Epidemiological and genetic analysis concerning the non-enterovirus 71 and non-coxsackievirus A16 causative agents related to hand, foot and mouth disease in Anyang city, Henan Province, China, from 2011 to 2015

Introduction Hand, foot and mouth disease (HFMD) is usually caused by several serotypes from human enterovirus A species, including enterovirus 71 (EV-A71) and coxsackievirus A16 (CV-A16). Two inactivated monovalent EV-A71 vaccines have been recently licensed in China and monovalent CV-A16 vaccine and bivalent EV-A71 and CV-A16 vaccine are under development. Methods: Using notifications from the national surveillance system, we describe the epidemiology and dynamics of HFMD in the country, before the introduction of EV-A71 vaccination, from 2008 through 2015. Results: Laboratory-identified serotype categories, i.e. CV-A16, EV-A71 and other enteroviruses, circulated annually. EV-A71 remained the most virulent serotype and was the major serotype for fatal cases (range: 88.5–95.4%) and severe cases (range: 50.7–82.3%) across years. Except for 2013 and 2015, when other enteroviruses were more frequently found in mild HFMD (48.8% and 52.5%), EV-A71 was more frequently detected from mild cases in the rest of the years covered by the study (range: 39.4–52.6%). The incidence rates and severity risks of HFMD associated with all serotype categories were the highest for children aged 1 year and younger, and decreased with increasing age. Discussion/conclusion: This study provides baseline epidemiology for evaluation of vaccine impact and potential serotype replacement.

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Glycyrrhizic acid as the antiviral component of Glycyrrhiza uralensis Fisch. against coxsackievirus A16 and enterovirus 71 of hand foot and mouth disease

Journal of Ethnopharmacology ◽

10.1016/j.jep.2013.02.017 ◽

2013 ◽

Vol 147 (1) ◽

pp. 114-121 ◽

Cited By ~ 50

Author(s):

Jingjing Wang ◽

Xiaoqing Chen ◽

Wei Wang ◽

Yating Zhang ◽

Ziying Yang ◽

...

Keyword(s):

Glycyrrhizic Acid ◽

Enterovirus 71 ◽

Foot And Mouth Disease ◽

Mouth Disease ◽

Glycyrrhiza Uralensis ◽

Coxsackievirus A16 ◽

Glycyrrhiza Uralensis Fisch ◽

Foot And Mouth

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Clinical and Etiological Characteristics of Atypical Hand-Foot-and-Mouth Disease in Children from Chongqing, China: A Retrospective Study

BioMed Research International ◽

10.1155/2015/802046 ◽

2015 ◽

Vol 2015 ◽

pp. 1-8 ◽

Cited By ~ 5

Author(s):

Xiang Yan ◽

Zhen-Zhen Zhang ◽

Zhen-Hua Yang ◽

Chao-Min Zhu ◽

Yun-Ge Hu ◽

...

Keyword(s):

Enterovirus 71 ◽

Foot And Mouth Disease ◽

Good Prognosis ◽

Mouth Disease ◽

Coxsackievirus A16 ◽

Neurologic Involvement ◽

Coxsackievirus A6 ◽

Foot And Mouth ◽

Two Peaks ◽

Epidemiological Characteristics

Background. Hand-foot-and-mouth disease (HFMD) is a disease that had similar manifestations to chickenpox, impetigo, and measles, which is easy to misdiagnose and subsequently causes delayed therapy and subsequent epidemic. To date, no study has been conducted to report the clinical and epidemiological characteristics of atypical HFMD.Methods. 64 children with atypical HFMD out of 887 HFMD children were recruited, stool was collected, and viral VP1 was detected.Results. The atypical HFMD accounted for 7.2% of total HFMD in the same period (64/887) and there were two peaks in its prevalence in nonepidemic seasons. Ten children (15.6%) had manifestations of neurologic involvement, of whom 4 (6.3%) were diagnosed with severe HFMD and 1 with critically severe HFMD, but all recovered smoothly. Onychomadesis and desquamation were found in 14 patients (21.9%) and 15 patients (23.4%), respectively. The most common pathogen was coxsackievirus A6 (CV-A6) which accounted for 67.2%, followed by nontypable enterovirus (26.6%), enterovirus 71 (EV-A71) (4.7%), and coxsackievirus A16 (A16) (1.5%).Conclusions. Atypical HFMD has seasonal prevalence. The manifestations of neurologic involvement in atypical HFMD are mild and usually have a good prognosis. CV-A6 is a major pathogen causing atypical HFMD, but not a major pathogen in Chongqing, China.

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Basic Reproduction Number of Enterovirus 71 Coxsackievirus A16 and A6: Evidence from Outbreaks of Hand, Foot and Mouth Disease in China between 2011 and 2018

Clinical Infectious Diseases ◽

10.1093/cid/ciaa1853 ◽

2020 ◽

Author(s):

Zhong Zhang ◽

Yang Liu ◽

Fengfeng Liu ◽

Minrui Ren ◽

Taoran Nie ◽

...

Keyword(s):

Basic Reproduction Number ◽

Reproduction Number ◽

Mainland China ◽

Enterovirus 71 ◽

Foot And Mouth Disease ◽

Mouth Disease ◽

Initial Growth ◽

Coxsackievirus A16 ◽

Foot And Mouth ◽

Common Serotypes

Abstract Background Enterovirus 71 (EV-A71), Coxsackievirus A16 (CV-A16) and Coxsackievirus A6 (CV-A6) are common serotypes causing hand, foot, and mouth disease (HFMD). Analyses on the basic reproduction number (R0) of common pathogens causing HFMD are limited and there are no related studies using field data from outbreaks in mainland China. Methods We estimated the pathogen-specific basic reproduction number based on laboratory-confirmed HFMD outbreaks (clusters of ≥10 HFMD cases) reported to the national surveillance system between 2011 and 2018. The reproduction numbers were calculated using a mathematical model and the cumulative cases during the initial growth periods. Results This study included 539 outbreaks, of which 198 were caused by EV-A71, 316 by CV-A16, and 25 by CV-A6. All 10417 cases involved were children. Assuming the outbreaks occurred in closed systems and the incubation period is 5 days, the median R0s of EV-A71, CV-A16, and CV-A6 were 5.06 [2.81, 10.20], 4.84 [3.00, 9.00] and 5.94 [3.27, 10.00] (Median [IQR]). After adjusting for seroprevalences, the R0s for EV-A71, CV-A16 (optimistic and conservative scenarios), and CV-A6 were 12.60 [IQR: 7.35, 25.40], 9.29 [IQR: 6.01, 19.20], 15.50 [IQR: 9.77, 30.40], and 25.80 [IQR: 14.20, 43.50], respectively. We did not observe changes in the R0s of EV-A71 after vaccine licensure (p-value = 0.67). Conclusions HFMD is highly transmissible when caused by the three most common serotypes. In mainland China, it primarily affects young children. Although a vaccine became available in 2016, we have not yet observed any related changes in the disease dynamics.

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