Abstract
Background Evidence of hand, foot, and mouth disease (HFMD) in neonates is limited. This study aimed to report the clinical symptoms, possible transmission routes, and prognosis of neonatal HFMD in Shanghai. Methods This was a case-control study based on registry system of HFMD. All neonates and infected family members were enrolled between 2016 and 2017 in Shanghai. Neonates with HFMD were followed for at least half a year. The detailed questionnaires, medical history and physical examination were recorded. Routine blood examination, liver and renal function, immunophenotypes of peripheral blood lymphocytes (CD3, CD4, and CD8 T-cells; NK cells), immunoglobulin (Ig) M, IgG, and IgA and cytokine interleukin (IL-1β, IL-2R, IL-6, IL-8, IL-10, and TNF-α) levels were detected. All rectal swab specimens were collected and genotyped for enterovirus. T-test or nonparametric test was used to evaluate the differences. Logistic analysis was applied to find the risk of clinical symptoms in the group of neonates and their HFMD paired siblings.Results There were 16 neonates among the 12608 diagnosed patients with HFMD, accounting for 1.3‰. All the neonates were transmitted within-family, mainly by the elder sibling, with different types of coxsackievirus A6 infection. Coxsackievirus A6 was also the emerging and predominant causative agent of HFMD in Shanghai. None of the neonates with HFMD suffered fever, onychomadesis, or severe complications. However, two elder sibling patients showed lethargy, and one developed hypoperfusion. The white blood cells in the elder siblings with HFMD were generally higher than the neonates with HFMD. The immunologic function of the neonates was basically normal. The inflammatory response was high regardless of the neonates or elder siblings. The clinical symptoms receded at about one week. None of the neonates had sequalae.Conclusions The severity of neonates infected with HFMD may vary with pathogen. With the two-child policy in China, it should be noticed that elder siblings may be the main route of HFMD transmission.
Scavenger receptor class a, member 3 is associated with severity of hand, foot, and mouth disease in a case-control study
