. 253 Gong ye da dao zhong, Guangzhou, 510282, People's Republic of China
| | - Bin Wang
- Department of Paediatrics, Zhujiang Hospital, Southern Medical University, Guangdong, 510282, People's Republic of China
| | - Shao-Hua Tao
- Department of Paediatrics, Zhujiang Hospital, Southern Medical University, Guangdong, 510282, People's Republic of China
| | - Nan Yu
- Laboratory of Emerging Infectious Diseases and Division of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, No. 253 Gong ye da dao zhong, Guangzhou, 510282, People's Republic of China.
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Omaña-Cepeda C, Martínez-Valverde A, del Mar Sabater-Recolons M, Jané-Salas E, Marí-Roig A, López-López J. A literature review and case report of hand, foot and mouth disease in an immunocompetent adult. BMC Res Notes 2016; 9:165. [PMID: 26975350 PMCID: PMC4791924 DOI: 10.1186/s13104-016-1973-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 03/03/2016] [Indexed: 01/27/2023] Open
Abstract
Background To report an uncommon case of hand, foot and mouth disease, (HFMD) in an immunocompetent adult; a highly infectious disease, characterized by the appearance of vesicles on the mouth, hands and feet, associated with coxsackieviruses and enteroviruses; including a literature review. Case report A 23 year Caucasian male with no medical or surgical history, no allergies, was not taking any medication and smoked ten cigarettes a day, suffering from discomfort in the oral cavity; itching, burning and pain when swallowing associated with small erythematous lesions located on the hard palate, and small ulcers in tonsillar pillars and right buccal mucosa. Mild fever of 37.8 °C and general malaise. The patient reported he had had contact with a child diagnosed with HFMD. From his background and symptoms, the patient was diagnosed with HFMD. Following symptomatic treatment, the symptoms remitted in 7 days. Methods A literature review in MEDLINE (PubMed). The inclusion criteria were for studies on humans over the last 5 years, using the keywords HFMD. Results We found 925 articles, which were subsequently reduced to 52 documents after applying the inclusion criteria. Maculopapular lesions were found on hands and feet. Conclusions Dentists may have a key role diagnosing the disease. A surveillance system to predict future outbreaks, encourage early diagnosis, put appropriate public health measures in place and research vaccine development is vitally important in order to control the disease.
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Affiliation(s)
- Carlos Omaña-Cepeda
- School of Dentistry, University of Los Andes, Mérida, Venezuela.,Department of Odontostomatology, School of Dentistry, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Andrea Martínez-Valverde
- Department of Odontostomatology, School of Dentistry, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
| | - María del Mar Sabater-Recolons
- Department of Odontostomatology, School of Dentistry, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.,Oral Health and Masticatory System Group (Bellvitge Biomedical Research Institute) IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Enric Jané-Salas
- Department of Odontostomatology, School of Dentistry, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.,Oral Health and Masticatory System Group (Bellvitge Biomedical Research Institute) IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - Antonio Marí-Roig
- Department of Odontostomatology, School of Dentistry, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain.,Department of Oral and Maxillofacial Surgery, University Hospital Bellvitge (HUB), c/Feixa Llarga, Hospitalet de Llobregat, 08907, Barcelona, Spain
| | - José López-López
- Department of Odontostomatology, School of Dentistry, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain. .,Oral Health and Masticatory System Group (Bellvitge Biomedical Research Institute) IDIBELL, University of Barcelona, L'Hospitalet de Llobregat, 08907, Barcelona, Spain. .,Dental Hospital Barcelona University, Universitary Campus of Bellvitge, C/Feixa LLarga S/N, L'Hospitalet de Llobregat, 08907, Barcelona, Spain.
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20
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Zhang A, Xiu B, Zhang H, Li N. Protein microarray-mediated detection of antienterovirus antibodies in serum. J Int Med Res 2016; 44:287-96. [PMID: 26831405 PMCID: PMC5580062 DOI: 10.1177/0300060515604981] [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: 05/04/2015] [Accepted: 08/14/2015] [Indexed: 11/16/2022] Open
Abstract
Objective To utilize prokaryotic gene expression and protein microarray to develop and evaluate a sensitive, accurate protein microarray assay for detecting antienterovirus antibodies in serum samples from patients with hand, foot and mouth disease (HFMD). Enterovirus 71 (EV71) and coxsackievirus A16 (CA16), two common causative agents for HFMD, were used for assay development. Methods Serum was collected from patients with HFMD and healthy controls. EV71 and CA16 VP1 and VP3 genes were expressed in transfected Escherichia coli; the resultant VP1 and 3 proteins were used in a microarray assay for human serum EV71 and CA16 immunoglobulin (Ig) M and IgG. To validate the microarray assay, serum samples were tested for EV71 IgM using enzyme-linked immunosorbent assay (ELISA). Results Out of 50 patients with HFMD, EV71 IgM and CA16 IgM was detected in 80% and 44% of serum samples, respectively, using protein microarray, and EV71 IgM was detected in 78% of samples using ELISA. Protein microarray and ELISA showed 100% specificity for EV71-IgM detection. Conclusion The protein microarray assay developed in the present study shows potential as a sensitive technique for detecting EV71 IgM in serum samples from patients with HFMD.
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Affiliation(s)
- Aiying Zhang
- Beijing Institute of Hepatology, Beijing YouAn Hospital, Capital Medical University, Beijing, China
| | - Bingshui Xiu
- Department of Vaccine Engineering, Institute of Basic Medical Sciences, Beijing, China
| | - Heqiu Zhang
- Department of Vaccine Engineering, Institute of Basic Medical Sciences, Beijing, China
| | - Ning Li
- Beijing Institute of Hepatology, Beijing YouAn Hospital, Capital Medical University, Beijing, China
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21
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Hand, Foot, and Mouth Disease in China: Modeling Epidemic Dynamics of Enterovirus Serotypes and Implications for Vaccination. PLoS Med 2016; 13:e1001958. [PMID: 26882540 PMCID: PMC4755668 DOI: 10.1371/journal.pmed.1001958] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 01/05/2016] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Hand, foot, and mouth disease (HFMD) is a common childhood illness caused by serotypes of the Enterovirus A species in the genus Enterovirus of the Picornaviridae family. The disease has had a substantial burden throughout East and Southeast Asia over the past 15 y. China reported 9 million cases of HFMD between 2008 and 2013, with the two serotypes Enterovirus A71 (EV-A71) and Coxsackievirus A16 (CV-A16) being responsible for the majority of these cases. Three recent phase 3 clinical trials showed that inactivated monovalent EV-A71 vaccines manufactured in China were highly efficacious against HFMD associated with EV-A71, but offered no protection against HFMD caused by CV-A16. To better inform vaccination policy, we used mathematical models to evaluate the effect of prospective vaccination against EV-A71-associated HFMD and the potential risk of serotype replacement by CV-A16. We also extended the model to address the co-circulation, and implications for vaccination, of additional non-EV-A71, non-CV-A16 serotypes of enterovirus. METHODS AND FINDINGS Weekly reports of HFMD incidence from 31 provinces in Mainland China from 1 January 2009 to 31 December 2013 were used to fit multi-serotype time series susceptible-infected-recovered (TSIR) epidemic models. We obtained good model fit for the two-serotype TSIR with cross-protection, capturing the seasonality and geographic heterogeneity of province-level transmission, with strong correlation between the observed and simulated epidemic series. The national estimate of the basic reproduction number, R0, weighted by provincial population size, was 26.63 for EV-A71 (interquartile range [IQR]: 23.14, 30.40) and 27.13 for CV-A16 (IQR: 23.15, 31.34), with considerable variation between provinces (however, predictions about the overall impact of vaccination were robust to this variation). EV-A71 incidence was projected to decrease monotonically with higher coverage rates of EV-A71 vaccination. Across provinces, CV-A16 incidence in the post-EV-A71-vaccination period remained either comparable to or only slightly increased from levels prior to vaccination. The duration and strength of cross-protection following infection with EV-A71 or CV-A16 was estimated to be 9.95 wk (95% confidence interval [CI]: 3.31, 23.40) in 68% of the population (95% CI: 37%, 96%). Our predictions are limited by the necessarily short and under-sampled time series and the possible circulation of unidentified serotypes, but, nonetheless, sensitivity analyses indicate that our results are robust in predicting that the vaccine should drastically reduce incidence of EV-A71 without a substantial competitive release of CV-A16. CONCLUSIONS The ability of our models to capture the observed epidemic cycles suggests that herd immunity is driving the epidemic dynamics caused by the multiple serotypes of enterovirus. Our results predict that the EV-A71 and CV-A16 serotypes provide a temporary immunizing effect against each other. Achieving high coverage rates of EV-A71 vaccination would be necessary to eliminate the ongoing transmission of EV-A71, but serotype replacement by CV-A16 following EV-A71 vaccination is likely to be transient and minor compared to the corresponding reduction in the burden of EV-A71-associated HFMD. Therefore, a mass EV-A71 vaccination program of infants and young children should provide significant benefits in terms of a reduction in overall HFMD burden.
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22
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Zhuang ZC, Kou ZQ, Bai YJ, Cong X, Wang LH, Li C, Zhao L, Yu XJ, Wang ZY, Wen HL. Epidemiological Research on Hand, Foot, and Mouth Disease in Mainland China. Viruses 2015; 7:6400-11. [PMID: 26690202 PMCID: PMC4690870 DOI: 10.3390/v7122947] [Citation(s) in RCA: 93] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 11/27/2015] [Accepted: 12/01/2015] [Indexed: 01/23/2023] Open
Abstract
Hand, foot, and mouth disease (HFMD), which has led to millions of attacks and several outbreaks across the world and become more predominant in Asia-Pacific Region, especially in Mainland China, is caused by several Human Enteroviruses including new enterovirus, coxsakievirus and echovirus. In recent years, much research has focused on the epidemiological characteristics of HFMD. In this article, multiple characteristics of HFMD such as basic epidemiology, etiology and molecular epidemiology; influencing factors; detection; and surveillance are reviewed, as these can be help protect high risks groups, prevalence prediction and policy making for disease prevention.
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Affiliation(s)
- Zhi-Chao Zhuang
- Department of Virology, School of Public Health, Shandong University, Jinan 250012, China.
| | - Zeng-Qiang Kou
- Shandong Center for Disease Control and Prevention, Jinan 250014, China.
| | - Yong-Juan Bai
- Department of Virology, School of Public Health, Shandong University, Jinan 250012, China.
| | - Xiang Cong
- Qilu Hospital of Shandong University, Jinan 250012, China.
| | - Li-Hong Wang
- Department of Virology, School of Public Health, Shandong University, Jinan 250012, China.
| | - Chun Li
- Department of Virology, School of Public Health, Shandong University, Jinan 250012, China.
| | - Li Zhao
- Department of Virology, School of Public Health, Shandong University, Jinan 250012, China.
| | - Xue-Jie Yu
- Department of Virology, School of Public Health, Shandong University, Jinan 250012, China.
- Center for Biodefense and Emerging Infectious Diseases, Departments of Pathology and Microbiology, Institute for Human Infections and Immunity, University of Texas Medical Branch, Galveston, TX 77555-0609, USA.
| | - Zhi-Yu Wang
- Department of Virology, School of Public Health, Shandong University, Jinan 250012, China.
| | - Hong-Ling Wen
- Department of Virology, School of Public Health, Shandong University, Jinan 250012, China.
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23
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Guan H, Wang J, Wang C, Yang M, Liu L, Yang G, Ma X. Etiology of Multiple Non-EV71 and Non-CVA16 Enteroviruses Associated with Hand, Foot and Mouth Disease in Jinan, China, 2009-June 2013. PLoS One 2015; 10:e0142733. [PMID: 26562154 PMCID: PMC4642993 DOI: 10.1371/journal.pone.0142733] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 10/26/2015] [Indexed: 11/18/2022] Open
Abstract
Hand, foot, and mouth disease (HFMD) is an infectious disease caused by human enterovirus 71 (EV71), coxsackievirus A16 (CVA16) and other enteroviruses. It is of interest that other enteroviruses associated with HFMD in Jinan have been rarely reported. The aim of the present study is to detect and characterize the circulating serotypes of non-EV71 and non-CVA16 enteroviruses associated with HFMD in Jinan city, Shandong province, China. A total of 400 specimens were collected from clinically diagnosed HFMD cases in Jinan from January 2009 to June 2013. All specimens were infected with non-EV71 and non-CVA16 enteroviruses previously confirmed by RT-PCR or real-time PCR according to the protocols at that time. The GeXP-based multiplex RT-PCR assay (GeXP assay) was performed to investigate the pathogen spectrum of 15 enteroviruses (coxsackieviruses A4, A5, A6, A9, A10, A16; coxsackieviruses B1, B3, B5; Echoviruses 6, 7, 11, 13, 19 and EV71) infections associated with HMFD. For GeXP assay negative samples, reverse transcription nested PCR (nested RT-PCR) based on the 5’ -untranslated region (5’- UTR) sequence and phylogenetic analysis were conducted to further explore the etiology of multiple enteroviruses. The results showed that a total of twenty serotypes of enteroviruses (including EV71 and CVA16) were identified by GeXP assay and nested RT-PCR. The most circulating twelve serotypes of enteroviruses with HFMD in Jinan from 2009 to June 2013 were EV71, CVA16, CVA10, CVA6, CVA12, CVA2, Echo3, CVA4, CVA9, CVB1, CVB3 and Echo6. CVA10 and CVA6 were the most prevalent pathogens other than EV71 and CVA16 in Jinan and their most prevalent seasons were spring and summer, and a slight increase was observed in autumn and early winter. It should be noted that mixed-infections were identified by GeXP assay and the phylogenetic tree clearly discriminated the multiple pathogens associated with HFMD. Our results thus demonstrate that there was a clear lack of a reliable testing method for EV71 and CVA16 and multiple non-EV71 and non-CVA16 enteroviruses associated with HFMD were present in Jinan. The GeXP assay combined with nested RT-PCR based on 5’-UTR region could meet the need for the national surveillance of multiple enteroviruses or the investigation of epidemic outbreaks triggered by enteroviruses in the future.
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Affiliation(s)
- Hengyun Guan
- Viral Disease Inspection Laboratory, Jinan Municipal Center for Disease Control and Prevention, Jinan, China
| | - Ji Wang
- Key Laboratory of Medical Virology, Ministry of Health, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Chunrong Wang
- Viral Disease Inspection Laboratory, Jinan Municipal Center for Disease Control and Prevention, Jinan, China
| | - Mengjie Yang
- Key Laboratory of Medical Virology, Ministry of Health, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lanzheng Liu
- Viral Disease Inspection Laboratory, Jinan Municipal Center for Disease Control and Prevention, Jinan, China
- * E-mail: (LZL); (XJM)
| | - Guoliang Yang
- Viral Disease Inspection Laboratory, Jinan Municipal Center for Disease Control and Prevention, Jinan, China
| | - Xuejun Ma
- Key Laboratory of Medical Virology, Ministry of Health, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
- * E-mail: (LZL); (XJM)
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Zhongping X, Hua L, Ting Y, Zhengling L, Min F, Tianhong X, Runxiang L, Dong S, Guangju J, Lei Y, Rong Y, Fangyu L, Qihan L. Biological characteristics of different epidemic enterovirus 71 strains and their pathogeneses in neonatal mice and rhesus monkeys. Virus Res 2015; 213:82-89. [PMID: 26555165 DOI: 10.1016/j.virusres.2015.11.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Revised: 11/01/2015] [Accepted: 11/04/2015] [Indexed: 11/19/2022]
Abstract
Hand, foot and mouth disease (HFMD) has been prevalent in China since 2008. Enterovirus 71 (EV71) is a common causative agent of HFMD, and various strains of EV71 are prevalent worldwide. The EV71C4 subgenotype is the most endemic strain in China. However, few studies investigating the biological characteristics and pathogeneses of different C4 strains have been reported. Therefore, the current study investigated 19 clinical EV71 strains in neonatal ICR mice and neonatal rhesus monkeys by comparing pathogenicity; the virulence of different viral passages, dosages, and routes of infection; and the effects produced by subject animal age. These 19 clinical EV71 strains, which were of the same subtype, displayed varying pathogenic effects. Three strains (HE31, 231 and 262) induced limb paralysis in neonatal ICR mice. In addition, the degree of virulence was largely dependent upon the dose, route of infection, and number of passages of the challenge virus, as well as the ages of the infected animals. The present study provides valuable basic data to enable further research into EV71 pathogenesis and to facilitate the development of new drugs and vaccines.
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Affiliation(s)
- Xie Zhongping
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, 650118, China
| | - Li Hua
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, 650118, China
| | - Yang Ting
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, 650118, China
| | - Liu Zhengling
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, 650118, China
| | - Feng Min
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, 650118, China
| | - Xie Tianhong
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, 650118, China
| | - Long Runxiang
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, 650118, China
| | - Shen Dong
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, 650118, China
| | - Jiang Guangju
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, 650118, China
| | - Yue Lei
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, 650118, China
| | - Yang Rong
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, 650118, China
| | - Luo Fangyu
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, 650118, China
| | - Li Qihan
- Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, 650118, China.
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Wu CY, Lin YW, Kuo CH, Liu WH, Tai HF, Pan CH, Chen YT, Hsiao PW, Chan CH, Chang CC, Liu CC, Chow YH, Chen JR. Inactivated Enterovirus 71 Vaccine Produced by 200-L Scale Serum-Free Microcarrier Bioreactor System Provides Cross-Protective Efficacy in Human SCARB2 Transgenic Mouse. PLoS One 2015; 10:e0136420. [PMID: 26287531 PMCID: PMC4543551 DOI: 10.1371/journal.pone.0136420] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 08/03/2015] [Indexed: 11/23/2022] Open
Abstract
Epidemics and outbreaks caused by infections of several subgenotypes of EV71 and other serotypes of coxsackie A viruses have raised serious public health concerns in the Asia-Pacific region. These concerns highlight the urgent need to develop a scalable manufacturing platform for producing an effective and sufficient quantity of vaccines against deadly enteroviruses. In this report, we present a platform for the large-scale production of a vaccine based on the inactivated EV71(E59-B4) virus. The viruses were produced in Vero cells in a 200 L bioreactor with serum-free medium, and the viral titer reached 10(7) TCID50/mL 10 days after infection when using an MOI of 10(-4). The EV71 virus particles were harvested and purified by sucrose density gradient centrifugation. Fractions containing viral particles were pooled based on ELISA and SDS-PAGE. TEM was used to characterize the morphologies of the viral particles. To evaluate the cross-protective efficacy of the EV71 vaccine, the pooled antigens were combined with squalene-based adjuvant (AddaVAX) or aluminum phosphate (AlPO4) and tested in human SCARB2 transgenic (Tg) mice. The Tg mice immunized with either the AddaVAX- or AlPO4-adjuvanted EV71 vaccine were fully protected from challenges by the subgenotype C2 and C4 viruses, and surviving animals did not show any degree of neurological paralysis symptoms or muscle damage. Vaccine treatments significantly reduced virus antigen presented in the central nervous system of Tg mice and alleviated the virus-associated inflammatory response. These results strongly suggest that this preparation results in an efficacious vaccine and that the microcarrier/bioreactor platform offers a superior alternative to the previously described roller-bottle system.
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Affiliation(s)
| | - Yi-Wen Lin
- Institute of Infectious Disease and Vaccinology, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
| | | | | | | | | | | | - Pei-Wen Hsiao
- Agricultural Biotechnology Research Center, Academia Sinica, Taipei, Taiwan
| | | | | | - Chung-Cheng Liu
- Adimmune Corporation, Taichung, Taiwan
- Enimmune Corporation, Taichung, Taiwan
| | - Yen-Hung Chow
- Institute of Infectious Disease and Vaccinology, National Health Research Institutes, Zhunan, Miaoli County, Taiwan
- Graduate Institute of Immunology, China Medical University, Taichung, Taiwan
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Ma Z, Zha J. Characterization of VP1 gene of coxsackievirus A16 prevalent among hand foot mouth disease suffered children in Taizhou, P. R. China, between 2010 and 2013. J Med Virol 2015; 88:202-10. [PMID: 26174468 DOI: 10.1002/jmv.24324] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2015] [Indexed: 12/11/2022]
Abstract
A total of 453 strains of Coxsackievirus A16 (CV-A16) were screened out of 1,509 hand-foot-mouth disease (HFMD) samples collected in Taizhou during the period from 2010 to 2013. And between first quarter of 2011 and first quarter of 2013, an outbreak of CV-A16 was found among the HFMD sufferers in Taizhou. Phylogenic analysis of VP1 sequences indicated a major CV-A16 sub-group in Taizhou, whose change pattern of effective population sizes was found to be similar to the pattern of the actual percentage changes of CV-A16 during the outbreak over the same period. More importantly, the sub-group all displayed a Leu (L) to Met (M) mutation at site-23 of capsid VP1 which might be correlated with the outbreak of CV-A16 in Taizhou.
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Affiliation(s)
- Zhilong Ma
- Taizhou Center for Disease Control and Prevention, Taizhou, China
| | - Jie Zha
- Taizhou Center for Disease Control and Prevention, Taizhou, China
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27
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Zhang X, Sun C, Xiao X, Pang L, Shen S, Zhang J, Cen S, Yang BB, Huang Y, Sheng W, Zeng Y. Phage Display-Derived Cross-Reactive Neutralizing Antibody against Enterovirus 71 and Coxsackievirus A16. Jpn J Infect Dis 2015; 69:66-74. [PMID: 26073737 DOI: 10.7883/yoken.jjid.2015.060] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Enterovirus 71 (EV71) and coxsackievirus A16 (CVA16) are members of the Picornaviridae family and are considered the main causative agents of hand, foot and mouth disease (HFMD). In recent decades large HFMD outbreaks caused by EV71 and CVA16 have become significant public health concerns in the Asia-Pacific region. Vaccines and antiviral drugs are unavailable to prevent EV71 and CVA16 infection. In the current study, a chimeric antibody targeting a highly conserved peptide in the EV71 VP4 protein was isolated by using a phage display technique. The antibody showed cross-neutralizing capability against EV71 and CVA16 in vitro. The results suggest that this phage display-derived antibody will have great potential as a broad neutralizing antibody against EV71 and CVA16 after affinity maturation and humanization.
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Affiliation(s)
- Xiao Zhang
- College of Life Science and Bioengineering, Beijing University of Technology
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Zha J, Ma Z. Epidemiological and genetic analysis concerning the coxsackievirus A6 related endemic outbreak of hand-foot-mouth disease in Taizhou, China, during 2013. J Med Virol 2015; 87:2000-8. [DOI: 10.1002/jmv.24272] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/07/2015] [Indexed: 12/22/2022]
Affiliation(s)
- Jie Zha
- Taizhou Center for Disease Control and Prevention; Taizhou; Jiangsu Province P.R. China
| | - Zhilong Ma
- Taizhou Center for Disease Control and Prevention; Taizhou; Jiangsu Province P.R. China
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Klein M, Chong P. Is a multivalent hand, foot, and mouth disease vaccine feasible? Hum Vaccin Immunother 2015; 11:2688-704. [PMID: 26009802 DOI: 10.1080/21645515.2015.1049780] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Enterovirus A infections are the primary cause of hand, foot and mouth disease (HFMD) in infants and young children. Although enterovirus 71 (EV-A71) and coxsackievirus A16 (CV-A16) are the predominant causes of HFMD epidemics worldwide, EV-A71 has emerged as a major neurovirulent virus responsible for severe neurological complications and fatal outcomes. HFMD is a serious health threat and economic burden across the Asia-Pacific region. Inactivated EV-A71 vaccines have elicited protection against EV-A71 but not against CV-A16 infections in large efficacy trials. The current development of a bivalent inactivated EV-A71/CV-A16 vaccine is the next step toward that of multivalent HFMD vaccines. These vaccines should ultimately include other prevalent pathogenic coxsackieviruses A (CV-A6 and CV-A10), coxsackieviruses B (B3 and B5) and echovirus 30 that often co-circulate during HFMD epidemics and can cause severe HFMD, aseptic meningitis and acute viral myocarditis. The prospect and challenges for the development of such multivalent vaccines are discussed.
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Affiliation(s)
| | - Pele Chong
- b Vaccine R&D Center; National Health Research Institutes ; Zhunan Town, Miaoli County , Taiwan.,c Graduate Institute of Immunology; China Medical University ; Taichung , Taiwan
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Liu Y, Wang X, Pang C, Yuan Z, Li H, Xue F. Spatio-temporal analysis of the relationship between climate and hand, foot, and mouth disease in Shandong province, China, 2008-2012. BMC Infect Dis 2015; 15:146. [PMID: 25887074 PMCID: PMC4374415 DOI: 10.1186/s12879-015-0901-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 03/13/2015] [Indexed: 12/03/2022] Open
Abstract
Background Hand, foot, and mouth disease (HFMD) is the most common communicable disease in China. Shandong Province is one of the most seriously affected areas. The distribution of HFMD had spatial heterogeneity and seasonal characteristic in this setting. The aim of this study was to explore the associations between climate and HFMD by a Bayesian approach from spatio-temporal interactions perspective. Methods The HFMD data of Shandong Province during 2008–2012 were derived from the China National Disease Surveillance Reporting and Management System. And six climatic indicators were obtained from the Meteorological Bureau of Shandong Province. The global spatial autocorrelation statistic (Moran’s I) was used to detect the spatial autocorrelation of HFMD cases in each year. The optimal one among four Bayesian models was further adopted to estimate the relative risk of the occurrence of HFMD via Markov chain Monte Carlo. Results The annual average incidence rate of HFMD was 104.40 per 100,000 in Shandong Province. Positive spatial autocorrelation appeared at county level (Moran’s I ≥0.30, P < 0.001). The best fitting Spatio-temporal interactive model showed that annual average temperature, annual average pressure, annual average relative humidity, annual average wind speed and annual sunshine hours were significantly positive related to the occurrence of HFMD. The estimated relative risk of 36, 87, 91, 79, 65 out of 140 counties for 2008–2012 respectively were significantly more than 1. Conclusions There were obvious spatio-temporal heterogeneity of HFMD in Shandong Province, and the climatic indicators were associated with the epidemic of HFMD. Bayesian approach should be recommended to capture the spatial-temporal pattern of HFMD.
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Affiliation(s)
- Yunxia Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, Shandong, China.
| | - Xianjun Wang
- Shandong Center for Disease Control and Prevention, Jinan, Shandong, China.
| | - Chunkun Pang
- Institute office, Shandong Academy of Medical Science, Jinan, Shandong, China.
| | - Zhongshang Yuan
- Department of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, Shandong, China.
| | - Hongkai Li
- Department of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, Shandong, China.
| | - Fuzhong Xue
- Department of Epidemiology and Biostatistics, School of Public Health, Shandong University, Jinan, Shandong, China.
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Yang Q, Ding J, Cao J, Huang Q, Hong C, Yang B. Epidemiological and etiological characteristics of hand, foot, and mouth disease in Wuhan, China from 2012 to 2013: outbreaks of coxsackieviruses A10. J Med Virol 2015; 87:954-60. [PMID: 25754274 DOI: 10.1002/jmv.24151] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2015] [Indexed: 11/06/2022]
Abstract
Hand-foot-mouth disease (HFMD) is a common infectious disease which often occurs in young children. It is caused by enteroviruses, most commonly enterovirus71 (EV71) and Coxsackievirus A16 (CVA16). The present study focuses on the molecular epidemiology of the pathogen of HFMD in the Wuhan region of China during the period 2012 to 2013. A total of 463 viruses were isolated from throat swab of 3,208 HFMD patients and analyzed by quantitative RT-PCR with all sets of specific primers for EV71, CVA16, and pan-enterovirus. Of the 463 viruses, 111 (21.2%) were EV71, 52 (9.6%) were CVA16, and 300 (69.2%) were pan-enterovirus. In pan-enterovirus isolations 190 (52.8%) were CVA10, 50 (13.9%) were CVA4, 30 were CB2, 17 were CB3, 13 were CB5 identified by VP4 gene sequencing. Eleven EV71 isolates were complete genome sequenced and phylogenetic analysis revealed that the EV71 strains that circulated in Wuhan belonged to the C4 subgenotype. Among the 190 CVA10 isolations, 187 CVA10 strains have the same nucleotide sequence, the other three CVA10 strains belongs to another type of nucleotide sequence. Phylogenetic analysis based on 19 CVA10 isolations suggested that they belonged to the clade of Chinese strains, but form different clusters isolated from Japan, Europe. This study showed that EVA71 and CVA16 were detected as the predominant viruses (>60%) in 2012 and the total reported HFMD cases attained a peak in June and July. In contrast, CVA10 was also detected during April 2012 and replaced EVA71 and CVA16 as the major HFMD-associated pathogen from May 2013.
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Affiliation(s)
- Qin Yang
- Department of Medical Laboratory, Wuhan General Hospital of Guangzhou Command, Wuhan, China
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Phylogenetic analysis of the major causative agents of hand, foot and mouth disease in Suzhou City, Jiangsu province, China, in 2012-2013. Emerg Microbes Infect 2015; 4:e12. [PMID: 26038764 PMCID: PMC4345287 DOI: 10.1038/emi.2015.12] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 12/11/2014] [Accepted: 01/15/2015] [Indexed: 11/29/2022]
Abstract
Hand, foot and mouth disease (HFMD) is a serious public health problem that has emerged over the past several decades. Pathogen detection by the Chinese national HFMD surveillance system has focused mainly on enterovirus 71 (EV71) and coxsackievirus A16 (CA16). Therefore, epidemiological information regarding the other causative enteroviruses is limited. To identify the pandemic enterovirus in Suzhou, Jiangsu province, China, clinical samples from patients with HFMD were collected from 2012 to 2013 and analyzed. The results revealed that CA16 was the most dominant HFMD pathogen in 2012, whereas CA6 and CA10 were the dominant pathogens in 2013. Phylogenetic analysis revealed that the C4a sub-genogroup of EV71 and the B1a and B1b sub-genogroups of CA16 continued to evolve and circulate in Suzhou. The CA6 strains were assigned to six genotypes (A–F) and the CA10 strains were assigned to seven genotypes (A–G), with clear geographical and temporal distributions. All of the CA6 strains in Suzhou belonged to genogroup F, and there were several lineages circulating in Suzhou. All of the CA10 strains in Suzhou belonged to genogroup G, and they had the same genetic origin. Co-infections of EV71/CA16 and CA6/CA10 were found in the samples, and bootscan analysis of 5′-untranslated regions (UTRs) revealed that some CA16 strains in Suzhou had genetic recombination with EV71. This property might allow CA16 to alter its evolvability and circulating ability. This study underscores the need for surveillance of CA6 and CA10 in the Yangtze River Delta and East China.
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Saeed MI, Omar AR, Hussein MZ, Elkhidir IM, Sekawi Z. Systemic antibody response to nano-size calcium phospate biocompatible adjuvant adsorbed HEV-71 killed vaccine. Clin Exp Vaccine Res 2015; 4:88-98. [PMID: 25649429 PMCID: PMC4313114 DOI: 10.7774/cevr.2015.4.1.88] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Revised: 12/28/2014] [Accepted: 12/31/2014] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Since 1980s, human enterovirus-71 virus (HEV-71) is one of the common infectious disease in Asian Pacific region since late 1970s without effective commercial antiviral or protective vaccine is unavailable yet. The work examines the role of vaccine adjuvant particle size and the route of administration on postvaccination antibody response towards HEV-71 vaccine adsorbed to calcium phosphate (CaP) adjuvant. MATERIALS AND METHODS First, CaP nano-particles were compared to a commercial micro-size and vaccine alone. Secondly, intradermal reduced dosage was compared to the conventional intramuscular immunization. Killed HEV-71 vaccines adsorbed to CaP nano-size (73 nm) and commercial one of micro-size (1.7 µm) were administered through intradermal, intramuscular, rabbits received vaccine alone and unvaccinated animals. RESULTS CaP nano-particles adsorbed HEV-71 vaccine displayed higher antibody than the micro-size or unadsorbed vaccine alone, through both parenteral immunization routes. Moreover, the intradermal route (0.5 µg/mL) of 0.1-mL volume per vaccine dose induced equal IgG antibody level to 1.0-mL intramuscular route (0.5 µg/mL). CONCLUSION The intradermal vaccine adsorbed CaP nano-adjuvant showed safer and significant antibody response after one-tenth reduced dose quantity (0.5 µg/mL) of only 0.1-mL volume as the most suitable protective, cost effective and affordable formulation not only for HEV-71; but also for developing further effective vaccines toward other human pathogens.
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Affiliation(s)
- Mohamed Ibrahim Saeed
- Department of Microbiology and Parasitology, University of Putra Malaysia, Medical Faculty, Serdang, Malaysia
| | - Abd Rahaman Omar
- University of Putra Malaysia, Institute of Biosciences, Serdang, Malaysia
| | - Mohd Zobir Hussein
- University of Putra Malaysia, Institute of Advanced Technology, Serdang, Malaysia
| | - Isam Mohamed Elkhidir
- Department of Microbiology and Parasitology, University of Khartoum, Faculty of Medicine, Sudan, Malaysia
| | - Zamberi Sekawi
- Department of Microbiology and Parasitology, University of Putra Malaysia, Medical Faculty, Serdang, Malaysia
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Ma S, Zhang Y, Du C, Yang T, Liu Q, Pan Y, Chen J, Shi H, Sun Q, Liu L, Li Q. Dynamic Constitution of the Pathogens Inducing Encephalitis in Hand, Foot and Mouth Disease in Kunming, 2009–2011. Jpn J Infect Dis 2015; 68:504-10. [DOI: 10.7883/yoken.jjid.2014.428] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Shaohui Ma
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Disease, Institute of Medical Biology, Chinese Academy of Medicine Sciences and Peking Union Medical College
| | - Ying Zhang
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Disease, Institute of Medical Biology, Chinese Academy of Medicine Sciences and Peking Union Medical College
| | - Cengqing Du
- Department of Infectious Diseases of Kunming Children's Hospital
| | - Ting Yang
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Disease, Institute of Medical Biology, Chinese Academy of Medicine Sciences and Peking Union Medical College
| | - Qiong Liu
- Department of Infectious Diseases of Kunming Children's Hospital
| | - Yue Pan
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Disease, Institute of Medical Biology, Chinese Academy of Medicine Sciences and Peking Union Medical College
| | - Junying Chen
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Disease, Institute of Medical Biology, Chinese Academy of Medicine Sciences and Peking Union Medical College
| | - Haijing Shi
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Disease, Institute of Medical Biology, Chinese Academy of Medicine Sciences and Peking Union Medical College
| | - Qiangming Sun
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Disease, Institute of Medical Biology, Chinese Academy of Medicine Sciences and Peking Union Medical College
| | - Longding Liu
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Disease, Institute of Medical Biology, Chinese Academy of Medicine Sciences and Peking Union Medical College
| | - Qihan Li
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Disease, Institute of Medical Biology, Chinese Academy of Medicine Sciences and Peking Union Medical College
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Prediction of signaling pathways involved in enterovirus 71 infection by algorithm analysis based on miRNA profiles and their target genes. Arch Virol 2014; 160:173-82. [PMID: 25287131 DOI: 10.1007/s00705-014-2249-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2014] [Accepted: 09/29/2014] [Indexed: 12/12/2022]
Abstract
Enterovirus 71 (EV71) causes major outbreaks of hand, foot, and mouth disease. Host factors and signaling pathways exhibit important functions in the EV71 life cycle. We conducted algorithm analysis based on miRNA profiles and their target genes to identify the miRNAs and downstream signaling pathways involved in EV71 infection. The miRNA profiles of human rhabdomyosarcoma cells treated with interferon (IFN-)-α or IFN-γ were compared with those of cells infected with EV71. Genes targeted by differentially expressed miRNAs were identified and assigned to different signaling pathways according to public databases. The results showed that host miRNAs specifically responded to the viral infection and IFN treatment. Some miRNAs, including miR-124 and miR-491-3p, were regulated in opposite manners by the IFNs and EV71. Some signaling pathways regulated by both EV71 infection and IFN treatment were also predicted. These pathways included axon guidance, Wingless/Int1 (Wnt) signaling cascade, platelet-derived growth factor receptor (PDGFR)/PDGF, phosphatidylinositol 3-kinase (PI3K), Jun N-terminal kinase (JNK)/mitogen-activated protein kinase (MAPK), transforming growth factor-beta receptor (TGF-βR)/TGF-β, SMAD2/3, insulin/insulin-like growth factor (IGF), bone morphogenetic protein (BMP), CDC42, ERB1, hepatocyte growth factor receptor (c-Met), eukaryotic translation initiation factor 4E (eIF4E), protein kinase A (PKA), and IFN-γ pathways. The identified miRNA and downstream signaling pathways would help to elucidate the interaction between the virus and the host. The genomics method using algorithm analysis also provided a new way to investigate the host factors and signaling pathways critical for viral replication.
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A neonatal gnotobiotic pig model of human enterovirus 71 infection and associated immune responses. Emerg Microbes Infect 2014; 3:e35. [PMID: 26038741 PMCID: PMC4051366 DOI: 10.1038/emi.2014.35] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 02/10/2014] [Accepted: 03/25/2014] [Indexed: 12/13/2022]
Abstract
Vaccine development and pathogenesis studies for human enterovirus 71 are limited by a
lack of suitable animal models. Here, we report the development of a novel neonatal
gnotobiotic pig model using the non-pig-adapted neurovirulent human enterovirus 71 strain
BJ110, which has a C4 genotype. Porcine small intestinal epithelial cells, peripheral
blood mononuclear cells and neural cells were infected in vitro. Oral and
combined oral–nasal infection of 5-day-old neonatal gnotobiotic pigs with
5×108 fluorescence forming units (FFU) resulted in shedding up to 18
days post-infection, with viral titers in rectal swab samples peaking at
2.22×108 viral RNA copies/mL. Viral capsid proteins were detected in
enterocytes within the small intestines on post-infection days (PIDs) 7 and 14.
Additionally, viral RNA was detected in intestinal and extra-intestinal tissues, including
the central nervous system, the lung and cardiac muscle. The infected neonatal gnotobiotic
pigs developed fever, forelimb weakness, rapid breathing and some hand, foot and mouth
disease symptoms. Flow cytometry analysis revealed increased frequencies of both
CD4+ and CD8+ IFN-γ-producing T cells in the brain
and the blood on PID 14, but reduced frequencies were observed in the lung. Furthermore,
high titers of serum virus-neutralizing antibodies were generated in both orally and
combined oral–nasally infected pigs on PIDs 7, 14, 21 and 28. Together, these
results demonstrate that neonatal gnotobiotic pigs represent a novel animal model for
evaluating vaccines for human enterovirus 71 and for understanding the pathogenesis of
this virus and the associated immune responses.
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Zhang Q, MacDonald NE, Smith JC, Cai K, Yu H, Li H, Lei C. Severe enterovirus type 71 nervous system infections in children in the Shanghai region of China: clinical manifestations and implications for prevention and care. Pediatr Infect Dis J 2014; 33:482-7. [PMID: 24732390 DOI: 10.1097/inf.0000000000000194] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Severe outbreaks of enterovirus 71 (EV71) have been on the rise in the Western Pacific region, including in China since 2007. We describe features of pediatric patients admitted with severe disease EV71 to a tertiary care hospital during the 2010 ongoing outbreak in the Shanghai region. METHODS The Shanghai EV71 outbreak was studied prospectively from January 2010 to December 2012. To be eligible, children had to be 1 month to <14 years of age, admitted with confirmed EV71 infection to Xinhua Hospital and have severe illness needing Pediatric Infectious Diseases Service care with symptoms/signs of high prolonged fever and/or very unwell general appearance and/or neurological findings but no underlying medical condition. Clinical, laboratory, treatment discharge and follow-up data were recorded and analyzed. RESULTS Of 26, 829 children presenting with possible EV71 disease, 2.9% (767) were admitted, more from less developed areas than from Shanghai proper. Of these, 29.2% (224) had severe enough EV71 for study enrolment, 4 excluded for underlying disease. Of 220 enrolled, 40.5% (89) had neurological involvement, 10.5% (23) needed pediatric intensive care unit care and 3% (7) died. Factors associated with severe disease were young age, male gender, high white count, prolonged high fever, high glucose, high C-reactive protein and neurological findings. The majority with neurological involvement and all who died were from the countryside. Early intravenous gamma globulin intervention had better survival. No survivor had persistent sequelae 2 months after discharge. CONCLUSIONS This study confirms the morbidity for EV71 disease in China, especially for patients from the countryside versus Shanghai proper. The potential impact of public education, an EV71 vaccine, and the potential benefits versus harms of IVIG treatment are discussed.
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Affiliation(s)
- Qingli Zhang
- From the *Department of Pediatrics, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, P.R. China; and †Department of Paediatrics, Dalhousie University, IWK Health Centre, Halifax, Nova Scotia, Canada
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Liu W, Wu S, Xiong Y, Li T, Wen Z, Yan M, Qin K, Liu Y, Wu J. Co-circulation and genomic recombination of coxsackievirus A16 and enterovirus 71 during a large outbreak of hand, foot, and mouth disease in Central China. PLoS One 2014; 9:e96051. [PMID: 24776922 PMCID: PMC4002479 DOI: 10.1371/journal.pone.0096051] [Citation(s) in RCA: 101] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2013] [Accepted: 04/03/2014] [Indexed: 11/18/2022] Open
Abstract
A total of 1844 patients with hand, foot, and mouth disease (HFMD), most of them were children of age 1–3-year-old, in Central China were hospitalized from 2011 to 2012. Among them, 422 were infected with coxsackievirus A16 (CVA16), 334 were infected with enterovirus 71 (EV71), 38 were co-infected with EV71 and CVA16, and 35 were infected with other enteroviruses. Molecular epidemiology analysis revealed that EV71 and CVA16 were detected year-round, but EV71 circulated mainly in July and CVA16 circulated predominantly in November, and incidence of HFMD was reduced in January and February and increased in March. Clinical data showed that hyperglycemia and neurologic complications were significantly higher in EV71-infected patients, while upper respiratory tract infection and C-reactive protein were significantly higher in CVA16-associated patients. 124 EV71 and 80 CVA16 strains were isolated, among them 56 and 68 EV71 strains were C4a and C4b, while 25 and 55 CVA16 strains were B1a and B1b, respectively. Similarity plots and bootscan analyses based on entire genomic sequences revealed that the three C4a sub-genotype EV71 strains were recombinant with C4b sub-genotype EV71 in 2B–2C region, and the three CVA16 strains were recombinant with EV71 in 2A–2B region. Thus, CVA16 and EV71 were the major causative agents in a large HFMD outbreak in Central China. HFMD incidence was high for children among household contact and was detected year-round, but outbreak was seasonal dependent. CVA16 B1b and EV71 C4b reemerged and caused a large epidemic in China after a quiet period of many years. Moreover, EV71 and CVA16 were co-circulated during the outbreak, which may have contributed to the genomic recombination between the pathogens. It should gain more attention as there may be an upward trend in co-circulation of the two pathogens globally and the new role recombination plays in the emergence of new enterovirus variants.
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Affiliation(s)
- Weiyong Liu
- State Key Laboratory of Virology and College of Life Sciences, Wuhan University, Wuhan, People's Republic of China
| | - Shimin Wu
- Department of Clinical Laboratory, Wuhan Medical Treatment Center, Wuhan, People's Republic of China
| | - Ying Xiong
- State Key Laboratory of Virology and College of Life Sciences, Wuhan University, Wuhan, People's Republic of China
| | - Tongya Li
- State Key Laboratory of Virology and College of Life Sciences, Wuhan University, Wuhan, People's Republic of China
| | - Zhou Wen
- State Key Laboratory of Virology and College of Life Sciences, Wuhan University, Wuhan, People's Republic of China
| | - Mingzhe Yan
- State Key Laboratory of Virology and College of Life Sciences, Wuhan University, Wuhan, People's Republic of China
| | - Kai Qin
- State Key Laboratory of Virology and College of Life Sciences, Wuhan University, Wuhan, People's Republic of China
| | - Yingle Liu
- State Key Laboratory of Virology and College of Life Sciences, Wuhan University, Wuhan, People's Republic of China
- * E-mail: (JW); (YL)
| | - Jianguo Wu
- State Key Laboratory of Virology and College of Life Sciences, Wuhan University, Wuhan, People's Republic of China
- * E-mail: (JW); (YL)
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Aetiologies of central nervous system infections in adults in Kathmandu, Nepal: a prospective hospital-based study. Sci Rep 2014; 3:2382. [PMID: 23924886 PMCID: PMC3737500 DOI: 10.1038/srep02382] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 07/15/2013] [Indexed: 11/09/2022] Open
Abstract
We conducted a prospective hospital based study from February 2009-April 2011 to identify the possible pathogens of central nervous system (CNS) infections in adults admitted to a tertiary referral hospital (Patan Hospital) in Kathmandu, Nepal. The pathogens of CNS infections were confirmed in cerebrospinal fluid (CSF) using molecular diagnostics, culture (bacteria) and serology. 87 patients were recruited for the study and the etiological diagnosis was established in 38% (n = 33). The bacterial pathogens identified were Neisseria meningitidis (n = 6); Streptococcus pneumoniae (n = 5) and Staphylococcus aureus (n = 2) in 13/87(14%). Enteroviruses were found in 12/87 (13%); Herpes Simplex virus (HSV) in 2/87(2%). IgM against Japanese encephalitis virus (JEV) was detected in the CSF of 11/73 (15%) tested samples. This is the first prospective molecular and serology based CSF analysis in adults with CNS infections in Kathmandu, Nepal. JEV and enteroviruses were the most commonly detected pathogens in this setting.
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Li J, Chang J, Liu X, Yang J, Guo H, Wei W, Zhang W, Yu XF. Protection from lethal challenge in a neonatal mouse model by circulating recombinant form coxsackievirus A16 vaccine candidates. J Gen Virol 2014; 95:1083-1093. [PMID: 24496826 PMCID: PMC3983757 DOI: 10.1099/vir.0.063560-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Circulating coxsackievirus A16 (CA16) is a major cause of hand, foot and mouth disease (HFMD) in South-east Asia. At present, there is no vaccine against CA16. Pathogenic animal models that are sensitive to diverse circulating CA16 viruses would be desirable for vaccine development and evaluation. In this study, we isolated and characterized several circulating CA16 viruses from recent HFMD patients. These CA16 viruses currently circulating in humans were highly pathogenic in a newly developed neonatal mouse model; we also observed and analysed the pathogenesis of representative circulating recombinant form CA16 viruses. An inactivated CA16 vaccine candidate, formulated with alum adjuvant and containing submicrogram quantities of viral proteins, protected neonatal mice born to immunized female mice from lethal-dose challenge with a series of CA16 viruses. Further analysis of humoral immunity showed that antibody elicited from both the immunized dams and their pups could neutralize various lethal viruses by a cytopathic effect in vitro. Moreover, viral titres and loads in the tissues of challenged pups in the vaccine group were far lower than those in the control group, and some were undetectable. This lethal-challenge model using pathogenic CA16 viruses and the vaccine candidates that mediated protection in this model could be useful tools for the future development and evaluation of CA16 vaccines.
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Affiliation(s)
- Jingliang Li
- First Hospital of Jilin University, Institute of Virology and AIDS Research, Changchun, Jilin Province, PR China
| | - Junliang Chang
- First Hospital of Jilin University, Institute of Virology and AIDS Research, Changchun, Jilin Province, PR China
| | - Xin Liu
- First Hospital of Jilin University, Institute of Virology and AIDS Research, Changchun, Jilin Province, PR China
| | - Jiaxin Yang
- First Hospital of Jilin University, Institute of Virology and AIDS Research, Changchun, Jilin Province, PR China
| | - Haoran Guo
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA.,First Hospital of Jilin University, Institute of Virology and AIDS Research, Changchun, Jilin Province, PR China
| | - Wei Wei
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA.,First Hospital of Jilin University, Institute of Virology and AIDS Research, Changchun, Jilin Province, PR China
| | - Wenyan Zhang
- First Hospital of Jilin University, Institute of Virology and AIDS Research, Changchun, Jilin Province, PR China
| | - Xiao-Fang Yu
- Department of Molecular Microbiology and Immunology, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Baltimore, MD 21205, USA.,First Hospital of Jilin University, Institute of Virology and AIDS Research, Changchun, Jilin Province, PR China
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Xing W, Liao Q, Viboud C, Zhang J, Sun J, Wu JT, Chang Z, Liu F, Fang VJ, Zheng Y, Cowling BJ, Varma JK, Farrar JJ, Leung GM, Yu H. Hand, foot, and mouth disease in China, 2008-12: an epidemiological study. THE LANCET. INFECTIOUS DISEASES 2014; 14:308-318. [PMID: 24485991 DOI: 10.1016/s1473-3099(13)70342-6] [Citation(s) in RCA: 677] [Impact Index Per Article: 67.7] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Hand, foot, and mouth disease is a common childhood illness caused by enteroviruses. Increasingly, the disease has a substantial burden throughout east and southeast Asia. To better inform vaccine and other interventions, we characterised the epidemiology of hand, foot, and mouth disease in China on the basis of enhanced surveillance. METHODS We extracted epidemiological, clinical, and laboratory data from cases of hand, foot, and mouth disease reported to the Chinese Center for Disease Control and Prevention between Jan 1, 2008, and Dec 31, 2012. We then compiled climatic, geographical, and demographic information. All analyses were stratified by age, disease severity, laboratory confirmation status, and enterovirus serotype. FINDINGS The surveillance registry included 7,200,092 probable cases of hand, foot, and mouth disease (annual incidence, 1·2 per 1000 person-years from 2010-12), of which 267,942 (3·7%) were laboratory confirmed and 2457 (0·03%) were fatal. Incidence and mortality were highest in children aged 12-23 months (38·2 cases per 1000 person-years and 1·5 deaths per 100,000 person-years in 2012). Median duration from onset to diagnosis was 1·5 days (IQR 0·5-2·5) and median duration from onset to death was 3·5 days (2·5-4·5). The absolute number of patients with cardiopulmonary or neurological complications was 82,486 (case-severity rate 1·1%), and 2457 of 82486 patients with severe disease died (fatality rate 3·0%); 1617 of 1737 laboratory confirmed deaths (93%) were associated with enterovirus 71. Every year in June, hand, foot, and mouth disease peaked in north China, whereas southern China had semiannual outbreaks in May and September-October. Geographical differences in seasonal patterns were weakly associated with climate and demographic factors (variance explained 8-23% and 3-19%, respectively). INTERPRETATION This is the largest population-based study up to now of the epidemiology of hand, foot, and mouth disease. Future mitigation policies should take into account the heterogeneities of disease burden identified. Additional epidemiological and serological studies are warranted to elucidate the dynamics and immunity patterns of local hand, foot, and mouth disease and to optimise interventions. FUNDING China-US Collaborative Program on Emerging and Re-emerging Infectious Diseases, WHO, The Li Ka Shing Oxford Global Health Programme and Wellcome Trust, Harvard Center for Communicable Disease Dynamics, and Health and Medical Research Fund, Government of Hong Kong Special Administrative Region.
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Affiliation(s)
- Weijia Xing
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China (W Xing PhD, Q Liao MD, J Zhang MD, J Sun PhD, Zhaorui Chang MD, F Liu MD, H Yu MD); Fogarty International Center, National Institutes of Health, Bethesda, MD, USA (C Viboud PhD); Division of Epidemiology and Biostatistics, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China (B J Cowling PhD, J T Wu PhD, V J Fang MPhil, Prof G M Leung MD); School of Public Health, Peking University, Health Science Center, Beijing, China (Y Zheng PhD); New York City Department of Health and Mental Hygiene, New York, USA (J K Varma MD); Oxford University Clinical Research Unit - Wellcome Trust Major Overseas Programmes, Vietnam (Prof J J Farrar PhD); ISARIC, Centre for Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom (Prof J J Farrar PhD); Department of Medicine, National University of Singapore, Singapore (Prof J J Farrar PhD); The Li Ka Shing Oxford Global Health Programme and Wellcome Trust (Prof J J Farrar PhD)
| | - Qiaohong Liao
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China (W Xing PhD, Q Liao MD, J Zhang MD, J Sun PhD, Zhaorui Chang MD, F Liu MD, H Yu MD); Fogarty International Center, National Institutes of Health, Bethesda, MD, USA (C Viboud PhD); Division of Epidemiology and Biostatistics, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China (B J Cowling PhD, J T Wu PhD, V J Fang MPhil, Prof G M Leung MD); School of Public Health, Peking University, Health Science Center, Beijing, China (Y Zheng PhD); New York City Department of Health and Mental Hygiene, New York, USA (J K Varma MD); Oxford University Clinical Research Unit - Wellcome Trust Major Overseas Programmes, Vietnam (Prof J J Farrar PhD); ISARIC, Centre for Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom (Prof J J Farrar PhD); Department of Medicine, National University of Singapore, Singapore (Prof J J Farrar PhD); The Li Ka Shing Oxford Global Health Programme and Wellcome Trust (Prof J J Farrar PhD)
| | - Cécile Viboud
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China (W Xing PhD, Q Liao MD, J Zhang MD, J Sun PhD, Zhaorui Chang MD, F Liu MD, H Yu MD); Fogarty International Center, National Institutes of Health, Bethesda, MD, USA (C Viboud PhD); Division of Epidemiology and Biostatistics, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China (B J Cowling PhD, J T Wu PhD, V J Fang MPhil, Prof G M Leung MD); School of Public Health, Peking University, Health Science Center, Beijing, China (Y Zheng PhD); New York City Department of Health and Mental Hygiene, New York, USA (J K Varma MD); Oxford University Clinical Research Unit - Wellcome Trust Major Overseas Programmes, Vietnam (Prof J J Farrar PhD); ISARIC, Centre for Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom (Prof J J Farrar PhD); Department of Medicine, National University of Singapore, Singapore (Prof J J Farrar PhD); The Li Ka Shing Oxford Global Health Programme and Wellcome Trust (Prof J J Farrar PhD)
| | - Jing Zhang
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China (W Xing PhD, Q Liao MD, J Zhang MD, J Sun PhD, Zhaorui Chang MD, F Liu MD, H Yu MD); Fogarty International Center, National Institutes of Health, Bethesda, MD, USA (C Viboud PhD); Division of Epidemiology and Biostatistics, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China (B J Cowling PhD, J T Wu PhD, V J Fang MPhil, Prof G M Leung MD); School of Public Health, Peking University, Health Science Center, Beijing, China (Y Zheng PhD); New York City Department of Health and Mental Hygiene, New York, USA (J K Varma MD); Oxford University Clinical Research Unit - Wellcome Trust Major Overseas Programmes, Vietnam (Prof J J Farrar PhD); ISARIC, Centre for Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom (Prof J J Farrar PhD); Department of Medicine, National University of Singapore, Singapore (Prof J J Farrar PhD); The Li Ka Shing Oxford Global Health Programme and Wellcome Trust (Prof J J Farrar PhD)
| | - Junling Sun
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China (W Xing PhD, Q Liao MD, J Zhang MD, J Sun PhD, Zhaorui Chang MD, F Liu MD, H Yu MD); Fogarty International Center, National Institutes of Health, Bethesda, MD, USA (C Viboud PhD); Division of Epidemiology and Biostatistics, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China (B J Cowling PhD, J T Wu PhD, V J Fang MPhil, Prof G M Leung MD); School of Public Health, Peking University, Health Science Center, Beijing, China (Y Zheng PhD); New York City Department of Health and Mental Hygiene, New York, USA (J K Varma MD); Oxford University Clinical Research Unit - Wellcome Trust Major Overseas Programmes, Vietnam (Prof J J Farrar PhD); ISARIC, Centre for Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom (Prof J J Farrar PhD); Department of Medicine, National University of Singapore, Singapore (Prof J J Farrar PhD); The Li Ka Shing Oxford Global Health Programme and Wellcome Trust (Prof J J Farrar PhD)
| | - Joseph T Wu
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China (W Xing PhD, Q Liao MD, J Zhang MD, J Sun PhD, Zhaorui Chang MD, F Liu MD, H Yu MD); Fogarty International Center, National Institutes of Health, Bethesda, MD, USA (C Viboud PhD); Division of Epidemiology and Biostatistics, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China (B J Cowling PhD, J T Wu PhD, V J Fang MPhil, Prof G M Leung MD); School of Public Health, Peking University, Health Science Center, Beijing, China (Y Zheng PhD); New York City Department of Health and Mental Hygiene, New York, USA (J K Varma MD); Oxford University Clinical Research Unit - Wellcome Trust Major Overseas Programmes, Vietnam (Prof J J Farrar PhD); ISARIC, Centre for Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom (Prof J J Farrar PhD); Department of Medicine, National University of Singapore, Singapore (Prof J J Farrar PhD); The Li Ka Shing Oxford Global Health Programme and Wellcome Trust (Prof J J Farrar PhD)
| | - Zhaorui Chang
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China (W Xing PhD, Q Liao MD, J Zhang MD, J Sun PhD, Zhaorui Chang MD, F Liu MD, H Yu MD); Fogarty International Center, National Institutes of Health, Bethesda, MD, USA (C Viboud PhD); Division of Epidemiology and Biostatistics, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China (B J Cowling PhD, J T Wu PhD, V J Fang MPhil, Prof G M Leung MD); School of Public Health, Peking University, Health Science Center, Beijing, China (Y Zheng PhD); New York City Department of Health and Mental Hygiene, New York, USA (J K Varma MD); Oxford University Clinical Research Unit - Wellcome Trust Major Overseas Programmes, Vietnam (Prof J J Farrar PhD); ISARIC, Centre for Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom (Prof J J Farrar PhD); Department of Medicine, National University of Singapore, Singapore (Prof J J Farrar PhD); The Li Ka Shing Oxford Global Health Programme and Wellcome Trust (Prof J J Farrar PhD)
| | - Fengfeng Liu
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China (W Xing PhD, Q Liao MD, J Zhang MD, J Sun PhD, Zhaorui Chang MD, F Liu MD, H Yu MD); Fogarty International Center, National Institutes of Health, Bethesda, MD, USA (C Viboud PhD); Division of Epidemiology and Biostatistics, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China (B J Cowling PhD, J T Wu PhD, V J Fang MPhil, Prof G M Leung MD); School of Public Health, Peking University, Health Science Center, Beijing, China (Y Zheng PhD); New York City Department of Health and Mental Hygiene, New York, USA (J K Varma MD); Oxford University Clinical Research Unit - Wellcome Trust Major Overseas Programmes, Vietnam (Prof J J Farrar PhD); ISARIC, Centre for Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom (Prof J J Farrar PhD); Department of Medicine, National University of Singapore, Singapore (Prof J J Farrar PhD); The Li Ka Shing Oxford Global Health Programme and Wellcome Trust (Prof J J Farrar PhD)
| | - Vicky J Fang
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China (W Xing PhD, Q Liao MD, J Zhang MD, J Sun PhD, Zhaorui Chang MD, F Liu MD, H Yu MD); Fogarty International Center, National Institutes of Health, Bethesda, MD, USA (C Viboud PhD); Division of Epidemiology and Biostatistics, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China (B J Cowling PhD, J T Wu PhD, V J Fang MPhil, Prof G M Leung MD); School of Public Health, Peking University, Health Science Center, Beijing, China (Y Zheng PhD); New York City Department of Health and Mental Hygiene, New York, USA (J K Varma MD); Oxford University Clinical Research Unit - Wellcome Trust Major Overseas Programmes, Vietnam (Prof J J Farrar PhD); ISARIC, Centre for Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom (Prof J J Farrar PhD); Department of Medicine, National University of Singapore, Singapore (Prof J J Farrar PhD); The Li Ka Shing Oxford Global Health Programme and Wellcome Trust (Prof J J Farrar PhD)
| | - Yingdong Zheng
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China (W Xing PhD, Q Liao MD, J Zhang MD, J Sun PhD, Zhaorui Chang MD, F Liu MD, H Yu MD); Fogarty International Center, National Institutes of Health, Bethesda, MD, USA (C Viboud PhD); Division of Epidemiology and Biostatistics, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China (B J Cowling PhD, J T Wu PhD, V J Fang MPhil, Prof G M Leung MD); School of Public Health, Peking University, Health Science Center, Beijing, China (Y Zheng PhD); New York City Department of Health and Mental Hygiene, New York, USA (J K Varma MD); Oxford University Clinical Research Unit - Wellcome Trust Major Overseas Programmes, Vietnam (Prof J J Farrar PhD); ISARIC, Centre for Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom (Prof J J Farrar PhD); Department of Medicine, National University of Singapore, Singapore (Prof J J Farrar PhD); The Li Ka Shing Oxford Global Health Programme and Wellcome Trust (Prof J J Farrar PhD)
| | - Benjamin J Cowling
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China (W Xing PhD, Q Liao MD, J Zhang MD, J Sun PhD, Zhaorui Chang MD, F Liu MD, H Yu MD); Fogarty International Center, National Institutes of Health, Bethesda, MD, USA (C Viboud PhD); Division of Epidemiology and Biostatistics, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China (B J Cowling PhD, J T Wu PhD, V J Fang MPhil, Prof G M Leung MD); School of Public Health, Peking University, Health Science Center, Beijing, China (Y Zheng PhD); New York City Department of Health and Mental Hygiene, New York, USA (J K Varma MD); Oxford University Clinical Research Unit - Wellcome Trust Major Overseas Programmes, Vietnam (Prof J J Farrar PhD); ISARIC, Centre for Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom (Prof J J Farrar PhD); Department of Medicine, National University of Singapore, Singapore (Prof J J Farrar PhD); The Li Ka Shing Oxford Global Health Programme and Wellcome Trust (Prof J J Farrar PhD)
| | - Jay K Varma
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China (W Xing PhD, Q Liao MD, J Zhang MD, J Sun PhD, Zhaorui Chang MD, F Liu MD, H Yu MD); Fogarty International Center, National Institutes of Health, Bethesda, MD, USA (C Viboud PhD); Division of Epidemiology and Biostatistics, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China (B J Cowling PhD, J T Wu PhD, V J Fang MPhil, Prof G M Leung MD); School of Public Health, Peking University, Health Science Center, Beijing, China (Y Zheng PhD); New York City Department of Health and Mental Hygiene, New York, USA (J K Varma MD); Oxford University Clinical Research Unit - Wellcome Trust Major Overseas Programmes, Vietnam (Prof J J Farrar PhD); ISARIC, Centre for Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom (Prof J J Farrar PhD); Department of Medicine, National University of Singapore, Singapore (Prof J J Farrar PhD); The Li Ka Shing Oxford Global Health Programme and Wellcome Trust (Prof J J Farrar PhD)
| | - Jeremy J Farrar
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China (W Xing PhD, Q Liao MD, J Zhang MD, J Sun PhD, Zhaorui Chang MD, F Liu MD, H Yu MD); Fogarty International Center, National Institutes of Health, Bethesda, MD, USA (C Viboud PhD); Division of Epidemiology and Biostatistics, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China (B J Cowling PhD, J T Wu PhD, V J Fang MPhil, Prof G M Leung MD); School of Public Health, Peking University, Health Science Center, Beijing, China (Y Zheng PhD); New York City Department of Health and Mental Hygiene, New York, USA (J K Varma MD); Oxford University Clinical Research Unit - Wellcome Trust Major Overseas Programmes, Vietnam (Prof J J Farrar PhD); ISARIC, Centre for Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom (Prof J J Farrar PhD); Department of Medicine, National University of Singapore, Singapore (Prof J J Farrar PhD); The Li Ka Shing Oxford Global Health Programme and Wellcome Trust (Prof J J Farrar PhD)
| | - Gabriel M Leung
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China (W Xing PhD, Q Liao MD, J Zhang MD, J Sun PhD, Zhaorui Chang MD, F Liu MD, H Yu MD); Fogarty International Center, National Institutes of Health, Bethesda, MD, USA (C Viboud PhD); Division of Epidemiology and Biostatistics, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China (B J Cowling PhD, J T Wu PhD, V J Fang MPhil, Prof G M Leung MD); School of Public Health, Peking University, Health Science Center, Beijing, China (Y Zheng PhD); New York City Department of Health and Mental Hygiene, New York, USA (J K Varma MD); Oxford University Clinical Research Unit - Wellcome Trust Major Overseas Programmes, Vietnam (Prof J J Farrar PhD); ISARIC, Centre for Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom (Prof J J Farrar PhD); Department of Medicine, National University of Singapore, Singapore (Prof J J Farrar PhD); The Li Ka Shing Oxford Global Health Programme and Wellcome Trust (Prof J J Farrar PhD)
| | - Hongjie Yu
- Division of Infectious Disease, Key Laboratory of Surveillance and Early-warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, China (W Xing PhD, Q Liao MD, J Zhang MD, J Sun PhD, Zhaorui Chang MD, F Liu MD, H Yu MD); Fogarty International Center, National Institutes of Health, Bethesda, MD, USA (C Viboud PhD); Division of Epidemiology and Biostatistics, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China (B J Cowling PhD, J T Wu PhD, V J Fang MPhil, Prof G M Leung MD); School of Public Health, Peking University, Health Science Center, Beijing, China (Y Zheng PhD); New York City Department of Health and Mental Hygiene, New York, USA (J K Varma MD); Oxford University Clinical Research Unit - Wellcome Trust Major Overseas Programmes, Vietnam (Prof J J Farrar PhD); ISARIC, Centre for Tropical Medicine, University of Oxford, Churchill Hospital, Oxford, United Kingdom (Prof J J Farrar PhD); Department of Medicine, National University of Singapore, Singapore (Prof J J Farrar PhD); The Li Ka Shing Oxford Global Health Programme and Wellcome Trust (Prof J J Farrar PhD)
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Guo Z, Zhong X, Lin L, Wu S, Wang T, Chen Y, Zhai X, Wang Y, Wu H, Tong L, Han Y, Pan B, Peng Y, Si X, Zhang F, Zhao W, Zhong Z. A 3C(pro)-dependent bioluminescence imaging assay for in vivo evaluation of anti-enterovirus 71 agents. Antiviral Res 2014; 101:82-92. [PMID: 24263113 DOI: 10.1016/j.antiviral.2013.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 11/01/2013] [Accepted: 11/06/2013] [Indexed: 11/29/2022]
Abstract
Enterovirus 71 (EV71), a member of Picornaviridae, is one of the major pathogens of human hand, foot and mouth disease. EV71 mainly infects children and causes severe neurological complications and even death. The pathogenesis of EV71 infection is largely unknown, and no clinically approved vaccine or effective treatment is available to date. Here we described a novel bioluminescence imaging approach for EV71 detection. In this approach, a plasmid-based reporter was constructed to express the fusion protein AmN(Q/G)BC, a split firefly luciferase mutant, which can be specifically cleaved by EV71 protease 3C(pro). Upon cleavage, the splitting fusion protein restores luciferase activity. Our test confirmed that AmN(Q/G)BC was specifically cleaved by 3C(pro) and EV71 and restored the luciferase activity to a degree that corresponds to the 3C(pro) and virus doses in cells and mice. The anti-EV71 effect of GW5074 and U0126, two mitogen-activated protein kinase (MAPK) inhibitors, was evaluated using this approach to validate its application of screening anti-EV71 agents. We found that the AmN(Q/G)BC reporter efficiently monitored the inhibitory effect of GW5074 and U0126 on EV71 infection under in vitro and in vivo conditions. The data from AmN(Q/G)BC reporter were consistent with Western blotting and histopathology examination. Taken together, this real-time imaging approach can quantitatively monitor the efficacy of anti-EV71 agents and is valuable for anti-EV71 drug screening and evaluation, especially, under in vivo conditions.
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Affiliation(s)
- Zhiwei Guo
- Department of Microbiology, Harbin Medical University, Harbin 150081, China
| | - Xiaoyan Zhong
- Department of Microbiology, Harbin Medical University, Harbin 150081, China
| | - Lexun Lin
- Department of Microbiology, Harbin Medical University, Harbin 150081, China
| | - Shuo Wu
- Department of Microbiology, Harbin Medical University, Harbin 150081, China
| | - Tianying Wang
- Department of Microbiology, Harbin Medical University, Harbin 150081, China
| | - Yang Chen
- Department of Microbiology, Harbin Medical University, Harbin 150081, China
| | - Xia Zhai
- Department of Microbiology, Harbin Medical University, Harbin 150081, China
| | - Yan Wang
- Department of Microbiology, Harbin Medical University, Harbin 150081, China
| | - Heng Wu
- Department of Microbiology, Harbin Medical University, Harbin 150081, China
| | - Lei Tong
- Department of Microbiology, Harbin Medical University, Harbin 150081, China
| | - Yelu Han
- Department of Microbiology, Harbin Medical University, Harbin 150081, China
| | - Bo Pan
- Department of Microbiology, Harbin Medical University, Harbin 150081, China
| | - Yihong Peng
- Department of Microbiology, Peking University Health Science Center, Beijing 100191, China
| | - Xiaoning Si
- Department of Microbiology, Harbin Medical University, Harbin 150081, China
| | - Fengmin Zhang
- Department of Microbiology, Harbin Medical University, Harbin 150081, China
| | - Wenran Zhao
- Department of Cell Biology, Harbin Medical University, Harbin 150081, China.
| | - Zhaohua Zhong
- Department of Microbiology, Harbin Medical University, Harbin 150081, China.
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Abzug MJ. The enteroviruses: Problems in need of treatments. J Infect 2014; 68 Suppl 1:S108-14. [DOI: 10.1016/j.jinf.2013.09.020] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2013] [Indexed: 01/26/2023]
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Li W, Yi L, Su J, Lu J, Ke C, Zeng H, Guan D, Ma C, Zhang W, Xiao H, Li H, Lin J, Zhang Y. Seroprevalence of human enterovirus 71 and coxsackievirus A16 in Guangdong, China, in pre- and post-2010 HFMD epidemic period. PLoS One 2013; 8:e80515. [PMID: 24324604 PMCID: PMC3850913 DOI: 10.1371/journal.pone.0080515] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Accepted: 10/04/2013] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Human Enterovirus 71 and Coxsackie A16 have caused many outbreaks in the last decade in mainland China, resulting in thousands of fatal cases. Seroepidemiology which provides important information to document population immunity is rare in China. METHODOLOGY/PRINCIPAL FINDINGS A cross sectional study of Enterovirus 71 (EV71) and Coxsackie A16 (CA16) seroprevalence was carried out in Guangdong, China, pre- and post- the 2010 hand, foot and mouth disease (HFMD) epidemic period. The levels of EV71 and CA16 specific antibodies were evaluated by a microneutralization test and the geometric mean titer (GMT) was calculated and compared. Our results indicated frequent infection by EV71 and CA16 in Guangdong before the 2010 epidemic. Only EV71 neutralizing antibody but not CA16 seroprevalence was significantly increased after the 2010 HFMD epidemic. Children less than 3 years old especially those aged 2 years showed the lowest positive rates for EV71 and CA16 NA before epidemic and the most significantly increased EV71 seroprevalence after epidemic. CA16 GMT values declined after the 2010 epidemic. CONCLUSIONS These results indicate EV71 was the major pathogen of HFMD in Guangdong during the 2010 epidemic. The infection occurs largely in children less than 3 years, who should have first priority to receive an EV71 vaccine.
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Affiliation(s)
- Wei Li
- Center of Pathogen Detection Research for Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Pathogen Detection for Emergency Response, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Depository and Application for Pathogenic Microbiology, Guangdong Provincial Centre for Disease Control and Prevention, Guangzhou, China
| | - Lina Yi
- Center of Pathogen Detection Research for Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Juan Su
- Center of Pathogen Detection Research for Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Pathogen Detection for Emergency Response, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Depository and Application for Pathogenic Microbiology, Guangdong Provincial Centre for Disease Control and Prevention, Guangzhou, China
| | - Jing Lu
- Center of Pathogen Detection Research for Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Changwen Ke
- Center of Pathogen Detection Research for Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Pathogen Detection for Emergency Response, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Depository and Application for Pathogenic Microbiology, Guangdong Provincial Centre for Disease Control and Prevention, Guangzhou, China
| | - Hanri Zeng
- Center of Pathogen Detection Research for Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Pathogen Detection for Emergency Response, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Depository and Application for Pathogenic Microbiology, Guangdong Provincial Centre for Disease Control and Prevention, Guangzhou, China
| | - Dawei Guan
- Center of Pathogen Detection Research for Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Pathogen Detection for Emergency Response, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Depository and Application for Pathogenic Microbiology, Guangdong Provincial Centre for Disease Control and Prevention, Guangzhou, China
| | - Cong Ma
- Center of Pathogen Detection Research for Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Pathogen Detection for Emergency Response, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Depository and Application for Pathogenic Microbiology, Guangdong Provincial Centre for Disease Control and Prevention, Guangzhou, China
| | - Wanly Zhang
- Center of Pathogen Detection Research for Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Pathogen Detection for Emergency Response, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Depository and Application for Pathogenic Microbiology, Guangdong Provincial Centre for Disease Control and Prevention, Guangzhou, China
| | - Hong Xiao
- Center of Pathogen Detection Research for Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Pathogen Detection for Emergency Response, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Depository and Application for Pathogenic Microbiology, Guangdong Provincial Centre for Disease Control and Prevention, Guangzhou, China
| | - Hui Li
- Center of Pathogen Detection Research for Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Pathogen Detection for Emergency Response, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Depository and Application for Pathogenic Microbiology, Guangdong Provincial Centre for Disease Control and Prevention, Guangzhou, China
| | - Jinyan Lin
- Center of Pathogen Detection Research for Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Pathogen Detection for Emergency Response, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Depository and Application for Pathogenic Microbiology, Guangdong Provincial Centre for Disease Control and Prevention, Guangzhou, China
| | - Yonghui Zhang
- Center of Pathogen Detection Research for Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Pathogen Detection for Emergency Response, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- Key Laboratory of Depository and Application for Pathogenic Microbiology, Guangdong Provincial Centre for Disease Control and Prevention, Guangzhou, China
- * E-mail:
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Han JF, Yu N, Pan YX, He SJ, Xu LJ, Cao RY, Li YX, Zhu SY, Zhang Y, Qin ED, Che XY, Qin CF. Phenotypic and genomic characterization of human coxsackievirus A16 strains with distinct virulence in mice. Virus Res 2013; 179:212-9. [PMID: 24211607 DOI: 10.1016/j.virusres.2013.10.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2013] [Revised: 10/21/2013] [Accepted: 10/22/2013] [Indexed: 01/18/2023]
Abstract
Human coxsackievirus A16 (CA16) infection results in hand, foot, and mouth disease (HFMD) along with other severe neurological diseases in children and poses an important public health threat in Asian countries. During an HFMD epidemic in 2009 in Guangdong, China, two CA16 strains (GD09/119 and GD09/24) were isolated and characterized. Although both strains were similar in plaque morphology and growth properties in vitro, the two isolates exhibited distinct pathogenicity in neonatal mice upon intraperitoneal or intracranial injection. Complete genome sequences of both CA16 strains were determined, and the possible virulence determinants were analyzed and predicted. Phylogenetic analysis revealed that these CA16 isolates from Guangdong belonged to the B1b genotype and were closely related to other recent CA16 strains isolated in mainland China. Similarity and bootscanning analyses of these CA16 strains detected homologous recombination with the EV71 prototype strain BrCr in the non-structural gene regions and the 3'-untranslated regions. Together, the phenotypic and genomic characterizations of the two clinical CA16 isolates circulating in China were compared in detail, and the potential amino acid residues responsible for CA16 virulence in mice were predicted. These findings will help explain the evolutionary relationship of the CA16 strains circulating in China, warranting future studies investigating enterovirus virulence.
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Affiliation(s)
- Jian-Feng Han
- Department of Virology, State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, China
| | - Nan Yu
- Laboratory of Emerging Infectious Disease and Division of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, No. 253 Gong ye da dao zhong, Guangzhou, Guangdong 510282, China
| | - Yu-Xian Pan
- Laboratory of Emerging Infectious Disease and Division of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, No. 253 Gong ye da dao zhong, Guangzhou, Guangdong 510282, China
| | - Si-Jie He
- Laboratory of Emerging Infectious Disease and Division of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, No. 253 Gong ye da dao zhong, Guangzhou, Guangdong 510282, China
| | - Li-Juan Xu
- Department of Virology, State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, China
| | - Rui-Yuan Cao
- Department of Virology, State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, China
| | - Yue-Xiang Li
- Department of Virology, State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, China
| | - Shun-Ya Zhu
- Department of Virology, State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, China
| | - Yu Zhang
- Department of Virology, State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, China
| | - E-De Qin
- Department of Virology, State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, China
| | - Xiao-Yan Che
- Laboratory of Emerging Infectious Disease and Division of Laboratory Medicine, Zhujiang Hospital, Southern Medical University, No. 253 Gong ye da dao zhong, Guangzhou, Guangdong 510282, China
| | - Cheng-Feng Qin
- Department of Virology, State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing 100071, China.
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Yip CCY, Lau SKP, Woo PCY, Yuen KY. Human enterovirus 71 epidemics: what's next? EMERGING HEALTH THREATS JOURNAL 2013; 6:19780. [PMID: 24119538 PMCID: PMC3772321 DOI: 10.3402/ehtj.v6i0.19780] [Citation(s) in RCA: 124] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Revised: 07/01/2013] [Accepted: 08/06/2013] [Indexed: 12/17/2022]
Abstract
Human enterovirus 71 (EV71) epidemics have affected various countries in the past 40 years. EV71 commonly causes hand, foot and mouth disease (HFMD) in children, but can result in neurological and cardiorespiratory complications in severe cases. Genotypic changes of EV71 have been observed in different places over time, with the emergence of novel genotypes or subgenotypes giving rise to serious outbreaks. Since the late 1990s, intra- and inter-typic recombination events in EV71 have been increasingly reported in the Asia-Pacific region. In particular, 'double-recombinant' EV71 strains belonging to a novel genotype D have been predominant in mainland China and Hong Kong over the last decade, though co-circulating with a minority of other EV71 subgenotypes and coxsackie A viruses. Continuous surveillance and genome studies are important to detect potential novel mutants or recombinants in the near future. Rapid and sensitive molecular detection of EV71 is of paramount importance in anticipating and combating EV71 outbreaks.
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Affiliation(s)
- Cyril C Y Yip
- Department of Microbiology, The University of Hong Kong, Hong Kong, China
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47
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Eupafolin and Ethyl Acetate Fraction of Kalanchoe gracilis Stem Extract Show Potent Antiviral Activities against Enterovirus 71 and Coxsackievirus A16. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 2013:591354. [PMID: 24078828 PMCID: PMC3775429 DOI: 10.1155/2013/591354] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/17/2013] [Accepted: 07/24/2013] [Indexed: 12/28/2022]
Abstract
Enterovirus 71 (EV71) and coxsackievirus A16 (CoxA16) are main pathogens of hand-foot-and-mouth disease, occasionally causing aseptic meningitis and encephalitis in tropical and subtropical regions. Kalanchoe gracilis, Da-Huan-Hun, is a Chinese folk medicine for treating pain and inflammation, exhibiting antioxidant and anti-inflammatory activities. Our prior report (2012) cited K. gracilis leaf extract as moderately active against EV71 and CoxA16. This study further rates antienteroviral potential of K. gracilis stem (KGS) extract to identify potent antiviral fractions and components. The extract moderately inhibits viral cytopathicity and virus yield, as well as in vitro replication of EV71 (IC50 = 75.18 μg/mL) and CoxA16 (IC50 = 81.41 μg/mL). Ethyl acetate (EA) fraction of KGS extract showed greater antiviral activity than that of n-butanol or aqueous fraction: IC50 values of 4.21 μg/mL against EV71 and 9.08 μg/mL against CoxA16. HPLC analysis, UV-Vis absorption spectroscopy, and plaque reduction assay indicate that eupafolin is a vital component of EA fraction showing potent activity against EV71 (IC50 = 1.39 μM) and CoxA16 (IC50 = 5.24 μM). Eupafolin specifically lessened virus-induced upregulation of IL-6 and RANTES by inhibiting virus-induced ERK1/2, AP-1, and STAT3 signals. Anti-enteroviral potency of KGS EA fraction and eupafolin shows the clinical potential against EV71 and CoxA16 infection.
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Tan S, Tan X, Sun X, Lu G, Chen CC, Yan J, Liu J, Xu W, Gao GF. VP2 dominated CD4+ T cell responses against enterovirus 71 and cross-reactivity against coxsackievirus A16 and polioviruses in a healthy population. THE JOURNAL OF IMMUNOLOGY 2013; 191:1637-47. [PMID: 23863902 DOI: 10.4049/jimmunol.1301439] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Enterovirus 71 (EV71)-associated hand-foot-mouth disease has become a major threat to public health in the Asia-Pacific region. Although T cell immunity is closely correlated with clinical outcomes of EV71 infection, little is known about T cell immunity baseline against EV71 and T cell immunogenecity of EV71 Ags in the population, which has restricted our understanding of immunoprotection mechanisms. In this study, we investigated the cellular immune responses against the four structural Ags of EV71 and determined the immunohierarchy of these Ags in healthy adults. A low frequency of EV71-responsive T cells was detected circulating in peripheral blood, and broad T cell immune responses could be identified in most of the subjects after in vitro expansion. We demonstrated that the VP2 Ag with broad distribution of immunogenic peptides dominates T cell responses against EV71 compared with VP1, VP3, and VP4. Furthermore, the responses were illuminated to be mainly single IFN-γ-secreting CD4(+) T cell dependent, indicating the previous natural acute viral infection of the adult population. Conservancy analysis of the immunogenic peptides revealed that moderately variant peptides were in the majority in coxsackievirus A16 (CV-A16) whereas most of the peptides were highly variant in polioviruses. Less efficient cross-reactivity against CV-A16 might broadly exist among individuals, whereas influences derived from poliovirus vaccination would be limited. Our findings suggest that the significance of VP2 Ag should be addressed in the future EV71-responsive immunological investigations. And the findings concerning the less efficient cross-reactivity against CV-A16 and limited influences from poliovirus vaccination in EV71-contacted population would contribute to a better understanding of immunoprotection mechanisms against enteroviruses.
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Affiliation(s)
- Shuguang Tan
- Chinese Academy of Sciences Key Laboratory of Pathogenic Microbiology and Immunology, Institute of Microbiology, Chinese Academy of Sciences, Beijing 100101, China
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49
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Li W, Yi L, Su J, Lu J, Zeng H, Guan D, Ma C, Zhang W, Xiao H, Li H, Zhang Y, Lin J, Ke C. Seroepidemiology of human enterovirus71 and coxsackievirusA16 among children in Guangdong province, China. BMC Infect Dis 2013; 13:322. [PMID: 23855481 PMCID: PMC3717138 DOI: 10.1186/1471-2334-13-322] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2013] [Accepted: 07/10/2013] [Indexed: 11/21/2022] Open
Abstract
Background Hand, foot and mouth disease (HFMD) is a common pediatric illness. Mainly induced by the Enterovirus 71 and Coxsackievirus A 16 infections, the frequently occurred HFMD outbreaks have become a serious public health problem in Southeast Asia. Currently,only a few studies have investigated the human immunity to HFMD in China. In this study, we conducted a cohort study in Guangdong province, China. Methods Stored serum samples from children less than 10 years old were analyzed. The levels of EV71 and CA16 specific antibodies before, during and shortly after the 2008 large outbreak of HFMD were evaluated by the microneutralization test. The geometric mean titer (GMT) was calculated and compared. Statistical significance was taken as P < 0.05. Results The seroprevalence data showed a continuous circulation of EV71 and CA16 in Guangdong province China in 2007–2009. The low positive rate in 2009 correlated well with the unprecedented outbreak of HFMD in 2010. Age related increase of seroprevalence was identified in 1–3 years old children for EV71 and in 1–5 years old children for CA16 in Guangdong province. High GMT of EV71 and CA16 antibody titers were also found for these age groups. Conclusions All of the above findings indicated common infections for these age groups. And they should clearly be at the top of the priority in periodical seroprevalence survey and future vaccination campaign.
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Affiliation(s)
- Wei Li
- Department of Pathogen Detection Research for Emerging Infectious Diseases, Center for Disease Control and Prevention of Guangdong Province, Guangzhou, China
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Severe hand, foot and mouth disease in Shenzhen, South China: what matters most? Epidemiol Infect 2013; 142:776-88. [PMID: 23809877 DOI: 10.1017/s0950268813001453] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Case report data and a matched case-control study were used to investigate the epidemiological characteristics of hand, foot and mouth disease (HFMD) in children in Shenzhen, China between 2008 and 2011. Multivariate analyses were used to evaluate factors associated with severity of infection. Laboratory tests were performed to determine aetiological identification for samples from 163 severe and fatal cases as well as an outpatient-based HFMD sentinel surveillance system (n = 446). All identified EV71 belonged to sub-genotype C4a. No major changes in the CA16 and EV71 viruses were found until the end of 2011. Annual attack rates and the case-severity ratios (CSRs) rose from 0.82/1000 and 0.56/1000, respectively, in 2008 to 2.12/1000 and 6.13/1000 in 2011. The CSR was higher in migrants than in local residents. The adjusted odds ratio (OR) of having a severe attack for being a migrant was 2.45, having a fever >39°C (OR 5.77), visiting a private clinic (OR 2.65), longer time from symptom onset to diagnosis (OR 1.49), visiting a doctor (OR 1.51), early use of intramuscular pyrazolone (OR 3.36), early use of intravenous glucocorticoids (OR 2.28), or the combination of both (OR 3.75). The mortality and increasing case severity appears to be associated with socioeconomic factors including migration and is of worldwide concern.
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