Neonatal hand, foot, and mouth disease: a case-control study in Shanghai

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.

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Risk factors for severe hand, foot, and mouth disease infected with Coxsackievirus A6: A hospital‐based case‐control study

Journal of Medical Virology ◽

10.1002/jmv.26343 ◽

2020 ◽

Vol 92 (12) ◽

pp. 3144-3150 ◽

Cited By ~ 1

Author(s):

Yanan Li ◽

Tiantian Xiong ◽

Yu Meng ◽

Rongxian Zhao ◽

Guangqing Yu ◽

...

Keyword(s):

Risk Factors ◽

Case Control Study ◽

Foot And Mouth Disease ◽

Case Control ◽

Mouth Disease ◽

Coxsackievirus A6 ◽

Foot And Mouth ◽

Control Study

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Neonatal hand, foot, and mouth disease due to Coxsackievirus A6 in Shanghai

10.21203/rs.2.14800/v4 ◽

2020 ◽

Author(s):

Shanshan Xu ◽

Huajun Li ◽

Peng Qiao ◽

Guofeng Xu ◽

Dongying Zhao ◽

...

Keyword(s):

Clinical Symptoms ◽

White Blood Cells ◽

Clinical Manifestations ◽

Foot And Mouth Disease ◽

Nonparametric Test ◽

Peripheral Blood Lymphocytes ◽

Mouth Disease ◽

Logistic Analysis ◽

Coxsackievirus A6 ◽

Foot And Mouth

Abstract Background: Evidence of hand, foot, and mouth disease (HFMD) in neonates is limited. The aim of this study was to evaluate the clinical symptoms, pathogens, possible transmission routes, and prognosis of neonatal HFMD in Shanghai. Methods: This was a case-control study based on the HFMD registry surveillance system. 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. 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 measured. All rectal swab specimens were collected and genotyped for enterovirus, and phylogenetic analysis based on the VP1 sequences of coxsackievirus A6 (CV-A6) was performed to investigate molecular and evolutionary characteristics. T-test or nonparametric test was used to evaluate the differences. Logistic analysis was applied to calculate the risk of clinical manifestations in the group of HFMD neonates and their paired siblings. Results: There were 16 neonates among the 12608 diagnosed patients with HFMD, accounting for 0.13%. All neonatal infections were transmitted by other members of the family, mainly the elder siblings, and were caused by CV-A6. CV-A6 was the emerging and predominant causative agent of HFMD in Shanghai. None of the neonates with HFMD experienced fever, onychomadesis, or severe complications. However, two elder sibling patients showed lethargy, and one developed hypoperfusion. In the elder siblings with HFMD, the proportion of white blood cells was generally higher than in neonates with HFMD. The immunologic function of the neonates with HFMD was basically normal. The levels of inflammatory markers were higher in both neonates and elder siblings with HFMD compared to age-matched controls. The clinical symptoms receded about one week after onset. None of the neonates had sequelae. Conclusions: In our study, CV-A6 infection in neonates was benign, but had the character of family clustering. Due to the two-child policy in China, elder siblings may be the main route of HFMD transmission.

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Neonatal hand, foot, and mouth disease due to Coxsackievirus A6 in Shanghai

10.21203/rs.2.14800/v2 ◽

2019 ◽

Author(s):

Shanshan Xu ◽

Huajun Li ◽

Peng Qiao ◽

Guofeng Xu ◽

Dongying Zhao ◽

...

Keyword(s):

Clinical Symptoms ◽

White Blood Cells ◽

Foot And Mouth Disease ◽

Nonparametric Test ◽

Peripheral Blood Lymphocytes ◽

Mouth Disease ◽

Mild Disease ◽

Logistic Analysis ◽

Coxsackievirus A6 ◽

Foot And Mouth

Abstract Background: Evidence of hand, foot, and mouth disease (HFMD) in neonates is limited. The aim of this study was to evaluate the clinical symptoms, possible transmission routes, and prognosis of neonatal HFMD in Shanghai. Methods: This was a case-control study based on the HFMD registry surveillance system. 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. 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 measured. 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 calculate the risk of clinical symptoms in the group of HFMD neonates and their paired siblings. Results: There were 16 neonates among the 12608 diagnosed patients with HFMD, accounting for 1.3‰. All neonatal infections were transmitted by other members of the family, mainly the elder siblings, and involved different types of coxsackievirus A6. Coxsackievirus A6 is 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. In the elder siblings with HFMD, the proportion of white blood cells was generally higher than in neonates with HFMD. The immunologic function of the neonates with HFMD was basically normal. The levels of inflammatory markers were higher in both neonates and elder siblings with HFMD compared to their age-matched controls. The clinical symptoms receded after about one week of onset. None of the neonates had sequelae. Conclusions: All neonates with coxsackievirus A6 HFMD had mild disease with no complications or sequelae. Notably, due to the two-child policy in China, elder siblings may be the main route of HFMD transmission.

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Neonatal hand, foot, and mouth disease due to Coxsackievirus A6 in Shanghai

10.21203/rs.2.14800/v3 ◽

2020 ◽

Author(s):

Shanshan Xu ◽

Huajun Li ◽

Peng Qiao ◽

Guofeng Xu ◽

Dongying Zhao ◽

...

Keyword(s):

Clinical Symptoms ◽

White Blood Cells ◽

Foot And Mouth Disease ◽

Nonparametric Test ◽

Peripheral Blood Lymphocytes ◽

Mouth Disease ◽

Mild Disease ◽

Logistic Analysis ◽

Coxsackievirus A6 ◽

Foot And Mouth

Abstract Background: Evidence of hand, foot, and mouth disease (HFMD) in neonates is limited. The aim of this study was to evaluate the clinical symptoms, possible transmission routes, and prognosis of neonatal HFMD in Shanghai. Methods: This was a case-control study based on the HFMD registry surveillance system. 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. 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 measured. 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 calculate the risk of clinical symptoms in the group of HFMD neonates and their paired siblings. Results: There were 16 neonates among the 12608 diagnosed patients with HFMD, accounting for 0.1%. All neonatal infections were transmitted by other members of the family, mainly the elder siblings, and involved different types of coxsackievirus A6. Coxsackievirus A6 is 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. In the elder siblings with HFMD, the proportion of white blood cells was generally higher than in neonates with HFMD. The immunologic function of the neonates with HFMD was basically normal. The levels of inflammatory markers were higher in both neonates and elder siblings with HFMD compared to their age-matched controls. The clinical symptoms receded after about one week of onset. None of the neonates had sequelae. Conclusions: All neonates with coxsackievirus A6 HFMD had mild disease with no complications or sequelae. Notably, due to the two-child policy in China, elder siblings may be the main route of HFMD transmission.

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