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Yuan J, Zhang M, Yan Z, Zhang W. Sudden Secondary Sensorineural Hearing Loss Following Hand, Foot, and Mouth Disease in an Adult Patient: A Case Report. Ear Nose Throat J 2024:1455613241229960. [PMID: 38327251 DOI: 10.1177/01455613241229960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Abstract
Introduction: Sudden sensorineural hearing loss (SSNHL) can present as sudden hearing loss within 72 hours. Studies have shown that viral infection, including direct invasion, indirect reactions, stress responses, and immune-mediated hearing loss, is the main cause of SSNHL. Viral infection may play an important role in SSNHL by causing injury to the inner ear through blood or cerebrospinal fluid. In this article, we describe an adult case of SSNHL following hand, foot, and mouth disease (HFMD). Case Report: A 34-year-old man presented with sudden hearing loss in the right ear 4 days after HFMD onset. Tinnitus, ear fullness, and a slightly heavy head appeared synchronously as accompanying symptoms. Before 6 days, he had a fever for 2 days (the highest temperature was 39.4°C), followed by vesicles in the oral mucosa and papules on the hands and feet after cohabitation with his child diagnosed with HFMD.
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Affiliation(s)
- Jingjing Yuan
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
- Department of Otolaryngology, Head and Neck Institute of Traditional Chinese Medicine, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Mingsheng Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
- Department of Otolaryngology, Head and Neck Institute of Traditional Chinese Medicine, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Zhanfeng Yan
- Department of Otorhinolaryngology-Head and Neck Surgery, Dongzhimen Hospital Affiliated to Beijing University of Chinese Medicine, Beijing, China
- Department of Otolaryngology, Head and Neck Institute of Traditional Chinese Medicine, Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Wei Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, Eye Hospital China Academy of Chinese Medical Sciences, Beijing, China
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Ji W, Tao L, Li D, Zhu P, Wang Y, Zhang Y, Zhang L, Chen S, Yang H, Jin Y, Duan G. A mouse model and pathogenesis study for CVA19 first isolated from hand, foot, and mouth disease. Emerg Microbes Infect 2023; 12:2177084. [PMID: 36735880 PMCID: PMC9937014 DOI: 10.1080/22221751.2023.2177084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
ABSTRACTCoxsackievirus A19 (CVA19) is a member of Enterovirus (EV) C group in the Picornaviridae family. Recently, we reported a case of CVA19-infected hand, foot, and mouth disease (HFMD) for the first time. However, the current body of knowledge on the CVA19 infection, particularly the pathogenesis of encephalomyelitis and diarrhoea is still very limited, due to the lack of suitable animal models. Here, we successfully established a CVA19 mouse model via oral route based on 7-day-old ICR mice. Our results found the virus strain could directly infect the neurons, astrocytes of brain, and motor neurons of spinal cord causing neurological complications, such as acute flaccid paralysis. Importantly, viruses isolated from the spinal cords of infected mice caused severe illness in suckling mice, fulfilling Koch's postulates to some extent. CVA19 infection led to diarrhoea with typical pathological features of shortened intestinal villi, increased number of secretory cells and apoptotic intestinal cells, and inflammatory cell infiltration. Much higher concentrations of serum cytokines and more peripheral blood inflammatory cells in CVA19-infected mice indicated a systematic inflammatory response induced by CVA19 infection. Finally, we found ribavirin and CVA19 VP1 monoclonal antibody could not prevent the disease progression, but higher concentrations of antisera and interferon alpha 2 (IFN-α2) could provide protective effects against CVA19. In conclusion, this study shows that a natural mouse-adapted CVA19 strain leads to diarrhoea and encephalomyelitis in a mouse model via oral infection, which provides a useful tool for studying CVA19 pathogenesis and evaluating the efficacy of vaccines and antivirals.
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Affiliation(s)
- Wangquan Ji
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, People’s Republic of China,Academy of Medical Science, Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Ling Tao
- School of Public Health, Xinxiang Medical University, Xinxiang, People’s Republic of China
| | - Dong Li
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Peiyu Zhu
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Yuexia Wang
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Yu Zhang
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Liang Zhang
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Shuaiyin Chen
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Haiyan Yang
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, People’s Republic of China
| | - Yuefei Jin
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, People’s Republic of China, Yuefei Jin Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou450001, Henan, People’s Republic of China
| | - Guangcai Duan
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, People’s Republic of China,Academy of Medical Science, Zhengzhou University, Zhengzhou, People’s Republic of China,Guangcai Duan Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou 450001, Henan, People’s Republic of China; Academy of Medical Science, Zhengzhou University, Zhengzhou450001, Henan, People’s Republic of China
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3
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Zhu SY, Jiang YZ, Shen N, Li M, Yin HJ, Qiao JB. Changes in the intestinal microbiota of children with hand, foot, and mouth disease under 3 years old. Medicine (Baltimore) 2023; 102:e33687. [PMID: 37145009 PMCID: PMC10158917 DOI: 10.1097/md.0000000000033687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Accepted: 04/13/2023] [Indexed: 05/06/2023] Open
Abstract
This study aimed to clarify the characteristics of intestinal microbiota in children with hand, foot, and mouth disease (HFMD) under 3 years old. Fresh feces were collected from 54 children with HFMD and 30 healthy children. All of them were <3 years old. Sequencing of the 16S rDNA amplicons was performed. Between the 2 groups, the richness, diversity, and structure of the intestinal microbiota were analyzed by α-diversity and β-diversity. Linear discriminant analysis and LEfSe analyses were used to compare different bacterial classifications. The sex and age of the children in the 2 groups were not statistically significant (P = .92 and P = .98, respectively). Compared to healthy children, the Shannon index, Ace index, and Chao index were lower in children with HFMD (P = .027, P = .012, and P = .012, respectively). Based on the weighted or unweighted UniFrac distance analysis, the structure of the intestinal microbiota in HFMD was also significantly changed (P = .002 and P < .001, respectively). Linear discriminant analysis and LEfSe analysis showed that the changes of key bacteria were manifested as a decrease in Prevotella and Clostridium_XIVa (P < .001 and P < .001, respectively), while Escherichia and Bifidobacterium increased (P = .025 and P = .001, respectively). Children with HFMD under 3 years of age have intestinal microbiota disorder and show a decrease in diversity and richness. The decrease in the abundance of Prevotella and Clostridium, which can produce short-chain fatty acids, is also one of the characteristics of the change. These results can offer a theoretical foundation for the pathogenesis and microecological treatment of HFMD in infants.
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Affiliation(s)
- Su Yue Zhu
- Department of Pediatrics, Suqian Hospital Affiliated to Xuzhou Medical University, Suqian, Jiangsu, China
| | - Ya Zhou Jiang
- Department of Pediatrics, Suqian Hospital Affiliated to Xuzhou Medical University, Suqian, Jiangsu, China
| | - Nan Shen
- Department of Pediatrics, Suqian Hospital Affiliated to Xuzhou Medical University, Suqian, Jiangsu, China
- Department of Hematology, The Children’s Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Min Li
- Department of Hematology, The Children’s Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Han Jun Yin
- Department of Pediatrics, Suqian Hospital Affiliated to Xuzhou Medical University, Suqian, Jiangsu, China
| | - Ji Bing Qiao
- Department of Pediatrics, Suqian Hospital Affiliated to Xuzhou Medical University, Suqian, Jiangsu, China
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Liu Y, Chen J, Zhang M, Guo W, Feng C, Liu J, Xu L, Gao N, Ma S. Coxsackievirus B: the important agent of hand, foot, and mouth disease. J Med Virol 2023; 95:e28669. [PMID: 36912377 DOI: 10.1002/jmv.28669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 03/03/2023] [Accepted: 03/09/2023] [Indexed: 03/14/2023]
Abstract
Hand, foot, and mouth disease (HFMD) is a common pediatric infectious illness caused by enteroviruses (EVs). EV-A serotypes are the main pathogens associated with HFMD. In this study, 213 stool samples from 213 children with severe HFMD in Yunnan, China in 2013, 2015 and 2016 were further analyzed retrospectively for EV-B infection. A total of 70.0% of the specimens tested positive for EV.20 EV serotypes were detected. The predominant serotype was enterovirus A71 (EV-A71,27.7%), followed by coxsackievirus B4 (CV-B4, 16.4%), CV-A16 (9.9%), CV-B5 (6.6%), and Echovirus 9 (E-9,4.7%). EV-A and EV-B accounted for 45.1% and 41.3%, respectively. Among the positive specimens, 28.6% were CV-Bs. Co-infection was present in 19.3% of these cases. In the study, CV-B5 and the majority of CV-B4 isolates belonged to genotypes VI and C3, respectively. This result indicates that EV-B, especially CV-Bs, might be the important agents associated with HFMD and this knowledge will contribute to the prevention and treatment of the disease. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Yuhan Liu
- Institute of Medical Biology, Chinese Academy of Medical Sciences, and Peking Union Medical College, Kunming, 650118, PR China.,Yunnan Key Laboratory of Vaccine Research Development on Severe Infectious Disease, Kunming, 650118, PR China
| | - Junwei Chen
- Institute of Medical Biology, Chinese Academy of Medical Sciences, and Peking Union Medical College, Kunming, 650118, PR China.,School of Life Sciences, Yunnan University
| | - Ming Zhang
- Institute of Medical Biology, Chinese Academy of Medical Sciences, and Peking Union Medical College, Kunming, 650118, PR China.,Yunnan Key Laboratory of Vaccine Research Development on Severe Infectious Disease, Kunming, 650118, PR China
| | - Wei Guo
- Institute of Medical Biology, Chinese Academy of Medical Sciences, and Peking Union Medical College, Kunming, 650118, PR China.,Yunnan Key Laboratory of Vaccine Research Development on Severe Infectious Disease, Kunming, 650118, PR China
| | - Changzeng Feng
- Institute of Medical Biology, Chinese Academy of Medical Sciences, and Peking Union Medical College, Kunming, 650118, PR China.,Yunnan Key Laboratory of Vaccine Research Development on Severe Infectious Disease, Kunming, 650118, PR China
| | - Jiansheng Liu
- Institute of Medical Biology, Chinese Academy of Medical Sciences, and Peking Union Medical College, Kunming, 650118, PR China.,Yunnan Key Laboratory of Vaccine Research Development on Severe Infectious Disease, Kunming, 650118, PR China
| | - Lilan Xu
- Institute of Medical Biology, Chinese Academy of Medical Sciences, and Peking Union Medical College, Kunming, 650118, PR China.,Yunnan Key Laboratory of Vaccine Research Development on Severe Infectious Disease, Kunming, 650118, PR China
| | - Na Gao
- Institute of Medical Biology, Chinese Academy of Medical Sciences, and Peking Union Medical College, Kunming, 650118, PR China.,Yunnan Key Laboratory of Vaccine Research Development on Severe Infectious Disease, Kunming, 650118, PR China
| | - Shaohui Ma
- Institute of Medical Biology, Chinese Academy of Medical Sciences, and Peking Union Medical College, Kunming, 650118, PR China.,Yunnan Key Laboratory of Vaccine Research Development on Severe Infectious Disease, Kunming, 650118, PR China
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Guo J, Cao Z, Liu H, Xu J, Zhao L, Gao L, Zuo Z, Song Y, Han Z, Zhang Y, Wang J. Epidemiology of hand, foot, and mouth disease and the genetic characteristics of Coxsackievirus A16 in Taiyuan, Shanxi, China from 2010 to 2021. Front Cell Infect Microbiol 2022; 12:1040414. [PMID: 36439232 PMCID: PMC9692002 DOI: 10.3389/fcimb.2022.1040414] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 10/26/2022] [Indexed: 11/13/2022] Open
Abstract
Hand, foot, and mouth disease (HFMD) is a common childhood infectious disease caused by human enteroviruses (EV). This study aimed to describe the epidemiological features of HFMD and the genetic characteristics of Coxsackievirus A16 (CVA16) in Taiyuan, Shanxi, China, from 2010 to 2021. Descriptive epidemiological methods were used to analyze the time and population distribution of HFMD and the genetic characteristics of CVA16. Except being affected by the COVID-19 epidemic in 2020, HFMD epidemics were sporadic from January to March each year, and began to increase in April, with a major epidemic peak from May to August, which declined in September, followed by a secondary peak from October to December. The prevalence of EV infection was the highest in children aged one to five years (84.42%), whereas its incidence was very low in children under one year of age (5.48%). Enterovirus nucleic acid was detected by real-time reverse transcription polymerase chain reaction in 6641 clinical specimens collected from patients with HFMD from 2010 to 2021, and 4236 EV-positive specimens were detected, including 988 enterovirus A71 (EV-A71), 1488 CVA16, and 1760 other enteroviruses. CVA16 remains prevalent and has co-circulated with other EVs in Taiyuan from 2010 to 2021. A phylogenetic tree constructed based on the VP1 region showed that all CVA16 strains belonged to two different clades of the B1 genotype, B1a and B1b. They showed a nucleotide similarity of 86.5-100%, and an amino acid similarity of 96.9-100%. Overall, these findings add to the global genetic resources of CVA16, demonstrate the epidemiological characteristics of HFMD as well as the genetic features of CVA16 in Taiyuan City during 2010-2021, and provide supporting evidence for the prevention and control of HFMD.
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Affiliation(s)
- Jiane Guo
- School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China,Department of Microbiology Test, Taiyuan Center for Disease Control and Prevention, Taiyuan, Shanxi, China
| | - Zijun Cao
- School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Hongyan Liu
- School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China
| | - Jihong Xu
- Department of Microbiology Test, Taiyuan Center for Disease Control and Prevention, Taiyuan, Shanxi, China
| | - Lifeng Zhao
- Department of Microbiology Test, Taiyuan Center for Disease Control and Prevention, Taiyuan, Shanxi, China
| | - Li Gao
- Department of Microbiology Test, Taiyuan Center for Disease Control and Prevention, Taiyuan, Shanxi, China
| | - Zhihong Zuo
- Department of Microbiology Test, Taiyuan Center for Disease Control and Prevention, Taiyuan, Shanxi, China
| | - Yang Song
- World Health Organization (WHO) Western Pacific Region Office (WPRO) Regional Polio Reference Laboratory, National Health Commission Key Laboratory of Biosafety, National Health Commission Key Laboratory of Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zhenzhi Han
- World Health Organization (WHO) Western Pacific Region Office (WPRO) Regional Polio Reference Laboratory, National Health Commission Key Laboratory of Biosafety, National Health Commission Key Laboratory of Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yong Zhang
- World Health Organization (WHO) Western Pacific Region Office (WPRO) Regional Polio Reference Laboratory, National Health Commission Key Laboratory of Biosafety, National Health Commission Key Laboratory of Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China,Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, China,*Correspondence: Jitao Wang, ; Yong Zhang,
| | - Jitao Wang
- School of Public Health, Shanxi Medical University, Taiyuan, Shanxi, China,Department of Microbiology Test, Taiyuan Center for Disease Control and Prevention, Taiyuan, Shanxi, China,*Correspondence: Jitao Wang, ; Yong Zhang,
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6
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Guo X, Lan Z, Wen Y, Zheng C, Rong Z, Liu T, Chen S, Yang X, Zheng H, Wu W. Synbiotics Supplements Lower the Risk of Hand, Foot, and Mouth Disease in Children, Potentially by Providing Resistance to Gut Microbiota Dysbiosis. Front Cell Infect Microbiol 2021; 11:729756. [PMID: 34660342 PMCID: PMC8515124 DOI: 10.3389/fcimb.2021.729756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/27/2021] [Indexed: 11/17/2022] Open
Abstract
Background Hand, foot and mouth disease (HFMD) is an acute enterovirus-induced disease. Gut microbiota dysbiosis has been identified as a factor that plays an important role in enteral virus infection, but the gut microbiota profile in hand, foot and mouth disease has rarely been studied in a large population. Methods A total of 749 children (HFMD: n = 262, healthy control: n = 487) aged 2 to 7 years were recruited from hospitals and communities in the period from May to July, 2017. Clinical and demographical information was collected by trained personnel, and fecal samples were collected and processed for 16S ribosomal RNA(rRNA) gene sequencing. Results We observed a significant alteration in the microbiota profile of children with HFMD compared with that of control children. Patients with enteroviruses A71(EV71) positive had more dysbiotic gut microbiota than those with coxsackievirus A16 (CAV16) positive. We found that Prevotella and Streptococcus were enriched in children with HFMD, whereas beneficial bacteria, including Bifidobacterium and Faecalibacterium, were depleted. Children with synbiotics supplements had lower risk of HFMD and we observed that the gut microbiota of HFMD patients who were administered synbiotics exhibited potential resistance to the dysbiosis detected in HFMD. Conclusions This study suggested that the gut microbiota of patients with hand, foot and mouth disease exhibits dysbiosis and that synbiotics supplements potentially helps maintain the homeostasis of the gut flora.
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Affiliation(s)
- Xiaoying Guo
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- School of Public Health, Southern Medical University, Guangzhou, China
| | - Zixin Lan
- The Second Clinical Medical College, Southern Medical University, Guangzhou, China
| | - Yaling Wen
- School of Mathematics and Computational Science, Guilin University of Electronic Technology, Guangxi, China
| | - Chanjiao Zheng
- Modern Service Industry Department, Guangzhou Technician College, Guangzhou, China
| | - Zuhua Rong
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Tao Liu
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Siyi Chen
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Xingfen Yang
- School of Public Health, Southern Medical University, Guangzhou, China
| | - Huimin Zheng
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| | - Wei Wu
- Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
- School of Public Health, Southern Medical University, Guangzhou, China
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Ji W, Hu Q, Zhang M, Zhang C, Chen C, Yan Y, Zhang X, Chen S, Tao L, Zhang W, Jin Y, Duan G. The Disruption of the Endothelial Barrier Contributes to Acute Lung Injury Induced by Coxsackievirus A2 Infection in Mice. Int J Mol Sci 2021; 22:9895. [PMID: 34576058 DOI: 10.3390/ijms22189895] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 08/15/2021] [Accepted: 09/10/2021] [Indexed: 01/10/2023] Open
Abstract
Sporadic occurrences and outbreaks of hand, foot, and mouth disease (HFMD) caused by Coxsackievirus A2 (CVA2) have frequently reported worldwide recently, which pose a great challenge to public health. Epidemiological studies have suggested that the main cause of death in critical patients is pulmonary edema. However, the pathogenesis of this underlying comorbidity remains unclear. In this study, we utilized the 5-day-old BALB/c mouse model of lethal CVA2 infection to evaluate lung damage. We found that the permeability of lung microvascular was significantly increased after CVA2 infection. We also observed the direct infection and apoptosis of lung endothelial cells as well as the destruction of tight junctions between endothelial cells. CVA2 infection led to the degradation of tight junction proteins (e.g., ZO-1, claudin-5, and occludin). The gene transcription levels of von Willebrand factor (vWF), endothelin (ET), thrombomodulin (THBD), granular membrane protein 140 (GMP140), and intercellular cell adhesion molecule-1 (ICAM-1) related to endothelial dysfunction were all significantly increased. Additionally, CVA2 infection induced the increased expression of inflammatory cytokines (IL-6, IL-1β, and MCP-1) and the activation of p38 mitogen-activated protein kinase (MAPK). In conclusion, the disruption of the endothelial barrier contributes to acute lung injury induced by CVA2 infection; targeting p38-MAPK signaling may provide a therapeutic approach for pulmonary edema in critical infections of HFMD.
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Abstract
Naive CD4+ T cells can differentiate into different cell subsets after receiving antigen stimulation, which secrete corresponding characteristic cytokines and thereby exert biological effects in various diseases. Th22 cells, a novel subset of CD4+ T cells, are different from Th1, Th2, Th17, and Treg cell subsets, which have been discovered in recent years. They can express CCR4, CCR6, and CCR10 molecules and secrete IL-22, IL-13, and TNF-α. They are not able to secrete IL-17, IL-4, and interferon-γ (IFN-γ). IL-22 is considered as a major effector molecule of Th22 cells whose functions and mechanisms of regulating cell differentiation have been constantly improved. In this review, we provide an overview of the origin, differentiation of Th22 cells. Moreover, we also describe the interrelationships between Th22 cells and Th17, Th1, and Th2 cells. Additionally, the role of Th22 cells were discussed in human diseases with virus infection, which will provide novel insight for the prevention and treatment of viral infection in human.
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Affiliation(s)
- Jianguang Gong
- Department of Nephrology, Nephrology Center, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Huifang Zhan
- Department of Emergency, Zhejiang University Hospital, Hangzhou, China
| | - Yan Liang
- Department of Nephrology, Nephrology Center, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China.,Zhejiang Academy of Medical Sciences, Hangzhou, China
| | - Qiang He
- Department of Nephrology, Nephrology Center, Zhejiang Provincial People's Hospital, Affiliated People's Hospital, Hangzhou Medical College, Hangzhou, China
| | - Dawei Cui
- Department of Blood Transfusion, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Yang T, Xie T, Li H, Song X, Yue L, Wang X, Shen D, Ma K, Jiang Q, Long R, Yang R, He X, Zhang Y, Xie Z, Li Q. Immune responses of a CV-A16 live attenuated candidate strain and its protective effects in rhesus monkeys. Emerg Microbes Infect 2021; 9:2136-2146. [PMID: 32930072 PMCID: PMC7580583 DOI: 10.1080/22221751.2020.1823889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Coxsackievirus A16 (CV-A16) is a major causative pathogen of hand, foot, and mouth diseases (HFMDs). The licensed HFMD vaccine targets EV-A71 without cross-protection against CV-A16. Thus, a CV-A16 vaccine is needed. In this study, the immunogenicity and protective efficacy of a live attenuated CV-A16 candidate, K168-8Ac, were evaluated in a rhesus monkey model. Four passages of this strain (P35, P50, P60, and P70) were administered to monkeys, and its protective effect was identified. The immunized monkeys were clinically asymptomatic, except for slight fever. Weak viraemia was observed, and two doses of vaccination were found to significantly reduce virus shedding. High levels of antibody responses were observed (1:1024–1:2048), along with a significant increase in plasma IL-8. The I.M. group showed a much stronger humoural immunity. Pathological damage was detected mainly in lung tissues, although thalamus, spinal cord, lymph nodes, and livers were involved. After the viral challenge, it was found that two doses of vaccine reduced virus shedding, and the degree of lung damage and the number of organs involved decreased as the passage number increased. Overall, a robust immune response and partial protection against CV-A16, triggered by the K168-8Ac strain, were demonstrated. This study provides valuable data for CV-A16 vaccine development.
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Affiliation(s)
- Ting Yang
- Institute of Medical Biology, Chinese Academic Medical Sciences and Peking Union Medical College, Kunming, People's Republic of China
| | - Tianhong Xie
- Institute of Medical Biology, Chinese Academic Medical Sciences and Peking Union Medical College, Kunming, People's Republic of China
| | - Hua Li
- Institute of Medical Biology, Chinese Academic Medical Sciences and Peking Union Medical College, Kunming, People's Republic of China
| | - Xia Song
- Institute of Medical Biology, Chinese Academic Medical Sciences and Peking Union Medical College, Kunming, People's Republic of China
| | - Lei Yue
- Institute of Medical Biology, Chinese Academic Medical Sciences and Peking Union Medical College, Kunming, People's Republic of China
| | - Xi Wang
- Institute of Medical Biology, Chinese Academic Medical Sciences and Peking Union Medical College, Kunming, People's Republic of China
| | - Dong Shen
- Institute of Medical Biology, Chinese Academic Medical Sciences and Peking Union Medical College, Kunming, People's Republic of China
| | - Kaili Ma
- Institute of Medical Biology, Chinese Academic Medical Sciences and Peking Union Medical College, Kunming, People's Republic of China
| | - Qinfang Jiang
- Institute of Medical Biology, Chinese Academic Medical Sciences and Peking Union Medical College, Kunming, People's Republic of China
| | - Runxiang Long
- Institute of Medical Biology, Chinese Academic Medical Sciences and Peking Union Medical College, Kunming, People's Republic of China
| | - Rong Yang
- Institute of Medical Biology, Chinese Academic Medical Sciences and Peking Union Medical College, Kunming, People's Republic of China
| | - Xin He
- Institute of Medical Biology, Chinese Academic Medical Sciences and Peking Union Medical College, Kunming, People's Republic of China
| | - Ye Zhang
- Institute of Medical Biology, Chinese Academic Medical Sciences and Peking Union Medical College, Kunming, People's Republic of China
| | - Zhongping Xie
- Institute of Medical Biology, Chinese Academic Medical Sciences and Peking Union Medical College, Kunming, People's Republic of China
| | - Qihan Li
- Institute of Medical Biology, Chinese Academic Medical Sciences and Peking Union Medical College, Kunming, People's Republic of China
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10
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Lim ZQ, Ng QY, Oo Y, Chu JJH, Ng SY, Sze SK, Alonso S. Enterovirus-A71 exploits peripherin and Rac1 to invade the central nervous system. EMBO Rep 2021; 22:e51777. [PMID: 33871166 DOI: 10.15252/embr.202051777] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 03/02/2021] [Accepted: 03/10/2021] [Indexed: 12/28/2022] Open
Abstract
Enterovirus-A71 (EV-A71) has been associated with severe neurological forms of hand, foot, and mouth disease (HFMD). EV-A71 infects motor neurons at neuromuscular junctions (NMJs) to invade the central nervous system (CNS). Here, we investigate the role of peripherin (PRPH) during EV-A71 infection, a type III intermediate neurofilament involved in neurodegenerative conditions. In mice infected with EV-A71, PRPH co-localizes with viral particles in the muscles at NMJs and in the spinal cord. In motor neuron-like and neuroblastoma cell lines, surface-expressed PRPH facilitates viral entry, while intracellular PRPH influences viral genome replication through interactions with structural and non-structural viral components. Importantly, PRPH does not play a role during infection with coxsackievirus A16, another causative agent of HFMD rarely associated with neurological complications, suggesting that EV-A71 ability to exploit PRPH represents a unique attribute for successful CNS invasion. Finally, we show that EV-A71 also exploits some of the many PRPH-interacting partners. Of these, small GTP-binding protein Rac1 represents a potential druggable host target to limit neuroinvasion of EV-A71.
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Affiliation(s)
- Ze Qin Lim
- Infectious Diseases Translational Research Programme, Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Immunology Programme, Life Sciences Institute, National University of Singapore, Singapore, Singapore
| | - Qing Yong Ng
- Infectious Diseases Translational Research Programme, Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Immunology Programme, Life Sciences Institute, National University of Singapore, Singapore, Singapore
| | - Yukei Oo
- Infectious Diseases Translational Research Programme, Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Immunology Programme, Life Sciences Institute, National University of Singapore, Singapore, Singapore
| | - Justin Jang Hann Chu
- Infectious Diseases Translational Research Programme, Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Shi Yan Ng
- Institute of Molecular and Cell Biology, A*STAR, Singapore, Singapore
| | - Siu Kwan Sze
- Proteomics and Mass Spectrometry Services Core Facility, School of Biological Sciences, Nanyang Technological University, Singapore, Singapore
| | - Sylvie Alonso
- Infectious Diseases Translational Research Programme, Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.,Immunology Programme, Life Sciences Institute, National University of Singapore, Singapore, Singapore
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11
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Chen C, Jiang Q, Song Z, Li Y, Wang H, Lu Y, Wang D, Li M, Li T. Influence of temperature and humidity on hand, foot, and mouth disease in Guangzhou, 2013-2017. J Int Med Res 2021; 48:300060520929895. [PMID: 32527174 PMCID: PMC7446274 DOI: 10.1177/0300060520929895] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Objective To explore associations between temperature, humidity and hand, foot and mouth disease (HFMD) incidence in Guangzhou, China from 2013 to 2017. Methods A distributed lag non-linear model was applied to estimate the effects of daily temperature and humidity on HFMD incidence after adjusting for long-term trends, seasonal trends, and day of the week. Results In total, 353,431 confirmed HFMD cases were reported in Guangzhou over the study period. A bimodal seasonal pattern was observed. High temperatures had acute short-term effects on HFMD incidence that declined quickly over time. The effects of low humidity declined over lag periods, but increased when the humidity surpassed 60.5%. Temperature and humidity were both inversely associated with HFMD incidence during lag days 0 to 3 and with lag periods Conclusions Temperature and humidity play important roles in HFMD incidence. These data are important for developing public health strategies.
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Affiliation(s)
- Chun Chen
- Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong, China
| | - Qinqin Jiang
- Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong, China
| | - Zhuangzhi Song
- Center for Disease Control and Prevention of Inner Mongolia Autonomous Region, Hohhot, Inner Mongolia Autonomous Region, China
| | - Yilan Li
- Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong, China
| | - Hui Wang
- Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong, China
| | - Ying Lu
- Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong, China
| | - Dahu Wang
- Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong, China
| | - Meixia Li
- Guangzhou Center for Disease Control and Prevention, Guangzhou, Guangdong, China
| | - Tiegang Li
- Guangzhou Chest Hospital, Guangzhou, Guangdong, China
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12
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Yang YJ, Liu JN, Pan XD. Synthesis and antiviral activity of lycorine derivatives. J Asian Nat Prod Res 2020; 22:1188-1196. [PMID: 33176482 DOI: 10.1080/10286020.2020.1844674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 10/27/2020] [Accepted: 10/28/2020] [Indexed: 06/11/2023]
Abstract
There are no effective antiviral drugs to treat hand, foot, and mouth disease. In this study, a series of lycorine derivatives were synthesized and evaluated against enterovirus 71 and coxsackievirus A16 in vitro. Derivatives 7c-m with the phenoxyacyl group at the C-1 position showed higher efficacy and lower toxicity than lycorine. In addition, derivative 7e enhanced the survival rate to 40% in the mouse model of the lethal EV71 infection.
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Affiliation(s)
- Ya-Jun Yang
- Beijing Key Laboratory of Active Substance Discovery and Drug ability Evaluation Institute of Material Medical, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China
| | - Jiang-Ning Liu
- Key Laboratory of Human Disease Comparative Medicine, National Health Commission of China (NHC), Institute of Laboratory Animal Science, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing 100050, China
| | - Xian-Dao Pan
- Beijing Key Laboratory of Active Substance Discovery and Drug ability Evaluation Institute of Material Medical, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100050, China
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13
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Kim S, Bae KS, Kim JH, Kang JH, Choi UY. Seroprevalence of Neutralizing Antibodies Against Candidate Serotypes of Enterovirus Vaccines Among Korean Children. Viral Immunol 2020; 34:62-67. [PMID: 33030408 DOI: 10.1089/vim.2020.0073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Hand, foot, and mouth disease (HFMD) is a pediatric public health concern in Asia. Surveillance data on the circulating serotypes of HFMD suggest that Enterovirus A71 (EV-A71) and coxsackieviruses A6, A10, and A16 (CVA6, CVA10, and CVA16) are the major serotypes causing HFMD. Asian countries, including Korea, are currently developing a multivalent vaccine targeting these serotypes. However, the immunity of children against specific serotypes, indicating past infection, should also be considered while selecting candidate serotypes for vaccine development. Therefore, we aimed to identify the age-stratified serological statuses of Korean children to determine candidate serotypes for HFMD vaccine development. This study included 220 participants, categorized into four age groups, 7 months-2 years, 3-5 years, 6-10 years, and 11-15 years. A neutralization test was performed to quantitate the neutralizing antibodies (NtAbs) in the sera of the participants. Only EV-A71 and CVA6 were found suitable as candidate serotypes for vaccine development, whereas further study is needed for CVA10 and CVA16. The highest seropositivity and NtAb titer ranges were observed for CVA6 in all age groups, suggesting that the participants had been predominantly exposed to CVA6. For EV-A71, seropositivity and NtAb titer ranges steadily increased with age, suggesting that children were currently exposed to EV-A71. For CVA10, the 3-5 years group showed the highest seropositivity rate and higher NtAb titer ranges than the older age groups, indicating that the exposure to CVA10 had mainly occurred in recent years. Future studies will identify whether the exposure to CVA10 was transient or will continue. For CVA16, seropositivity and NtAb titer ranges were generally low, indicating that only a few participants had been exposed to CVA16. We identified discrepancies between the sentinel surveillance data and our findings. This study provides a new perspective for HFMD vaccine development and policy making in Asian countries.
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Affiliation(s)
- Sol Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Kil Seong Bae
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Department of Pediatrics, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jong-Hyun Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin Han Kang
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Ui Yoon Choi
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Department of Pediatrics, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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14
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Song Y, Wang D, Zhang Y, Han Z, Xiao J, Lu H, Yan D, Ji T, Yang Q, Zhu S, Xu W. Genetic Diversity Analysis of Coxsackievirus A8 Circulating in China and Worldwide Reveals a Highly Divergent Genotype. Viruses 2020; 12:E1061. [PMID: 32977444 PMCID: PMC7598191 DOI: 10.3390/v12101061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 09/21/2020] [Accepted: 09/22/2020] [Indexed: 02/07/2023] Open
Abstract
Coxsackievirus A8 (CV-A8) is one of the pathogens associated with hand, foot and mouth disease (HFMD) and herpangina (HA), occasionally leading to severe neurological disorders such as acute flaccid paralysis (AFP). Only one study aimed at CV-A8 has been published to date, and only 12 whole-genome sequences are publicly available. In this study, complete genome sequences from 11 CV-A8 strains isolated from HFMD patients in extensive regions from China between 2013 and 2018 were determined, and all sequences from GenBank were retrieved. A phylogenetic analysis based on a total of 34 complete VP1 sequences of CV-A8 revealed five genotypes: A, B, C, D and E. The newly emerging genotype E presented a highly phylogenetic divergence compared with the other genotypes and was composed of the majority of the strains sequenced in this study. Markov chain Monte Carlo (MCMC) analysis revealed that genotype E has been evolving for nearly a century and somehow arose in approximately 2010. The Bayesian skyline plot showed that the population size of CV-A8 has experienced three dynamic fluctuations since 2001. Amino acid residues of VP1100N, 103Y, 240T and 241V, which were embedded in the potential capsid loops of genotype E, might enhance genotype E adaption to the human hosts. The CV-A8 whole genomes displayed significant intra-genotypic genetic diversity in the non-capsid region, and a total of six recombinant lineages were detected. The Chinese viruses from genotype E might have emerged recently from recombining with European CV-A6 strains. CV-A8 is a less important HFMD pathogen, and the capsid gene diversity and non-capsid recombination variety observed in CV-A8 strains indicated that the constant generation of deleterious genomes and a constant selection pressure against these deleterious mutations is still ongoing within CV-A8 quasispecies. It is possible that CV-A8 could become an important pathogen in the HFMD spectrum in the future. Further surveillance of CV-A8 is greatly needed.
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Affiliation(s)
- Yang Song
- WHO WPRO Regional Polio Reference Laboratory, National Health Commission Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing 102206, China; (Y.S.); (D.W.); (Z.H.); (J.X.); (H.L.); (D.Y.); (T.J.); (Q.Y.); (S.Z.)
| | - Dongyan Wang
- WHO WPRO Regional Polio Reference Laboratory, National Health Commission Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing 102206, China; (Y.S.); (D.W.); (Z.H.); (J.X.); (H.L.); (D.Y.); (T.J.); (Q.Y.); (S.Z.)
| | - Yong Zhang
- WHO WPRO Regional Polio Reference Laboratory, National Health Commission Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing 102206, China; (Y.S.); (D.W.); (Z.H.); (J.X.); (H.L.); (D.Y.); (T.J.); (Q.Y.); (S.Z.)
- Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan 430071, China
| | - Zhenzhi Han
- WHO WPRO Regional Polio Reference Laboratory, National Health Commission Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing 102206, China; (Y.S.); (D.W.); (Z.H.); (J.X.); (H.L.); (D.Y.); (T.J.); (Q.Y.); (S.Z.)
| | - Jinbo Xiao
- WHO WPRO Regional Polio Reference Laboratory, National Health Commission Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing 102206, China; (Y.S.); (D.W.); (Z.H.); (J.X.); (H.L.); (D.Y.); (T.J.); (Q.Y.); (S.Z.)
| | - Huanhuan Lu
- WHO WPRO Regional Polio Reference Laboratory, National Health Commission Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing 102206, China; (Y.S.); (D.W.); (Z.H.); (J.X.); (H.L.); (D.Y.); (T.J.); (Q.Y.); (S.Z.)
| | - Dongmei Yan
- WHO WPRO Regional Polio Reference Laboratory, National Health Commission Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing 102206, China; (Y.S.); (D.W.); (Z.H.); (J.X.); (H.L.); (D.Y.); (T.J.); (Q.Y.); (S.Z.)
| | - Tianjiao Ji
- WHO WPRO Regional Polio Reference Laboratory, National Health Commission Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing 102206, China; (Y.S.); (D.W.); (Z.H.); (J.X.); (H.L.); (D.Y.); (T.J.); (Q.Y.); (S.Z.)
| | - Qian Yang
- WHO WPRO Regional Polio Reference Laboratory, National Health Commission Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing 102206, China; (Y.S.); (D.W.); (Z.H.); (J.X.); (H.L.); (D.Y.); (T.J.); (Q.Y.); (S.Z.)
| | - Shuangli Zhu
- WHO WPRO Regional Polio Reference Laboratory, National Health Commission Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing 102206, China; (Y.S.); (D.W.); (Z.H.); (J.X.); (H.L.); (D.Y.); (T.J.); (Q.Y.); (S.Z.)
| | - Wenbo Xu
- WHO WPRO Regional Polio Reference Laboratory, National Health Commission Key Laboratory for Medical Virology, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, No. 155, Changbai Road, Changping District, Beijing 102206, China; (Y.S.); (D.W.); (Z.H.); (J.X.); (H.L.); (D.Y.); (T.J.); (Q.Y.); (S.Z.)
- Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan 430071, China
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15
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An Q, Yao W, Wu J, Pan L, Wang X. Application of the Effect of Latitude on the Starting of Hand, Foot, and Mouth Disease Epidemic on Early Warning in Dalian, Liaoning Province, China. Soc Work Public Health 2020; 35:443-455. [PMID: 32870751 DOI: 10.1080/19371918.2020.1805386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Hand, foot, and mouth disease (HFMD) is a common infectious gastrointestinal disease in children under the age of 5. Many studies have documented that meteorological variables, especially temperature, are associated with HFMD. Since the general climate patterns occur as latitude increases, so latitude may indirectly influence the peak time of HFMD. The objective of this study was to explore the effect of latitude on the starting of an HFMD epidemic in Dalian, which can help in the development of an early warning model of HFMD in difference latitude districts. Spearman's rank correlation coefficient was used to analyze the tendency of HFMD incidence rate over the year. A circular distribution method was used to calculate the gold standard of beginning of the HFMD epidemic. A negative binomial regression model was used to establish the early warning of the starting of the HFMD epidemic. The annualized crude incidence rate of HFMD disease in Dalian, Liaoning Province, China as a whole was 169.14 per 100,000 from 2009 to 2013.The incidence rate of HFMD varied considerably by district during the study period, but there was no significant declining or rising trend in disease incidence over the years by district of Dalian. The circular statistical analysis results showed that there was latitudinal gradient in the starting of the HFMD epidemic except for region B; the starting time of HFMD epidemic of Region A was earlier than other regions range 9 days to 18 days. The starting time of the HFMD epidemic differs from region to region with different latitudes in Dalian, Liaoning Province, China. This result can provide a scientific basis for early warning of HFMD.
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Affiliation(s)
- Qingyu An
- Emergency department, Dalian Center for Disease Control and Prevention , Dalian City, Liaoning Province, PR China
| | - Wei Yao
- Emergency department, Dalian Center for Disease Control and Prevention , Dalian City, Liaoning Province, PR China
| | - Jun Wu
- Emergency department, Dalian Center for Disease Control and Prevention , Dalian City, Liaoning Province, PR China
| | - Liyang Pan
- Emergency department, Dalian Center for Disease Control and Prevention , Dalian City, Liaoning Province, PR China
| | - Xiaoli Wang
- Emergency department, Dalian Center for Disease Control and Prevention , Dalian City, Liaoning Province, PR China
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16
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He S, Huang Y, Zhao Y, Pang B, Wang L, Sun L, Yu H, Wang J, Li J, Song X, Li H. A Reverse Transcription-Polymerase Spiral Reaction (RT-PSR)-Based Rapid Coxsackievirus A16 Detection Method and Its Application in the Clinical Diagnosis of Hand, Foot, and Mouth Disease. Front Microbiol 2020; 11:734. [PMID: 32477283 PMCID: PMC7236501 DOI: 10.3389/fmicb.2020.00734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 03/30/2020] [Indexed: 12/13/2022] Open
Abstract
Hand, foot, and mouth disease (HFMD) is a common viral illness affecting infants and children that is usually caused by Coxsackievirus A16 (CVA-16). To diagnose HFMD, we developed a method for rapid detection of CVA-16 based on reverse transcription-polymerase spiral reaction (RT-PSR). We used two pairs of primers that specifically recognize the conserved sequences of VP1 coding region of CVA-16, and template RNA was reverse transcribed and amplified in a single tube under isothermal conditions, total reaction time could be reduced to less than 40 min. The detection limit of this method was between 2.4 × 102 and 2.4 × 101 copies/μl with excellent specificity. To test the clinical applicability of the method, 40 clinical stool samples were analyzed using RT-PSR and quantitative reverse transcription-polymerase chain reaction, and comparison showed that the coincidence rate was 100%. Compared with other similar detection methods, RT-PSR requires less time, simpler operation, and lower cost. These results prove that our novel, simple, and reliable isothermal nucleic acid testing assay has potential application for clinical detection of CVA-16.
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Affiliation(s)
- Shiyu He
- Department of Hygienic Inspection, School of Public Health, Jilin University, Changchun, China
| | - Yanzhi Huang
- Research Laboratory, Changchun Children's Hospital, Changchun, China
| | - Yanling Zhao
- Research Laboratory, Changchun Children's Hospital, Changchun, China
| | - Bo Pang
- Department of Hygienic Inspection, School of Public Health, Jilin University, Changchun, China
| | - Lixue Wang
- Research Laboratory, Changchun Children's Hospital, Changchun, China
| | - Liwei Sun
- Research Laboratory, Changchun Children's Hospital, Changchun, China
| | - Haoyan Yu
- Department of Hygienic Inspection, School of Public Health, Jilin University, Changchun, China
| | - Juan Wang
- Department of Hygienic Inspection, School of Public Health, Jilin University, Changchun, China
| | - Juan Li
- Department of Hygienic Inspection, School of Public Health, Jilin University, Changchun, China
| | - Xiuling Song
- Department of Hygienic Inspection, School of Public Health, Jilin University, Changchun, China
| | - Hui Li
- Department of Hygienic Inspection, School of Public Health, Jilin University, Changchun, China
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17
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Li YP, Wang MQ, Deng HL, Li M, Zhang X, Dang SS, Zhai S. Association of polymorphisms in the vitamin D receptor gene with susceptibility to and severity of hand, foot, and mouth disease caused by coxsackievirus A16. J Med Virol 2019; 92:271-278. [PMID: 31587312 DOI: 10.1002/jmv.25603] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 10/01/2019] [Indexed: 12/14/2022]
Abstract
Coxsackievirus A16 (CA16) remains the most common causative agent of hand, foot, and mouth disease (HFMD), and is related to high incidence and critical complications. Vitamin D receptor (VDR) activity might affect the outcome of CA16 infection. Our case-control research aims to evaluate the relationship between VDR polymorphisms in the gene encoding and susceptibility to and severity of HFMD due to CA16. Three single-nucleotide polymorphisms (SNPs) of VDR gene were selected according to functional prediction and linkage disequilibrium, and were examined utilizing the SNPscan method to identify possible associations with HFMD caused by CA16. A significant relationship was found in the HFMD cases of polymorphism rs11574129 (GA vs GG: odds ratio (OR) = 0.068, 95% confidence interval (CI) = 0.007-0.693, P = .023; GA + AA vs GG: OR = 0.322, 95%CI = 0.106-0.984, P = .047), and vitamin D levels in genotype AA were significantly higher than those in genotype GG (P < .05). These results suggest that VDR rs11574129 may influence genetic susceptibility to CA16-associated HFMD.
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Affiliation(s)
- Ya-Ping Li
- Department of Infectious Diseases, Xi'an Jiaotong University Second Affiliated Hospital, Xi'an, China
| | - Mu-Qi Wang
- Department of Infectious Diseases, Xi'an Jiaotong University Second Affiliated Hospital, Xi'an, China
| | - Hui-Ling Deng
- Department of Infectious Diseases, Xi'an Children's Hospital, Xi'an, China
| | - Mei Li
- Department of Infectious Diseases, Xi'an Jiaotong University Second Affiliated Hospital, Xi'an, China
| | - Xin Zhang
- Department of Infectious Diseases, Xi'an Jiaotong University Second Affiliated Hospital, Xi'an, China
| | - Shuang-Suo Dang
- Department of Infectious Diseases, Xi'an Jiaotong University Second Affiliated Hospital, Xi'an, China
| | - Song Zhai
- Department of Infectious Diseases, Xi'an Jiaotong University Second Affiliated Hospital, Xi'an, China
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18
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Yang D, Liu R, Ye L, Hu Q, Rui J, Zhou Y, Zhang H, Zhang X, Zhao B, Chen T. Hand, foot, and mouth disease in Changsha City, China, 2009-2017: a new method to analyse the epidemiological characteristics of the disease. Infect Dis (Lond) 2019; 52:39-44. [PMID: 31596157 DOI: 10.1080/23744235.2019.1675902] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Objectives: By adopting a new method, this study aimed to analyse the epidemiological characteristics of hand, foot, and mouth disease (HFMD) in nine districts and counties (cities) of Changsha City, China, from 2009 to 2017.Methods: The reported HFMD cases were collected in Changsha from 2009 to 2017. The traditional descriptive method and a new method (index system) including six indices (richness index N, Simpson diversity index D, Shannon diversity index H, Berger-Parker dominance index d, Shannon evenness index E, and Morisita-Horn similarity index C) were used to describe the epidemiological characteristics of HFMD in Changsha.Results: There were 214155 HFMD reported in Changsha during the study period. The incidence of the disease was higher in even-numbered years (2010, 2012, 2014, and 2016) than in uneven-numbered years (2009, 2011, 2013, 2015, and 2017), with two peaks in May to June and October to November every year. The age of onset was mainly from 0 to 5 years old, and the death was mainly from 0 to 2 years old. According to occupational classification, districts and counties (cities) had a high degree of similarity of the composition of HFMD, and there was no regional difference.Conclusions: Changsha had a yearly increasing trend of HFMD from 2009 to 2017, and the key population for prevention and control was children aged in 0-5 years old. Seasonal distribution of high incidence and peak incidence were occurred in even-numbered years. The sub-regions of the city shared moderate diversity and high similarity of occupational distribution of HFMD.
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Affiliation(s)
- Dong Yang
- Changsha Center for Disease Control and Prevention, Changsha, People's Republic of China
| | - Ruchun Liu
- Changsha Center for Disease Control and Prevention, Changsha, People's Republic of China
| | - Lan Ye
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, People's Republic of China
| | - Qingqing Hu
- Division of Public Health, School of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Jia Rui
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, People's Republic of China
| | - Yinzhu Zhou
- Changsha Center for Disease Control and Prevention, Changsha, People's Republic of China
| | - Heng Zhang
- Changsha Center for Disease Control and Prevention, Changsha, People's Republic of China
| | - Xixing Zhang
- Changsha Center for Disease Control and Prevention, Changsha, People's Republic of China
| | - Benhua Zhao
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, People's Republic of China
| | - Tianmu Chen
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, People's Republic of China
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Yan S, Wei L, Duan Y, Li H, Liao Y, Lv Q, Zhu F, Wang Z, Lu W, Yin P, Cheng J, Jiang H. Short-Term Effects of Meteorological Factors and Air Pollutants on Hand, Foot and Mouth Disease among Children in Shenzhen, China, 2009-2017. Int J Environ Res Public Health 2019; 16:ijerph16193639. [PMID: 31569796 PMCID: PMC6801881 DOI: 10.3390/ijerph16193639] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 09/12/2019] [Accepted: 09/23/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND A few studies have explored the association between meteorological factors and hand, foot, and mouth disease (HFMD) with inconsistent results. Besides, studies about the effects of air pollutants on HFMD are very limited. METHODS Daily HFMD cases among children aged 0-14 years in Shenzhen were collected from 2009 to 2017. A distributed lag nonlinear model (DLNM) model was fitted to simultaneously assess the nonlinear and lagged effects of meteorological factors and air pollutants on HFMD incidence, and to further examine the differences of the effect across different subgroups stratified by gender, age and childcare patterns. RESULTS The cumulative relative risk (cRR) (median as reference) of HFMD rose with the increase of daily temperature and leveled off at about 30 °C (cRR: 1.40, 95%CI: 1.29, 1.51). There was a facilitating effect on HFMD when relative humidity was 46.0% to 88.8% (cRR at 95th percentile: 1.18, 95%CI: 1.11, 1.27). Short daily sunshine duration (5th vs. 50th) promoted HFMD (cRR: 1.07, 95%CI: 1.02, 1.11). The positive correlation between rainfall and HFMD reversed when it exceeded 78.3 mm (cRR: 1.41, 95% CI: 1.22, 1.63). Ozone suppressed HFMD when it exceeded 104 µg /m3 (cRR at 99th percentile: 0.85, 95%CI: 0.76, 0.94). NO2 promoted HFMD among infants and the cRR peaked at lag 9 day (cRR: 1.47, 95%CI: 1.02, 2.13) (99th vs. 50th). Besides, children aged below one year, males and scattered children were more vulnerable to high temperature, high relative humidity, and short sunshine duration. CONCLUSIONS Temperature, relative humidity, sunshine duration, rainfall, ozone and NO2 were significantly associated with HFMD, and such effects varied with gender age and childcare patterns. These findings highlight the need for more prevention effort to the vulnerable populations and may be helpful for developing an early environment-based warning system for HFMD.
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Affiliation(s)
- Siyu Yan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan 430030, China.
| | - Lan Wei
- Shenzhen Center for Disease Control and Prevention, 8 Longyuan Rd, Shenzhen 518055, China.
| | - Yanran Duan
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan 430030, China.
| | - Hongyan Li
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan 430030, China.
| | - Yi Liao
- Shenzhen Center for Disease Control and Prevention, 8 Longyuan Rd, Shenzhen 518055, China.
| | - Qiuying Lv
- Shenzhen Center for Disease Control and Prevention, 8 Longyuan Rd, Shenzhen 518055, China.
| | - Fang Zhu
- Shenzhen Center for Disease Control and Prevention, 8 Longyuan Rd, Shenzhen 518055, China.
| | - Zhihui Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan 430030, China.
| | - Wanrong Lu
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan 430030, China.
| | - Ping Yin
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan 430030, China.
| | - Jinquan Cheng
- Shenzhen Center for Disease Control and Prevention, 8 Longyuan Rd, Shenzhen 518055, China.
| | - Hongwei Jiang
- Department of Epidemiology and Biostatistics, School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Rd, Wuhan 430030, China.
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Kanbayashi D, Kaida A, Hirai Y, Yamamoto SP, Fujimori R, Okada M, Kubo H, Iritani N. An Epidemic of Hand, Foot, and Mouth Disease Caused by Coxsackievirus A6 in Osaka City, Japan, in 2017. Jpn J Infect Dis 2019; 72:334-336. [PMID: 31061358 DOI: 10.7883/yoken.jjid.2018.532] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The second largest epidemic of hand, foot, and mouth disease since 1982 occurred in 2017, which involved 6,173 cases in Osaka City, Japan. The main causative agent was coxsackievirus A6 (CV-A6). Phylogenetic analysis revealed that the detected CV-A6 strains belonged to genetic groups A3 and A4 in clade A.
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Affiliation(s)
| | | | | | | | - Ryoko Fujimori
- Osaka City Public Health Bureau, Osaka City Health Center
| | - Megumi Okada
- Osaka City Public Health Bureau, Osaka City Health Center
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Giachè S, Borchi B, Zammarchi L, Colao MG, Ciccone N, Sterrantino G, Rossolini GM, Bartoloni A, Trotta M. Hand, foot, and mouth disease in pregnancy: 7 years Tuscan experience and literature review. J Matern Fetal Neonatal Med 2019; 34:1494-1500. [PMID: 31291796 DOI: 10.1080/14767058.2019.1638898] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVE Evaluation of hand, foot, and mouth disease (HFMD) diagnostic strategies in pregnancy and the risk of HFMD-related fetopathy. STUDY DESIGN Pregnant women consecutively evaluated between 2010 and 2016 at the Tuscany Reference Center for Infectious Diseases in Pregnancy for HFMD were enrolled. A descriptive analysis of infected patients/newborns data and literature review were carried out. RESULT Of the 128 women evaluated, 52 (41%) were symptomatic: 32 (61.5%) developed HFM vesicles, 12 (23%) palmoplantar vesicles, and 8 (15.5%) oral aphthae. Serological positivity and direct Enterovirus detection on blood and vesicle were obtained in 1.9% (1/52), 9.1% (1/11), and 68.7% (11/16), respectively. Three miscarriage and few cases of fetal/neonatal anomalies were reported. CONCLUSION HFMD diagnosis is primarily a clinical diagnosis. Direct viral detection is more sensitive than serology. Considering our series and literature review, data on embryo-fetal-neonatal outcomes are not conclusive. Although the role of EV as causative agents of congenital defects remains uncertain, the described cases of unfavorable outcome impose prudence and monitoring of pregnant women with HFMD throughout the gestation.
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Affiliation(s)
- Susanna Giachè
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Beatrice Borchi
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy.,Tuscany Reference Center for Infectious Diseases in Pregnancy, Careggi University Hospital, Florence, Italy
| | - Lorenzo Zammarchi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy.,Tuscany Reference Center for Infectious Diseases in Pregnancy, Careggi University Hospital, Florence, Italy
| | - Maria Grazia Colao
- Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy
| | - Nunziata Ciccone
- Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy
| | - Gaetana Sterrantino
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Gian Maria Rossolini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Microbiology and Virology Unit, Careggi University Hospital, Florence, Italy
| | - Alessandro Bartoloni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy
| | - Michele Trotta
- Infectious and Tropical Diseases Unit, Careggi University Hospital, Florence, Italy.,Tuscany Reference Center for Infectious Diseases in Pregnancy, Careggi University Hospital, Florence, Italy
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22
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Wang M, Li J, Yao MX, Zhang YW, Hu T, Carr MJ, Duchêne S, Zhang XC, Zhang ZJ, Zhou H, Tong YG, Ding SJ, Wang XJ, Shi WF. Genome Analysis of Coxsackievirus A4 Isolates From Hand, Foot, and Mouth Disease Cases in Shandong, China. Front Microbiol 2019; 10:1001. [PMID: 31134033 PMCID: PMC6513881 DOI: 10.3389/fmicb.2019.01001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 04/18/2019] [Indexed: 01/12/2023] Open
Abstract
Coxsackievirus A4 (CVA4) is one of the most prevalent pathogens associated with hand, foot and mouth disease (HFMD), an acute febrile illness in children, and is also associated with acute localized exanthema, myocarditis, hepatitis and pancreatitis. Despite this, limited CVA4 genome sequences are currently available. Herein, complete genome sequences from CVA4 strains (n = 21), isolated from patients with HFMD in Shandong province, China between 2014 and 2016, were determined and phylogenetically characterized. Phylogenetic analysis of the VP1 gene from a larger CVA4 collection (n = 175) showed that CVA4 has evolved into four separable genotypes: A, B, C, and D; and genotype D could be further classified in to two sub-genotypes: D1 and D2. Each of the 21 newly described genomes derived from isolates that segregated with sub-genotype D2. The CVA4 genomes displayed significant intra-genotypic genetic diversity with frequent synonymous substitutions occurring at the third codon positions, particularly within the P2 region. However, VP1 was relatively stable and therefore represents a potential target for molecular diagnostics assays and also for the rational design of vaccine epitopes. The substitution rate of VP1 was estimated to be 5.12 × 10-3 substitutions/site/year, indicative of ongoing CVA4 evolution. Mutations at amino acid residue 169 in VP1 gene may be responsible for differing virulence of CVA4 strains. Bayesian skyline plot analysis showed that the population size of CVA4 has experienced several dynamic fluctuations since 1948. In summary, we describe the phylogenetic and molecular characterization of 21 complete genomes from CVA4 isolates which greatly enriches the known genomic diversity of CVA4 and underscores the need for further surveillance of CVA4 in China.
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Affiliation(s)
- Min Wang
- Key Laboratory of Etiology and Epidemiology of Emerging Infectious Diseases in Universities of Shandong, Taishan Medical College, Tai'an, China
| | - Juan Li
- Key Laboratory of Etiology and Epidemiology of Emerging Infectious Diseases in Universities of Shandong, Taishan Medical College, Tai'an, China
| | - Ming-Xiao Yao
- Shandong Provincial Key Laboratory of Communicable Disease Control and Prevention, Institute for Viral Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Ya-Wei Zhang
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Tao Hu
- Key Laboratory of Etiology and Epidemiology of Emerging Infectious Diseases in Universities of Shandong, Taishan Medical College, Tai'an, China
| | - Michael J Carr
- Global Station for Zoonosis Control, Global Institution for Collaborative Research and Education, Hokkaido University, Sapporo, Japan.,National Virus Reference Laboratory, School of Medicine, University College Dublin, Dublin, Ireland
| | - Sebastián Duchêne
- Department of Biochemistry and Molecular Biology, Bio21 Molecular Science and Biotechnology Institute, The University of Melbourne, Parkville, VIC, Australia
| | - Xing-Cheng Zhang
- Key Laboratory of Etiology and Epidemiology of Emerging Infectious Diseases in Universities of Shandong, Taishan Medical College, Tai'an, China
| | - Zhen-Jie Zhang
- Key Laboratory of Etiology and Epidemiology of Emerging Infectious Diseases in Universities of Shandong, Taishan Medical College, Tai'an, China
| | - Hong Zhou
- Key Laboratory of Etiology and Epidemiology of Emerging Infectious Diseases in Universities of Shandong, Taishan Medical College, Tai'an, China
| | - Yi-Gang Tong
- State Key Laboratory of Pathogen and Biosecurity, Beijing Institute of Microbiology and Epidemiology, Beijing, China
| | - Shu-Jun Ding
- Shandong Provincial Key Laboratory of Communicable Disease Control and Prevention, Institute for Viral Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Xian-Jun Wang
- Shandong Provincial Key Laboratory of Communicable Disease Control and Prevention, Institute for Viral Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Wei-Feng Shi
- Key Laboratory of Etiology and Epidemiology of Emerging Infectious Diseases in Universities of Shandong, Taishan Medical College, Tai'an, China
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23
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Abstract
Hand, foot, and mouth disease is an enteroviral infection characterized by vesicles on the hands, feet, and oral mucosa. Given its rising incidence among adults, it is important to recognize its variable presentations and sequelae. These include onychomadesis, a complication of hand, foot, and mouth disease that is well described in children, with limited reports in adults. We present the unique case of a pregnant woman who developed onychomadesis following hand, foot, and mouth disease, with no adverse pregnancy outcomes. This case illustrates that (1) onychomadesis can occur in pregnant women with hand, foot, and mouth disease; (2) onychomadesis is typically a benign change that can occur following hand, foot, and mouth disease; and (3) onychomadesis is not necessarily associated with more severe disease or adverse pregnancy outcomes.
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Affiliation(s)
- Maya Deeb
- University of Toronto, Toronto, ON, Canada
| | - Renée A Beach
- University of Toronto, Toronto, ON, Canada.,Division of Dermatology, Women's College Hospital, Toronto, ON, Canada
| | - Susie Kim
- University of Toronto, Toronto, ON, Canada.,Division of Family Medicine, Women's College Hospital, Toronto, ON, Canada
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24
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Wang X, An Z, Huo D, Jia L, Li J, Yang Y, Liang Z, Wang Q, Wang H. Enterovirus A71 vaccine effectiveness in preventing enterovirus A71 infection among medically-attended hand, foot, and mouth disease cases, Beijing, China. Hum Vaccin Immunother 2019; 15:1183-1190. [PMID: 30779680 PMCID: PMC6605830 DOI: 10.1080/21645515.2019.1581539] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Introduction: Enterovirus A71(EV-A71)-associated hand, foot, and mouth disease (HFMD) has been reported worldwide, and poses a particularly heavy burden on patients, families, and society in China. Three Chinese companies have licensed inactivated EV-A71 vaccines, all of which have demonstrated good efficacy for preventing EV-A71-associated disease in clinical trials. However, real-world performance of EV-A71 vaccine has not been evaluated. Methods: We used a test-negative design case-control study to estimate vaccine effectiveness (VE) against medically attended EV-A71-associated HFMD. Subjects were children 5 years of age and under who had been in health facilities participating in the HFMD case and virologic surveillance platforms in Beijing. Enterovirus infections were laboratory confirmed, and EV-A71 vaccination status was extracted from electronic immunization records. Children testing positive for EV-A71 were cases; controls were children testing negative for EV-A71 infection. Logistic regression was used to estimate VE. We assessed sensitivity of VE estimates to control group inclusion criteria by repeating the regression analyses with two alternative control groups. Results: A total of 2,184 HFMD patients aged 5 years and under were enrolled in the study; 24 were severe, and 2,160 were mild. For severe cases, two-dose VE estimate was 100% (95% CI: −68.1%, 100%). For mild cases, 1-dose and 2-dose adjusted VE estimates were 69.8% and 83.7%, respectively. Two-dose VE estimates varied by less than 4 percentage points regardless of control group definition. Conclusions: Our findings suggested the vaccines performed well in the real world for children 5 years of age and under in Beijing, China.
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Affiliation(s)
- Xiaoli Wang
- a Department of the National Immunization Program , Chinese Center for Disease Control and Prevention , Beijing , China.,b Beijing Center for Disease Prevention and Control , Beijing Research Center for Preventive Medicine , Beijing , China
| | - Zhijie An
- a Department of the National Immunization Program , Chinese Center for Disease Control and Prevention , Beijing , China
| | - Da Huo
- b Beijing Center for Disease Prevention and Control , Beijing Research Center for Preventive Medicine , Beijing , China
| | - Lei Jia
- b Beijing Center for Disease Prevention and Control , Beijing Research Center for Preventive Medicine , Beijing , China
| | - Jie Li
- b Beijing Center for Disease Prevention and Control , Beijing Research Center for Preventive Medicine , Beijing , China
| | - Yang Yang
- b Beijing Center for Disease Prevention and Control , Beijing Research Center for Preventive Medicine , Beijing , China
| | - Zhichao Liang
- b Beijing Center for Disease Prevention and Control , Beijing Research Center for Preventive Medicine , Beijing , China
| | - Quanyi Wang
- b Beijing Center for Disease Prevention and Control , Beijing Research Center for Preventive Medicine , Beijing , China
| | - Huaqing Wang
- a Department of the National Immunization Program , Chinese Center for Disease Control and Prevention , Beijing , China
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25
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Zhang Y, Suo X, Zhang Y. Association of IL-13, S100B, and TLR-7 Gene Polymorphisms with Enterovirus 71 Infection in Hand, Foot, and Mouth Disease in China. Genet Test Mol Biomarkers 2019; 23:188-196. [PMID: 30807256 DOI: 10.1089/gtmb.2018.0239] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIM This study was conducted to determine if single nucleotide polymorphisms within the interleukin (IL)-13 (rs20541 locus), the S100B (rs9722 locus), and the toll-like receptor (TLR)-7 (rs179019 and rs3853839 loci) genes are associated with the clinical severity of disease caused by enterovirus 71 (EV71) in children suffering from hand, foot, and mouth disease (HFMD). MATERIALS AND METHODS A total of 355 children, diagnosed with HFMD, were divided into two groups: severe (totaling 162 cases) and mild (totaling 193 cases). Three hundred healthy children were recruited as a control group. The gene polymorphisms of the rs20541 locus in the IL-13 gene; the rs9722 locus in the S100B gene; and the rs179019 and the rs3853839 loci in the TLR-7 gene were analyzed with Sanger sequencing. The expression levels of IL-13, S100B, interferon (IFN)-α, IL-6 and the relative expression level of TLR-7 were calculated for each genotype. RESULTS This study demonstrated that the T allele at the rs9722 locus of the S100B gene was a significant risk factor for severe HFMD. The rs3853839 C allele of the TLR-7 gene was also a risk factor for severe HFMD in both male and female patients. The G allele at the rs20541 locus of IL-13 gene and the A allele at the rs179019 locus of the TLR-7 gene were not risk factors for severe HFMD in either male or female patients. CONCLUSION The T allele at the rs9722 locus of S100B gene is a risk factor for the severe HFMD caused by EV71 infection, of which the mechanism may be due to the promotion of S100B protein secretion. The allele C at TLR-7 rs3853839 locus is a risk factor for the severe HFMD caused by EV71 infection, which may be related to a reduction of the relative expression of TLR-7, IFN-α, and IL-6.
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Affiliation(s)
- Yuhong Zhang
- 1 Department of Infectious Diseases and Dongying People's Hospital, Dongying, China
| | - Xiaoying Suo
- 1 Department of Infectious Diseases and Dongying People's Hospital, Dongying, China
| | - Yufang Zhang
- 2 Department of Hyperbaric Oxygenation, Dongying People's Hospital, Dongying, China
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26
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Wang SH, Wang A, Liu PP, Zhang WY, Du J, Xu S, Liu GC, Zheng BS, Huan C, Zhao K, Yu XF. Divergent Pathogenic Properties of Circulating Coxsackievirus A6 Associated with Emerging Hand, Foot, and Mouth Disease. J Virol 2018; 92:e00303-18. [PMID: 29563294 DOI: 10.1128/JVI.00303-18] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 03/16/2018] [Indexed: 12/18/2022] Open
Abstract
Coxsackievirus A6 (CV-A6) is an emerging pathogen associated with hand, foot, and mouth disease (HFMD). Its genetic characterization and pathogenic properties are largely unknown. Here, we report 39 circulating CV-A6 strains isolated in 2013 from HFMD patients in northeast China. Three major clusters of CV-A6 were identified and related to CV-A6, mostly from Shanghai, indicating that domestic CV-A6 strains were responsible for HFMD emerging in northeast China. Four full-length CV-A6 genomes representing each cluster were sequenced and analyzed further. Bootscanning tests indicated that all four CV-A6-Changchun strains were most likely recombinants between the CV-A6 prototype Gdula and prototype CV-A4 or CV-A4-related viruses, while the recombination pattern was related to, yet distinct from, the strains isolated from other regions of China. Furthermore, different CV-A6 strains showed different capabilities of viral replication, release, and pathogenesis in a mouse model. Further analyses indicated that viral protein 2C contributed to the diverse pathogenic abilities of CV-A6 by causing autophagy and inducing cell death. To our knowledge, this study is the first to report lethal and nonlethal strains of CV-A6 associated with HFMD. The 2C protein region may play a key role in the pathogenicity of CV-A6 strains.IMPORTANCE Hand, foot, and mouth disease (HFMD) is a major and persistent threat to infants and children. Besides the most common pathogens, such as enterovirus A71 (EV-A71) and coxsackievirus A16 (CV-A16), other enteroviruses are increasingly contributing to HFMD. The present study focused on the recently emerged CV-A6 strain. We found that CV-A6 strains isolated in Changchun City in northeast China were associated with domestic origins. These Changchun viruses were novel recombinants of the CV-A6 prototype Gdula and CV-A4. Our results imply that measures to control CV-A6 transmission are urgently needed. Further analyses revealed differing pathogenicities in strains isolated in a neonatal mouse model. One of the possible causes has been narrowed down to the viral protein 2C, using phylogenetic studies, viral sequences, and direct tests on cultured human cells. Thus, the viral 2C protein is a promising target for antiviral drugs to prevent CV-A6-induced tissue damage.
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27
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Cox JA, Hiscox JA, Solomon T, Ooi MH, Ng LFP. Immunopathogenesis and Virus-Host Interactions of Enterovirus 71 in Patients with Hand, Foot and Mouth Disease. Front Microbiol 2017; 8:2249. [PMID: 29238324 PMCID: PMC5713468 DOI: 10.3389/fmicb.2017.02249] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 10/31/2017] [Indexed: 12/12/2022] Open
Abstract
Enterovirus 71 (EV71) is a global infectious disease that affects millions of people. The virus is the main etiological agent for hand, foot, and mouth disease with outbreaks and epidemics being reported globally. Infection can cause severe neurological, cardiac, and respiratory problems in children under the age of 5. Despite on-going efforts, little is known about the pathogenesis of EV71, how the host immune system responds to the virus and the molecular mechanisms behind these responses. Moreover, current animal models remain limited, because they do not recapitulate similar disease patterns and symptoms observed in humans. In this review the role of the host-viral interactions of EV71 are discussed together with the various models available to examine: how EV71 utilizes its proteins to cleave host factors and proteins, aiding virus replication; how EV71 uses its own viral proteins to disrupt host immune responses and aid in its immune evasion. These discoveries along with others, such as the EV71 crystal structure, have provided possible targets for treatment and drug interventions.
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Affiliation(s)
- Jonathan A. Cox
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore, Singapore
| | - Julian A. Hiscox
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore, Singapore
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom
| | - Tom Solomon
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom
- Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Mong-How Ooi
- Institute of Health and Community Medicine, Universiti Malaysia Sarawak, Samarahan, Malaysia
- Department of Paediatrics, Sarawak General Hospital, Kuching, Malaysia
| | - Lisa F. P. Ng
- Institute of Infection and Global Health, University of Liverpool, Liverpool, United Kingdom
- Singapore Immunology Network, Agency for Science, Technology and Research, Singapore, Singapore
- NIHR Health Protection Research Unit in Emerging and Zoonotic Infections, Liverpool, United Kingdom
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28
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Huang Q, Wang Y, Si C, Zhao D, Wang Y, Duan Y. Interleukin-35 Modulates the Imbalance Between Regulatory T Cells and T Helper 17 Cells in Enterovirus 71-Induced Hand, Foot, and Mouth Disease. J Interferon Cytokine Res 2017; 37:522-530. [PMID: 29172969 DOI: 10.1089/jir.2017.0080] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Interleukin (IL)-35 modulates the imbalance between regulatory T cells (Tregs) and T helper (Th) 17 cells, which played vital roles in the pathogenesis of autoimmune and infectious diseases. However, the role of Tregs/Th17 cell imbalance and the regulatory functions of IL-35 have remained largely unknown in enterovirus 71 (EV71)-induced hand, foot, and mouth disease (HFMD). In this study, a total of 47 HFMD patients (30 with mild HFMD and 17 with severe HFMD) and 13 healthy individuals were enrolled. The frequencies of CD4+CD25+CD127dim/- Tregs and CD4+IL-17+ Th17 cells, as well as IL-35 expression levels, were measured. Cellular proliferation and cytokine production was also determined in purified Tregs following recombinant IL-35 stimulation. An imbalance between Tregs and Th17 cells was observed in children with severe HFMD, which manifested as a reduction in the Tregs population and an elevation in the Th17 population. Serum IL-35 concentrations were also decreased in case of severe HFMD, which correlated with the Tregs:Th17 cell ratios. Recombinant IL-35 stimulation increased the proportion of Tregs, but downregulated that of Th17 cells. Treatment with IL-35 enhanced Tregs suppressive function and IL-35 and IL-10 expression, but reduced IL-22 secretion in both healthy individuals and those with severe HFMD. The Tregs:Th17 cell ratio was increased in the convalescent patients, however, a significant reduction in serum IL-35 was not observed. Our findings indicated that EV71 infection shifted the Tregs:Th17 cell ratio through IL-35 by downregulating inhibitory cytokine production and reducing the cell-to-cell contact inhibition of effector T cells. Regulation of IL-35 as it relates to the Tregs/Th17 balance may play a critical role in the pathogenesis of EV71-associated HFMD.
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Affiliation(s)
- Qian Huang
- 1 Department of Pediatrics, The First Affiliated Hospital of Xinxiang Medical University , Weihui, China
| | - Yanhua Wang
- 1 Department of Pediatrics, The First Affiliated Hospital of Xinxiang Medical University , Weihui, China
| | - Changyun Si
- 2 Department of Infectious Diseases, The First Affiliated Hospital of Xinxiang Medical University , Weihui, China
| | - De'an Zhao
- 1 Department of Pediatrics, The First Affiliated Hospital of Xinxiang Medical University , Weihui, China
| | - Yanping Wang
- 2 Department of Infectious Diseases, The First Affiliated Hospital of Xinxiang Medical University , Weihui, China
| | - Yuxiu Duan
- 2 Department of Infectious Diseases, The First Affiliated Hospital of Xinxiang Medical University , Weihui, China
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Sumi A, Toyoda S, Kanou K, Fujimoto T, Mise K, Kohei Y, Koyama A, Kobayashi N. Association between meteorological factors and reported cases of hand, foot, and mouth disease from 2000 to 2015 in Japan. Epidemiol Infect 2017; 145:2896-911. [PMID: 28826420 DOI: 10.1017/S0950268817001820] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The purpose of this study was to clarify the association between hand, foot, and mouth disease (HFMD) epidemics and meteorological conditions. We used HFMD surveillance data of all 47 prefectures in Japan from January 2000 to December 2015. Spectral analysis was performed using the maximum entropy method (MEM) for temperature-, relative humidity-, and total rainfall-dependent incidence data. Using MEM-estimated periods, long-term oscillatory trends were calculated using the least squares fitting (LSF) method. The temperature and relative humidity thresholds of HFMD data were estimated from the LSF curves. The average temperature data indicated a lower threshold at 12 °C and a higher threshold at 30 °C for risk of HFMD infection. Maximum and minimum temperature data indicated a lower threshold at 6 °C and a higher threshold at 35 °C, suggesting a need for HFMD control measures at temperatures between 6 and 35 °C. Based on our findings, we recommend the use of maximum and minimum temperatures rather than the average temperature, to estimate the temperature threshold of HFMD infections. The results obtained might aid in the prediction of epidemics and preparation for the effect of climatic changes on HFMD epidemiology.
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Zheng W, Shi H, Chen Y, Xu Z, Chen J, Jin L. Alteration of serum high-mobility group protein 1 (HMGB1) levels in children with enterovirus 71-induced hand, foot, and mouth disease. Medicine (Baltimore) 2017; 96:e6764. [PMID: 28445307 PMCID: PMC5413272 DOI: 10.1097/md.0000000000006764] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Hand, foot, and mouth disease (HFMD) is a common pediatric disease caused by enterovirus infection. It typically presents as a fever along with flat, discolored spots and bumps on the hands, feet, and mouth. Compared with other viruses, enterovirus 71 (EV71)-induced HFMD is more prone to cause severe complications in children, such as brainstem encephalitis, cardiopulmonary disorders, and even death. More in-depth studies are still necessary to understand the characteristics of EV71-induced HFMD, although some related research has been reported so far. High-mobility group box 1 (HMGB1) is an inflammatory cytokine that can upregulate other inflammatory factors through its receptors, such as Toll-like receptors and the receptor for advanced glycation endproducts.We prospectively investigated the alteration of serum HMGB1, interleukin (IL)-6, and tumor necrosis factor (TNF)-α levels before and after treatment in 82 children with HFMD.We found that the serum HMGB1, IL-6, and TNF-α levels were significantly increased in EV71-induced HFMD, and that these changes were more serious in the severe and critical HMFD groups; however, there was no significant difference in the HMGB1 level between the normal control and mild HMFD groups. Moreover, the serum HMGB1 level was positively correlated with the alteration of serum IL-6 and TNF-α concentrations.These results suggest that HMGB1 is involved in the inflammatory pathogenesis of EV71-induced HFMD and that the serum level of HMGB1 could be applied as a clinical indicator for the severity of HFMD, and also a sign for the recovery prognosis of HFMD.
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Miller PK, Zain-Ul-Abideen M, Paul J, Perry AE, Linos K, Carter JB, Kurtzberg J, Mann JA. A case of eczema coxsackium with erythema multiforme-like histopathology in a 14-year-old boy with chronic graft-versus-host disease. JAAD Case Rep 2017; 3:49-52. [PMID: 28203622 PMCID: PMC5292754 DOI: 10.1016/j.jdcr.2016.11.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Key Words
- CVA16, Coxsackievirus A16
- CVA6, Coxsackievirus A6
- EC, eczema coxsackium
- EM, erythema multiforme
- EV, enterovirus
- GVHD, graft-versus-host disease
- HFMD, hand, foot, and mouth disease
- HSV, herpes simplex virus
- RT-PCR, reverse transcriptase polymerase chain reaction
- SJS, Stevens-Johnson syndrome
- and mouth disease
- atypical
- coxsackievirus
- eczema coxsackium
- erythema multiforme
- foot
- graft-versus-host disease
- hand
- histopathology
- interface dermatitis
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Affiliation(s)
- Patricia K. Miller
- Department of Pathology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
- Correspondence to: Patricia K. Miller, MD, 3320 Oakwell Ct, San Antonio, TX 78218.3320 Oakwell CtSan AntonioTX78218
| | | | - Joan Paul
- Department of Surgery, Section of Dermatology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Ann E. Perry
- Department of Pathology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Konstantinos Linos
- Department of Pathology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Joi B. Carter
- Department of Surgery, Section of Dermatology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
| | - Joanne Kurtzberg
- Department of Pediatrics, Division of Blood and Marrow Transplantation, Duke University School of Medicine, Durham, North Carolina
| | - Julianne A. Mann
- Department of Surgery, Section of Dermatology, Dartmouth Hitchcock Medical Center, Lebanon, New Hampshire
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Yao X, Bian LL, Lu WW, Li JX, Mao QY, Wang YP, Gao F, Wu X, Ye Q, Li XL, Zhu FC, Liang Z. Epidemiological and etiological characteristics of herpangina and hand foot mouth diseases in Jiangsu, China, 2013-2014. Hum Vaccin Immunother 2016; 13:823-830. [PMID: 27768527 DOI: 10.1080/21645515.2016.1236879] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Herpangina (HA) and hand, foot, and mouth disease (HFMD) are common infectious diseases caused by human enteroviruses and frequently occurr in young children. Previous published studies have mainly focused on HFMD, while the HA epidemiological and etiological characteristics in mainland China have not been described. From June, 2013 to March, 2014, HA and HFMD patients were monitored in participants from clinical trial of EV-A71 vaccine conducted during 2012-2013. A total of 95 HA patients and 161 HFMD patients were defined. Enteroviruses of HA samples were differentiated into 17 serotypes (EV-A71, CV-A16, CV-A24, E6, CV-B5, CV-A22, CV-A6, CV-A10, CV-B3, E9, CV-A9, CV-B4, CV-B2, E1, E7, E21 and CV-A20), the most common serotypes were EV-A71(10/95,10.5%), CV-A16(4/95,4.2%) and CV-A24(4/95,4.2%); while enteroviruses detected from HFMD samples were classfied into 21 serotypes ( EV-A71, CV-A16, CV-A10, CV-A6, E6, CV-B3, CV-B5, CV-A9, E9, CV-B2, CV-B4, E3, E11, E15, E16, CV-A1, EV-A69, E5, CA22, CA24 and EV99), the most common serotypes were EV-A71(28/161,17.4%), CV-A16(7/161,4.4%) and CV-A10(5/161,3.1%). The first HA epidemic peak occurred in summer and a second smaller peak occurred in January. In HA patients, the body temperature (P < 0.0001) and the incidence of fever (P < 0.05) were significant higher than those in HFMD patients. Between HA and HFMD patients infected with EV-A71, no significant differences were found in age, sex, circulating season, and the viral genome diversity. In summary, we firstly reported the epidemiological and etiological characteristics of HA in mainland China. Developing a multivalent vaccine will be helpful for the control of the HA/HFMD epidemic.
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Affiliation(s)
- Xin Yao
- a National Institute for Food and Drug Control , Beijing , China
| | - Lian-Lian Bian
- a National Institute for Food and Drug Control , Beijing , China
| | - Wei-Wei Lu
- b Beijing Vigoo Biological , Beijing , China
| | - Jing-Xin Li
- c Jiangsu Provincial Center for Disease Control and Prevention , Nanjing , China
| | - Qun-Ying Mao
- a National Institute for Food and Drug Control , Beijing , China
| | - Yi-Ping Wang
- a National Institute for Food and Drug Control , Beijing , China
| | - Fan Gao
- a National Institute for Food and Drug Control , Beijing , China
| | - Xing Wu
- a National Institute for Food and Drug Control , Beijing , China
| | - Qiang Ye
- a National Institute for Food and Drug Control , Beijing , China
| | - Xiu-Ling Li
- b Beijing Vigoo Biological , Beijing , China
| | - Feng-Cai Zhu
- c Jiangsu Provincial Center for Disease Control and Prevention , Nanjing , China
| | - Zhenglun Liang
- a National Institute for Food and Drug Control , Beijing , China
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Abstract
INTRODUCTION Enterovirus A71 (EV71) is the predominant causative agent of hand, foot, and mouth disease (HFMD), which is often associated with severe cases and even deaths. EV71-associated epidemics have emerged as a serious threat to public health, particularly in the Asia-Pacific region. AREAS COVERED We searched PubMed using the terms 'enterovirus 71', 'hand, foot, and mouth disease', and 'vaccine', with no date or language restrictions for all publications before April 27, 2016. Among various vaccine candidates, the alum-adjuvant inactivated EV71 vaccines are most promising. Three alum-adjuvant inactivated EV71 vaccines developed by mainland China showed high efficacy, good immunogenicity persistence and acceptable safety profiles in clinical trials. Recently, two of these EV71 vaccines have been approved for marketing in China and the other one is undergoing the review process of licensure. In this manuscript, we summarized previous study results as well as discussed the regulatory affairs and post-market surveillances issues. Expert commentary: The marketing of EV71 vaccines is a milestone in the controlling of HFMD. International clinical trials are needed to further assess the efficacy and cross-immunogenicity. Establishing a sensitive pathogen monitoring system would be essential to monitor the variation of genotypes and control HFMD epidemics.
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Affiliation(s)
- Yang Zhou
- a School of Public Health , Southeast University , Nanjing , PR China
| | - Jing-Xin Li
- b Department of Vaccine Clinical Evaluation , Jiangsu Provincial Center for Disease Control and Prevention , Nanjing , PR China.,c College of Pharmacy , Third Military Medical University & National Engineering Research Center for Immunological Products , Chongqing , PR China
| | - Peng-Fei Jin
- d School of Public Health , Nanjing Medical University , Nanjing , PR China
| | - Yu-Xiao Wang
- a School of Public Health , Southeast University , Nanjing , PR China
| | - Feng-Cai Zhu
- b Department of Vaccine Clinical Evaluation , Jiangsu Provincial Center for Disease Control and Prevention , Nanjing , PR China
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Huang R, Bian G, He T, Chen L, Xu G. Effects of Meteorological Parameters and PM10 on the Incidence of Hand, Foot, and Mouth Disease in Children in China. Int J Environ Res Public Health 2016; 13:E481. [PMID: 27171104 DOI: 10.3390/ijerph13050481] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 04/29/2016] [Accepted: 05/05/2016] [Indexed: 12/13/2022]
Abstract
Hand, foot, and mouth disease (HFMD) is a globally-prevalent infectious disease. However, few data are available on prevention measures for HFMD. The purpose of this investigation was to evaluate the impacts of temperature, humidity, and air pollution, particularly levels of particulate matter with an aerodynamic diameter 10 micrometers (PM10), on the incidence of HFMD in a city in Eastern China. Daily morbidity, meteorological, and air pollution data for Ningbo City were collected for the period from January 2012 to December 2014. A total of 86,695 HFMD cases were enrolled in this study. We used a distributed lag nonlinear model (DLNM) with Poisson distribution to analyze the nonlinear lag effects of daily mean temperature, daily humidity, and found significant relationships with the incidence of HFMD; in contrast, PM10 level showed no relationship to the incidence of HFMD. Our findings will facilitate the development of effective preventive measures and early forecasting of HFMD outbreaks.
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Qui PT, Khanh TH, Trieu HT, Giang PT, Bich NN, Thoa LPK, Nhan LNT, Sabanathan S, Van Doorn R, Toan ND, Merson L, Dung NTP, Khanh LP, Wolbers M, Hung NT, Chau NVV, Wills B. Intravenous magnesium sulfate for the management of severe hand, foot, and mouth disease with autonomic nervous system dysregulation in Vietnamese children: study protocol for a randomized controlled trial. Trials 2016; 17:98. [PMID: 26896318 PMCID: PMC4759733 DOI: 10.1186/s13063-016-1215-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 02/05/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Over the last 15 years, hand, foot, and mouth disease (HFMD) has emerged as a major public health burden across the Asia-Pacific region. A small proportion of HFMD patients, typically those infected with enterovirus 71 (EV71), develop brainstem encephalitis with autonomic nervous system (ANS) dysregulation and may progress rapidly to cardiopulmonary failure and death. Although milrinone has been reported to control hypertension and support myocardial function in two small studies, in practice, a number of children still deteriorate despite this treatment. Magnesium sulfate (MgSO4) is a cheap, safe, and readily available medication that is effective in managing tetanus-associated ANS dysregulation and has shown promise when used empirically in EV71-confirmed severe HFMD cases. METHODS/DESIGN We describe the protocol for a randomized, placebo-controlled, double-blind trial of intravenous MgSO4 in Vietnamese children diagnosed clinically with HFMD plus ANS dysregulation with systemic hypertension. A loading dose of MgSO4 or identical placebo is given over 20 min followed by a maintenance infusion for 72 h according to response, aiming for Mg levels two to three times the normal level in the treatment arm. The primary endpoint is a composite of disease progression within 72 h defined as follows: development of pre-specified blood pressure criteria necessitating the addition of milrinone, the need for ventilation, shock, or death. Secondary endpoints comprise these parameters singly, plus other clinical endpoints including the following: requirement for other inotropic agents; duration of hospitalization; presence of neurological sequelae at discharge in survivors; and neurodevelopmental status assessed 6 months after discharge. The number and severity of adverse events observed in the two treatment arms will also be compared. Based on preliminary data from a case series, and allowing for some losses, 190 patients (95 in each arm) will allow detection of a 50 % reduction in disease progression with 90 % power at a two-sided 5 % significance level. DISCUSSION Given the large numbers of HFMD cases currently being seen in hospitals in Asia, if MgSO4 is shown to be effective in controlling ANS dysregulation and preventing severe HFMD complications, this finding would be important to pediatric care throughout the region. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01940250 (Registered 22 August 2013).
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Affiliation(s)
- Phan Tu Qui
- Hospital for Tropical Diseases, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam.
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam.
| | - Truong Huu Khanh
- Children's Hospital Number 1, 341 Sư Vạn Hạnh, District 10, Ho Chi Minh City, Vietnam.
| | - Huynh Trung Trieu
- Hospital for Tropical Diseases, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam.
| | - Phạm Thanh Giang
- Hospital for Tropical Diseases, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam.
| | - Nguyen Ngọc Bich
- Hospital for Tropical Diseases, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam.
| | - Le Phan Kim Thoa
- Children's Hospital Number 1, 341 Sư Vạn Hạnh, District 10, Ho Chi Minh City, Vietnam.
| | - Le Nguyen Thanh Nhan
- Children's Hospital Number 1, 341 Sư Vạn Hạnh, District 10, Ho Chi Minh City, Vietnam.
| | - Saraswathy Sabanathan
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, Oxford, OX1 2JD, UK.
| | - Rogier Van Doorn
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, Oxford, OX1 2JD, UK.
| | - Nguyen Duc Toan
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam.
| | - Laura Merson
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, Oxford, OX1 2JD, UK.
| | - Nguyen Thi Phuong Dung
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam.
| | - Lam Phung Khanh
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam.
| | - Marcel Wolbers
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, Oxford, OX1 2JD, UK.
| | - Nguyen Thanh Hung
- Children's Hospital Number 1, 341 Sư Vạn Hạnh, District 10, Ho Chi Minh City, Vietnam.
| | - Nguyen Van Vinh Chau
- Hospital for Tropical Diseases, 764 Vo Van Kiet, District 5, Ho Chi Minh City, Vietnam.
| | - Bridget Wills
- Oxford University Clinical Research Unit, Hospital for Tropical Diseases, 764 Vo Van Kiet, Quan 5, Ho Chi Minh City, Vietnam.
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, Oxford University, Oxford, OX1 2JD, UK.
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Liu L, Mo Z, Liang Z, Zhang Y, Li R, Ong KC, Wong KT, Yang E, Che Y, Wang J, Dong C, Feng M, Pu J, Wang L, Liao Y, Jiang L, Tan SH, David P, Huang T, Zhou Z, Wang X, Xia J, Guo L, Wang L, Xie Z, Cui W, Mao Q, Liang Y, Zhao H, Na R, Cui P, Shi H, Wang J, Li Q. Immunity and clinical efficacy of an inactivated enterovirus 71 vaccine in healthy Chinese children: a report of further observations. BMC Med 2015; 13:226. [PMID: 26381232 PMCID: PMC4574357 DOI: 10.1186/s12916-015-0448-7] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 08/12/2015] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND To investigate the long-term effects on immunity of an inactivated enterovirus 71 (EV71) vaccine and its protective efficacy. METHODS A sub-cohort of 1,100 volunteers from Guangxi Province in China was eligible for enrolment and randomly administered either the EV71 vaccine or a placebo on days 0 and 28 in a phase III clinical trial and then observed for the following 2 years with approval by an independent ethics committee of Guangxi Zhuang Autonomous Region, China. Serum samples from the 350 participants who provided a full series of blood samples (at all the sampling points) within the 2-year period were collected. Vaccine-induced immune effects, including the neutralizing antibody titres and cross-protection against different genotypes of EV71, were examined. This study also evaluated the protective efficacy of this vaccine based upon clinical diagnosis. RESULTS This sub-cohort showed a >60% drop-out rate over 2 years. The seroconversion rates among the 161 immunized subjects remained >95% at the end of study. The geometric mean titres of neutralizing antibodies (anti-genotype C4) 360 days after vaccination in 350 subjects were 81.0 (subjects aged 6-11 months), 98.4 (12-23 months), 95.0 (24-35 months), and 81.8 (36-71 months). These titres subsequently increased to 423.1, 659.0, 545.0, and 321.9, respectively, at 540 days post-immunization (d.p.i.), and similar levels were maintained at 720 d.p.i. Higher IFN-γ/IL-4-specific responses to the C4 genotype of EV71 and cross-neutralization reactivity against major EV71 genotype strains were observed in the vaccine group compared to those in the placebo group. Five EV71-infected subjects were observed in the placebo-treated control group and none in the vaccine-immunized group in per-protocol analysis. CONCLUSION These results are consistent with the induction of dynamic immune responses and protective efficacy of the vaccine against most circulating EV71 strains. TRIAL REGISTRATION NUMBER Clinicaltrials.gov, NCT01569581, Trial registration date: March 2012.
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Affiliation(s)
- Longding Liu
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Zhaojun Mo
- Guangxi Province Centres for Disease Control and Prevention, Nanning, China
| | - Zhenglun Liang
- National Institutes for Food and Drug Control, Beijing, China
| | - Ying Zhang
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Rongcheng Li
- Guangxi Province Centres for Disease Control and Prevention, Nanning, China
| | - Kien Chai Ong
- Departments of Biomedical Science and Pathology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Kum Thong Wong
- Departments of Biomedical Science and Pathology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Erxia Yang
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China.,Jiangsu Convac Biotechnology Co., Ltd, Taizhou, Jiangsu, China
| | - Yanchun Che
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Jingjing Wang
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Chenghong Dong
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Min Feng
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Jing Pu
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Lichun Wang
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Yun Liao
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Li Jiang
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China.,Jiangsu Convac Biotechnology Co., Ltd, Taizhou, Jiangsu, China
| | - Soon Hao Tan
- Departments of Biomedical Science and Pathology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Perera David
- Institute of Health & Community Medicine, University Malaysia Sarawak, Kuala Lumpur, Malaysia
| | - Teng Huang
- Guangxi Province Centres for Disease Control and Prevention, Nanning, China
| | - Zhenxin Zhou
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Xuanyi Wang
- Key Laboratory of Medical Molecular Virology, Ministries of Education and Health, Institute of Biological Sciences, Shanghai Medical College, Fudan University, Shanghai, China
| | - Jielai Xia
- Department of Health Statistics, Fourth Military Medical University, Xi'an, China
| | - Lei Guo
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Ling Wang
- Department of Health Statistics, Fourth Military Medical University, Xi'an, China
| | - Zhongping Xie
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Wei Cui
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Qunying Mao
- National Institutes for Food and Drug Control, Beijing, China
| | - Yan Liang
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Hongling Zhao
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Ruixiong Na
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Pingfang Cui
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Haijing Shi
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China
| | - Junzhi Wang
- National Institutes for Food and Drug Control, Beijing, China.
| | - Qihan Li
- Yunnan Key Laboratory of Vaccine Research and Development on Severe Infectious Diseases, Institute of Medical Biology, Chinese Academy of Medical Sciences and Peking Union Medical College, Kunming, China.
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Chen JF, Zhang RS, Ou XH, Chen FM, Sun BC. The role of enterovirus 71 and coxsackievirus A strains in a large outbreak of hand, foot, and mouth disease in 2012 in Changsha, China. Int J Infect Dis 2014; 28:17-25. [PMID: 25236389 DOI: 10.1016/j.ijid.2014.07.024] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2014] [Revised: 07/07/2014] [Accepted: 07/30/2014] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND During 2012, Changsha experienced a large outbreak of hand, foot, and mouth disease (HFMD), resulting in 25,438 cases, including 42 severe cases and eight deaths. METHODS Seven hundred and forty-six clinical specimens were collected from hospital-based surveillance for HFMD in 2012. The detection and genotyping of enterovirus were performed by real-time RT-PCR and sequencing of the VP1 regions; phylogenetic analysis was performed based on the VP1 sequences. RESULTS A total of 545 (73.1%) enterovirus-positive samples were identified, with the most frequently presenting serotype being enterovirus 71 (EV-71; n=364, 66.8%), followed by coxsackievirus A16 (CV-A16; n=84, 15.4%), CV-A6 (n=22, 4.0%), and CV-A10 (n=19, 3.5%). Most of the affected patients were children aged ≤5 years (n=524, 96.1%). EV-71 was the major pathogen in the severe and fatal cases (n=22, 78.6%). Phylogenetic analysis of VP1 gene sequences showed the EV-71 isolates to belong to subgenotype C4a, and the CV-A16 isolates to belong to subgenotype B1. The Changsha CV-A6 and CV-A10 circulating strains were homologous to strains circulating in other areas of mainland China. CONCLUSIONS Our results demonstrate that EV-71 was the primary causative agent responsible for the HFMD outbreak in Changsha in 2012, and the co-circulation of other coxsackievirus A strains posed a potential risk to public health.
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Affiliation(s)
- Jing-Fang Chen
- Laboratory of Microbiology, Changsha Center for Disease Control and Prevention, 149 Weier Road, Changsha 410001, China
| | - Ru-Sheng Zhang
- Laboratory of Microbiology, Changsha Center for Disease Control and Prevention, 149 Weier Road, Changsha 410001, China
| | - Xin-Hua Ou
- Laboratory of Microbiology, Changsha Center for Disease Control and Prevention, 149 Weier Road, Changsha 410001, China
| | - Fa-Ming Chen
- Laboratory of Microbiology, Changsha Center for Disease Control and Prevention, 149 Weier Road, Changsha 410001, China
| | - Bian-Cheng Sun
- Laboratory of Microbiology, Changsha Center for Disease Control and Prevention, 149 Weier Road, Changsha 410001, China.
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38
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Yu P, Gao Z, Zong Y, Bao L, Xu L, Deng W, Li F, Lv Q, Gao Z, Xu Y, Yao Y, Qin C. Histopathological features and distribution of EV71 antigens and SCARB2 in human fatal cases and a mouse model of enterovirus 71 infection. Virus Res 2014; 189:121-32. [PMID: 24842162 DOI: 10.1016/j.virusres.2014.05.006] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 05/08/2014] [Accepted: 05/08/2014] [Indexed: 10/25/2022]
Abstract
Enterovirus 71 (EV71) is a neurotropic pathogen that causes hand, foot, and mouth disease. While infection is usually self-limiting, a minority of patients infected with EV71 develop severe neurological complications. In humans, EV71 has been reported to utilize the scavenger receptor class B, member 2 (SCARB2) as a receptor for infectious cellular entry. In this study, we define the pathological features of EV71-associated disease as well as the distribution of EV71 antigen and SCARB2 in human fatal cases and a mouse model. Histopathologically, human fatal cases showed severe central nervous system (CNS) changes, mainly in the brainstems, spinal cords, and thalamus. These patient further exhibited pulmonary edema and necrotic enteritis. Immunohistochemical analysis of human fatal cases demonstrated that EV71 antigen and SCARB2 were observed mainly in neurons, microglia cells and inflammatory cells in the CNS, and epithelial cells in the intestines. However, skeletal muscle tissue was negative for EV71 antigen. In a mouse model of EV71 infection, we observed massive necrotic myositis, different degrees of viral diseases in CNS, and extensive interstitial pneumonia. In mice, EV71 exhibits strong myotropism compared to the neurotropism seen in humans. EV71 antigen was detected in the spinal cord and brainstem of mice. However, there was no clear correlation between mouse SCARB2 and EV71 antigen distribution in the mouse model, consistent with previous results that SCARB2 functions as a receptor for EV71 in humans but not mice. The EV71-induced lesions seen in the mouse model resembled the pathological changes seen in human samples. These results increase our understanding of EV71 pathogenesis and will inform further work developing a mouse model for EV71 infection.
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MESH Headings
- Animals
- Antigens, Viral/analysis
- CD36 Antigens/analysis
- Child, Preschool
- Disease Models, Animal
- Enterovirus A, Human/physiology
- Female
- Genome, Viral
- Hand, Foot and Mouth Disease/pathology
- Hand, Foot and Mouth Disease/virology
- Humans
- Infant
- Lysosomal Membrane Proteins/analysis
- Male
- Mice
- Mice, Inbred BALB C
- Molecular Sequence Data
- RNA, Viral/genetics
- Receptors, Scavenger/analysis
- Receptors, Virus/analysis
- Sequence Analysis, DNA
- Viral Tropism
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Affiliation(s)
- Pin Yu
- Institute of Laboratory Animal Sciences, Chinese Academy of Medical Sciences (CAMS) & Comparative Medicine Center, Peking Union Medical College (PUMC), Key Laboratory of Human Disease Comparative Medicine, Ministry of Health, Beijing 100021, China.
| | - Zifen Gao
- Department of Pathology, Peking University Health Science Center, Beijing 100191, China.
| | - Yuanyuan Zong
- Department of Pathology, Shandong Provincial Hospital Affiliated to Shandong University, Jinan 250021, China.
| | - Linlin Bao
- Institute of Laboratory Animal Sciences, Chinese Academy of Medical Sciences (CAMS) & Comparative Medicine Center, Peking Union Medical College (PUMC), Key Laboratory of Human Disease Comparative Medicine, Ministry of Health, Beijing 100021, China.
| | - Lili Xu
- Institute of Laboratory Animal Sciences, Chinese Academy of Medical Sciences (CAMS) & Comparative Medicine Center, Peking Union Medical College (PUMC), Key Laboratory of Human Disease Comparative Medicine, Ministry of Health, Beijing 100021, China.
| | - Wei Deng
- Institute of Laboratory Animal Sciences, Chinese Academy of Medical Sciences (CAMS) & Comparative Medicine Center, Peking Union Medical College (PUMC), Key Laboratory of Human Disease Comparative Medicine, Ministry of Health, Beijing 100021, China.
| | - Fengdi Li
- Institute of Laboratory Animal Sciences, Chinese Academy of Medical Sciences (CAMS) & Comparative Medicine Center, Peking Union Medical College (PUMC), Key Laboratory of Human Disease Comparative Medicine, Ministry of Health, Beijing 100021, China.
| | - Qi Lv
- Institute of Laboratory Animal Sciences, Chinese Academy of Medical Sciences (CAMS) & Comparative Medicine Center, Peking Union Medical College (PUMC), Key Laboratory of Human Disease Comparative Medicine, Ministry of Health, Beijing 100021, China.
| | - Zhancheng Gao
- Department of Respiratory & Critical Care Medicine, Peking University People's Hospital, Beijing 100044, China.
| | - Yanfeng Xu
- Institute of Laboratory Animal Sciences, Chinese Academy of Medical Sciences (CAMS) & Comparative Medicine Center, Peking Union Medical College (PUMC), Key Laboratory of Human Disease Comparative Medicine, Ministry of Health, Beijing 100021, China.
| | - Yanfeng Yao
- Institute of Laboratory Animal Sciences, Chinese Academy of Medical Sciences (CAMS) & Comparative Medicine Center, Peking Union Medical College (PUMC), Key Laboratory of Human Disease Comparative Medicine, Ministry of Health, Beijing 100021, China.
| | - Chuan Qin
- Institute of Laboratory Animal Sciences, Chinese Academy of Medical Sciences (CAMS) & Comparative Medicine Center, Peking Union Medical College (PUMC), Key Laboratory of Human Disease Comparative Medicine, Ministry of Health, Beijing 100021, China.
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Abstract
Enterovirus 71 (EV71) is one of the major causative agents for hand, foot and mouth disease (HFMD) in childhood. Nowadays, HFMD or EV71 infections have already become an important public health issue throughout the world. Vaccination may be the most effective measure to control the transmission of the virus. Therefore, to pave EV71 vaccine into human clinical trial, in the present study a comprehensive preclinical safety assessment of inactivated EV71 vaccine including single- and repeat-dose toxicity studies were conducted in rats and cynomolgus monkeys. No abnormal findings were observed in rats following single intramuscular administration with EV71 vaccine (640 U). The results also showed no obvious systemic toxicities from four repetitive intramuscular injections, with a 14-d interval, of two dosages of EV71 vaccine in the two animal species. Antinuclear antibody response was not detected after the repeated administrations. Histopathological examination demonstrated the minimal to severe inflammatory changes in muscle tissues of the injection sites in EV71 vaccine-injected animals and most of findings have been improved over time. Furthermore, test article could induce highly EV71-specfic neutralizing antibody response in both animal species. Taken together, these data suggested a favorable safety profile for inactivated EV71 vaccine and supported this product to enter human phase I clinical trial.
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Affiliation(s)
- Xiao-bing Zhou
- Graduate School of Peking Union Medical College; Dongcheng District, Beijing, P.R. China; National Center for Safety Evaluation of Drugs; National Institutes for Food and Drug Control; Beijing, P.R. China
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40
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Abstract
Enterovirus 71 (EV71) caused a large outbreak in Taiwan in 1998 with 78 deaths, and smaller outbreaks recurred in 2000 and 2001. The outbreak was recognized because of a large number of hand, foot, and mouth disease cases and the rapid deaths of children with the disease. Virologic and pathologic studies indicated that EV71 was the most important agent related to severe and fatal cases and that a neurogenic inflammatory response was involved in the pathogenesis of cardiopulmonary collapse resulting from fulminant EV71 infection. Seroepidemiologic study suggested that EV71 had circulated for at least 16 years and that the accumulation of susceptible hosts might have triggered the 1998 outbreak. However, a change in EV71 neurovirulence and host genetic susceptibility may also have affected the clinical outcome. The Taiwan outbreak shows that worldwide attention should be paid to such outbreaks, new antiviral drugs should be developed, and that vaccination of children under 5 years of age may be warranted.
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Affiliation(s)
- Tzou-Yien Lin
- Chang Gung University, Taoyuan, Taiwan
- Chang Gung Children’s Hospital, Taoyuan, Taiwan
| | | | | | | | - Chin-Yun Lee
- National Taiwan University Hospital, Taipei, Taiwan
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