scholarly journals Molecular Epidemiological Study of Hand, Foot, and Mouth Disease in a Kindergarten-Based Setting in Bangkok, Thailand

Pathogens ◽  
2021 ◽  
Vol 10 (5) ◽  
pp. 576
Author(s):  
Nipa Thammasonthijarern ◽  
Nathamon Kosoltanapiwat ◽  
Warisa Nuprasert ◽  
Pichamon Sittikul ◽  
Pimolpachr Sriburin ◽  
...  
Keyword(s):  
Molecular Genetic ◽  
Foot And Mouth Disease ◽  
Mouth Disease ◽  
School Closure ◽  
Asia Pacific ◽  
Supporting Evidence ◽  
Indirect Contact ◽  
Foot And Mouth ◽  
Closure Policy ◽  
Index Cases

Hand, foot, and mouth disease (HFMD) is a contagious childhood illness and annually affects millions of children aged less than 5 years across the Asia–Pacific region. HFMD transmission mainly occurs through direct contact (person-to-person) and indirect contact with contaminated surfaces and objects. Therefore, public health measures to reduce the spread of HFMD in kindergartens and daycare centers are essential. Based on the guidelines by the Department of Disease Control, a school closure policy for HFMD outbreaks wherein every school in Thailand must close when several HFMD classrooms (more than two cases in each classroom) are encountered within a week, was implemented, although without strong supporting evidence. We therefore conducted a prospective cohort study of children attending five kindergartens during 2019 and 2020. We used molecular genetic techniques to investigate the characteristics of the spreading patterns of HFMD in a school-based setting in Bangkok, Thailand. These analyses identified 22 index cases of HFMD (symptomatic infections) and 25 cases of enterovirus-positive asymptomatic contacts (24 students and one teacher). Enterovirus (EV) A71 was the most common enterovirus detected, and most of the infected persons (8/12) developed symptoms. Other enteroviruses included coxsackieviruses (CVs) A4, CV-A6, CV-A9, and CV-A10 as well as echovirus. The pattern of the spread of HFMD showed that 45% of the subsequent enteroviruses detected in each outbreak possessed the same serotype as the first index case. Moreover, we found a phylogenetic relationship among enteroviruses detected among contact and index cases in the same kindergarten. These findings confirm the benefit of molecular genetic assays to acquire accurate data to support school closure policies designed to control HFMD infections.

scholarly journals Meteorological factors and its association with hand, foot and mouth disease in Southeast and East Asia areas: a meta-analysis

2018 ◽  
Vol 147 ◽  
Author(s):  
Chunxiao Duan ◽  
Xuefeng Zhang ◽  
Hui Jin ◽  
Xiaoqing Cheng ◽  
Donglei Wang ◽  
...  
Keyword(s):  
East Asia ◽  
Meteorological Factors ◽  
Global Climate ◽  
Meta Analysis ◽  
Foot And Mouth Disease ◽  
Correlation Coefficients ◽  
Mouth Disease ◽  
Asia Pacific ◽  
China National Knowledge Infrastructure ◽  
Foot And Mouth

AbstractSince the late 1990s, hand, foot and mouth disease (HFMD) has become a common health problem that mostly affects children and infants in Southeast and East Asia. Global climate change is considered to be one of the major risk factors for HFMD. This study aimed to assess the correlation between meteorological factors and HFMD in the Asia-Pacific region. PubMed, Web of Science, Embase, China National Knowledge Infrastructure, Wanfang Data and Weipu Database were searched to identify relevant articles published before May 2018. Data were collected and analysed using R software. We searched 2397 articles and identified 51 eligible papers in this study. The present study included eight meteorological factors; mean temperature, mean highest temperature, mean lowest temperature, rainfall, relative humidity and hours of sunshine were positively correlated with HFMD, with correlation coefficients (CORs) of 0.52 (95% confidence interval (CI) 0.42–0.60), 0.43 (95% CI 0.23–0.59), 0.43 (95% CI 0.23–0.60), 0.27 (95% CI 0.19–0.35), 0.19 (95% CI 0.02–0.35) and 0.19 (95% CI 0.11–0.27), respectively. There were sufficient data to support a negative correlation between mean pressure and HFMD (COR = −0.51, 95% CI −0.63 to −0.36). There was no notable correlation with wind speed (COR = 0.10, 95% CI −0.03 to 0.23). Our findings suggest that meteorological factors affect the incidence of HFMD to a certain extent.

Virulence of enterovirus-A71 fluctuates depending on the phylogenetic clade formed in the epidemic year and epidemic region

2021 ◽  
Author(s):  
Kyousuke Kobayashi ◽  
Hidekazu Nishimura ◽  
Katsumi Mizuta ◽  
Tomoha Nishizawa ◽  
Son T. Chu ◽  
...  
Keyword(s):  
Transgenic Mice ◽  
Foot And Mouth Disease ◽  
Virus Genome ◽  
Mouth Disease ◽  
Asia Pacific ◽  
Enterovirus A71 ◽  
Viral Virulence ◽  
Foot And Mouth ◽  
Potential Risks ◽  
A Minor

Although epidemics of hand, foot, and mouth disease (HFMD) caused by enterovirus A71 (EV-A71) have occurred worldwide, the Asia-Pacific region has seen large sporadic outbreaks with many severe neurological cases. This suggests that the virulence of the circulating viruses fluctuates in each epidemic and that HFMD outbreaks with many severe cases occur when highly virulent viruses are circulating predominantly, which has not been experimentally verified. Here, we analyzed 32 clinically isolated strains obtained in Japan from 2002 to 2013, along with 27 Vietnamese strains obtained from 2015 to 2016 that we characterized previously using human SCARB2 transgenic mice. Phylogenetic analysis of the P1 region classified them into five clades belonging to subgenogroup B5 (B5-I to B5-V) and five clades belonging to subgenogroup C4 (C4-I to C4-V) according to the epidemic year and region. Interestingly, the clade B5-I and B5-II were very virulent, while clades B5-III, B5-IV, and B5-V were less virulent. Clades C4-II, C4-III, C4-IV, and C4-V were virulent, while clade C4-I was not. The result experimentally showed for the first time that several clades with different virulence levels emerged one after another. The experimental virulence evaluation of circulating viruses using SCARB2 transgenic mice is helpful to assess potential risks of circulating viruses. These results also suggest that a minor nucleotide or amino acid substitution in the EV-A71 genome during circulation may cause fluctuations in virulence. The data presented herein may increase our understanding of the dynamics of viral virulence during epidemics. IMPORTANCE Outbreaks of hand, foot, and mouth disease (HFMD) with severe enterovirus A71 (EV-A71) cases have occurred repeatedly, mainly in Asia. In severe cases, central nervous system complications can lead to death, making it an infectious disease of importance to public health. An unanswered question about this disease is why outbreaks of HFMD with many severe cases sometimes occur. Here, we collected EV-A71 strains that were prevalent in Japan and Vietnam over the past 20 years and evaluated their virulence in a mouse model of EV-A71 infection. This method clearly revealed that viruses belonging to different clades have different virulence, indicating that the method is powerful to assess the potential risks of the circulating viruses. The results also suggested that factors in the virus genome may potentially cause an outbreak with many severe cases and that further studies may facilitate the prediction of large epidemics of EV-A71 in the future.

scholarly journals Early Evidence of Inactivated Enterovirus 71 Vaccine Impact Against Hand, Foot, and Mouth Disease in a Major Center of Ongoing Transmission in China, 2011–2018: A Longitudinal Surveillance Study

2019 ◽  
Author(s):  
Jennifer R Head ◽  
Philip A Collender ◽  
Joseph A Lewnard ◽  
Nicholas K Skaff ◽  
Ling Li ◽  
...  
Keyword(s):  
Time Series ◽  
Incidence Rate ◽  
Enterovirus 71 ◽  
Foot And Mouth Disease ◽  
Mouth Disease ◽  
Asia Pacific ◽  
Full Time ◽  
Study Region ◽  
Foot And Mouth ◽  
Vaccine Impact

Abstract Background Enterovirus 71 (EV71) is a major causative agent of hand, foot, and mouth disease (HFMD), associated with severe manifestations of the disease. Pediatric immunization with inactivated EV71 vaccine was initiated in 2016 in the Asia-Pacific region, including China. We analyzed a time series of HFMD cases attributable to EV71, coxsackievirus A16 (CA16), and other enteroviruses in Chengdu, a major transmission center in China, to assess early impacts of immunization. Methods Reported HFMD cases were obtained from China’s notifiable disease surveillance system. We compared observed postvaccination incidence rates during 2017–2018 with counterfactual predictions made from a negative binomial regression and a random forest model fitted to prevaccine years (2011–2015). We fit a change point model to the full time series to evaluate whether the trend of EV71 HFMD changed following vaccination. Results Between 2011 and 2018, 279 352 HFMD cases were reported in the study region. The average incidence rate of EV71 HFMD in 2017–2018 was 60% (95% prediction interval [PI], 41%–72%) lower than predicted in the absence of immunization, corresponding to an estimated 6911 (95% PI, 3246–11 542) EV71 cases averted over 2 years. There were 52% (95% PI, 42%–60%) fewer severe HFMD cases than predicted. However, the incidence rate of non-CA16 and non-EV71 HFMD was elevated in 2018. We identified a significant decline in the trend of EV71 HFMD 4 months into the postvaccine period. Conclusions We provide the first real-world evidence that programmatic vaccination against EV71 is effective against childhood HFMD and present an approach to detect early vaccine impact or intended consequences from surveillance data.

scholarly journals Structure, Immunogenicity, and Protective Mechanism of an Engineered Enterovirus 71-Like Particle Vaccine Mimicking 80S Empty Capsid

2017 ◽  
Vol 92 (1) ◽  
Author(s):  
Xiaoli Wang ◽  
Zhiqiang Ku ◽  
Xiang Zhang ◽  
Xiaohua Ye ◽  
Jinhuan Chen ◽  
...  
Keyword(s):  
Neutralizing Antibodies ◽  
Enterovirus 71 ◽  
Foot And Mouth Disease ◽  
Mouth Disease ◽  
Asia Pacific ◽  
Protective Mechanism ◽  
Particle Assembly ◽  
Virus Like Particle ◽  
Empty Capsid ◽  
Foot And Mouth

ABSTRACTEnterovirus 71 (EV71) is the major causative agent of severe hand, foot, and mouth disease, which affects millions of young children in the Asia-Pacific region annually. In this study, we engineered a novel EV71 virus-like particle (VLP) that lacks VP4 (therefore designated VLPΔVP4) and investigated its structure, antigenicity, and vaccine potential. The cryo-electron microscopy (cryo-EM) structure of VLPΔVP4was reconstructed to 3.71-Å resolution. Results from structural and biochemical analyses revealed that VLPΔVP4resembles the end product of the viral uncoating process, the 80S empty capsid. VLPΔVP4is able to elicit high-titer neutralizing antibodies and to fully protect mice against lethal viral challenge. Mechanistic studies showed that, at the cellular level, the anti-VLPΔVP4sera exert neutralization effects at both pre- and postattachment stages by inhibiting both virus attachment and internalization, and at the molecular level, the antisera can block multiple interactions between EV71 and its key receptors. Our study gives a better understanding of EV71 capsid assembly and provides important information for the design and development of new-generation vaccines for EV71, and perhaps for other enteroviruses, as well.IMPORTANCEEnterovirus 71 (EV71) infection may lead to severe hand, foot, and mouth disease, with significant morbidity and mortality. Knowledge regarding EV71 particle assembly remains limited. Here, we report the generation and characterization of a novel EV71 virus-like particle that lacks the VP4 capsid subunit protein. This particle, termed VLPΔVP4, structurally mimics the 80S empty capsid, which is the end stage of EV71 uncoating. We further show that VLPΔVP4exhibits desirable immunogenicity and protective efficacy in proof-of-concept studies. In addition, the inhibitory mechanisms of the VLPΔVP4-induced antibodies are unraveled at both the cellular and molecular levels. Our work provides the first evidence of picornaviral particle assembly in the complete absence of VP4 and identifies VLPΔVP4as an improved EV71 vaccine candidate with desirable traits. These findings not only enhance our understanding of particle assembly and uncoating of picornaviruses, but also provide important information for structure-guided vaccine design for EV71 and other enteroviruses.

scholarly journals Hand, Foot and Mouth Disease (HFMD): An Update

2017 ◽  
Vol 40 (2) ◽  
pp. 115-119 ◽  
Author(s):  
Probir Kumar Sarkar ◽  
Nital Kumar Sarker ◽  
Md Abu Tayab
Keyword(s):  
Enterovirus 71 ◽  
Foot And Mouth Disease ◽  
Mouth Disease ◽  
Coxsackie Virus ◽  
Asia Pacific ◽  
Human Enterovirus ◽  
Small Scale ◽  
Human Enterovirus 71 ◽  
Mild Disease ◽  
Foot And Mouth

Hand, foot, and mouth disease (HFMD) also known as vesicular stomatitis with exanthema, first reported in New Zealand in 1957 is caused by Coxsackie virus A16 (CVA16), human enterovirus 71 (HEV71) and occasionally by other HEV-A serotypes, such as Coxsackie virus A6 and Coxsackie virus A10, are also associated with HFMD and herpangina. While all these viruses can cause mild disease in children, EV71 has been associated with neurological disease and mortality in large outbreaks in the Asia Pacific region over the last decade. It is highly contagious and is spread through direct contact with the mucus, saliva, or feces of an infected person. This is characterized by erythrematous papulo vesicular eruptions over hand, feet, perioral area, knee, buttocks and also intra-orally mostly in children, typically occurs in small epidemics usually during the summer and autumn months. HFMD symptoms are usually mild and resolve on their own in 7 to 10 days. Treatment is symptomatic but good hygiene during and after infection is very important in preventing the spread of the disease. Though only small scale outbreaks have been reported from United States, Europe, Australia Japan and Brazil for the first few decade, since 1997 the disease has conspicuously changed its behavior as noted in different Southeast Asian countries. There was sharp rise in incidence, severity, complications and even fatal outcomes that were almost unseen before that period. There are reports of disease activity in different corners of India since 2004, and the largest outbreak of HFMD occurred in eastern part of India in and around Kolkata in 2007and Bhubaneswar, Odisha in 2009. In recent years there are cases of HFMD have been seen in Bangladesh also. Although of milder degree, continuous progress to affect larger parts of the neighboring may indicate vulnerability of Bangladesh from possible future outbreaks.Bangladesh J Child Health 2016; VOL 40 (2) :115-119

scholarly journals Weather effects on hand, foot, and mouth disease at individual level: a case-crossover study

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Zhicheng Du ◽  
Shao Lin ◽  
Tia Marks ◽  
Wangjian Zhang ◽  
Te Deng ◽  
...  
Keyword(s):  
Relative Humidity ◽  
Foot And Mouth Disease ◽  
Mouth Disease ◽  
Asia Pacific ◽  
Public Health Issue ◽  
Targeted Prevention ◽  
Weather Factors ◽  
Lag Effects ◽  
Case Crossover ◽  
Foot And Mouth

Abstract Background Hand, foot, and mouth disease (HFMD) raises an urgent public health issue in the Asia-Pacific region, especially in China. The associations between weather factors and HFMD have been widely studied but with inconsistent results. Moreover, previous studies utilizing ecological design could not rule out the bias of exposure misclassification and unobserved confounders. Methods We used case-crossover analysis to assess the associations of weather factors on HFMD. Individual HFMD cases from 2009 to 2012 in Guangdong were collected and cases located within 10 km of the meteorological monitoring sites were included. Lag effects were examined through the previous 7 days. In addition, we explored the variability by changing the distance within 20 km and 30 km. Results We observed associations between HFMD and weather factors, including temperature and relative humidity. An approximately U-shaped relationship was observed for the associations of temperature on HFMD across the same day and the previous 7 days, while an approximately exponential-shaped was seen for relative humidity. Statistically significant increases in rates of HFMD were associated with each 10-unit increases in temperature [Excess rate (ER): 7.7%; 95% Confidence Interval (CI): 3.9, 11.7%] and relative humidity (ER: 1.9%; 95% CI: 0.7, 3.0%) on lag days 0–6, when assessing within 10 km of the monitoring sites. Potential thresholds for temperature (30.0 °C) and relative humidity (70.3%) detected showed associations with HFMD. The associations remained robust for 20 km and 30 km. Conclusions Our study found that temperature and relative humidity are significantly associated with the increased rates of HFMD. Thresholds and lag effects were observed between weather factors and HFMD. Our findings are useful for planning on targeted prevention and control of HFMD.

scholarly journals The Effect of School Closure on Hand, Foot, and Mouth Disease Transmission in Singapore: A Modeling Approach

2018 ◽  
Vol 99 (6) ◽  
pp. 1625-1632 ◽  
Author(s):  
Yirong Chen ◽  
Hishamuddin Badaruddin ◽  
Vernon J. Lee ◽  
Jeffery Cutter ◽  
Alex R. Cook
Keyword(s):  
Disease Transmission ◽  
Foot And Mouth Disease ◽  
Mouth Disease ◽  
School Closure ◽  
Modeling Approach ◽  
Foot And Mouth

scholarly journals Human enterovirus 71 and hand, foot and mouth disease

2010 ◽  
Vol 138 (8) ◽  
pp. 1071-1089 ◽  
Author(s):  
S. S. Y. WONG ◽  
C. C. Y. YIP ◽  
S. K. P. LAU ◽  
K. Y. YUEN
Keyword(s):  
Vaccine Development ◽  
Enterovirus 71 ◽  
Foot And Mouth Disease ◽  
Mouth Disease ◽  
Asia Pacific ◽  
Human Enterovirus ◽  
Human Enterovirus 71 ◽  
Asian Pacific Region ◽  
Route Of Transmission ◽  
Foot And Mouth

SUMMARYHand, foot and mouth disease (HFMD) is generally a benign febrile exanthematous childhood disease caused by human enteroviruses. The route of transmission is postulated to be faeco-oral in developing areas but attributed more to respiratory droplet in developed areas. Transmission is facilitated by the prolonged environmental survival of these viruses and their greater resistance to biocides. Serious outbreaks with neurological and cardiopulmonary complications caused by human enterovirus 71 (HEV-71) seem to be commoner in the Asian Pacific region than elsewhere in the world. This geographical predilection is unexplained but could be related to the frequency of intra- and inter-typic genetic recombinations of the virus, the host populations' genetic predisposition, environmental hygiene, and standard of healthcare. Vaccine development could be hampered by the general mildness of the illness and rapid genetic evolution of the virus. Antivirals are not readily available; the role of intravenous immunoglobulin in the treatment of serious complications should be investigated. Monitoring of this disease and its epidemiology in the densely populated Asia Pacific epicentre is important for the detection of emerging epidemics due to enteroviruses.

scholarly journals Spatial-temporal mapping and risk factors for hand foot and mouth disease in northwestern inland China

2021 ◽  
Vol 15 (3) ◽  
pp. e0009210
Author(s):  
Ruifang Huang ◽  
Jiate Wei ◽  
Zhenwei Li ◽  
Zhenguo Gao ◽  
Muti Mahe ◽  
...  
Keyword(s):  
Risk Factors ◽  
Land Cover ◽  
Negative Binomial ◽  
Foot And Mouth Disease ◽  
Mouth Disease ◽  
Asia Pacific ◽  
Land Cover Type ◽  
Cover Type ◽  
Multiple Factors ◽  
Foot And Mouth

Background Hand foot and mouth disease (HFMD) is becoming one of the common human infectious diseases in China. Previous studies have described HFMD in tropical or coastal areas of Asia-Pacific countries. However, limited studies have thoroughly studied the epidemiology and potential risk factors for HFMD in inland areas with complex environmental conditions. Methodology/Principal findings Using the data from 2009 to 2018 on reported cases of Xinjiang Uighur Autonomous Region, we characterized the epidemic features of HFMD. Panel negative binomial model was used to identify climate, geographical and demographic determinants for HFMD incidence. A total of 70856 HFMD cases (average annual incidence: 305 per million persons) were reported in Xinjiang during the 10-year study period, of which 10393 (14.7%) were laboratory-confirmed and 98 (0.1%) were severe. HFMD peaked in summer every year during the study period, and incidence in 2012, 2015, 2016 and 2018 had minor peaks in autumn. After adjusting the school or holiday month, multiple factors were found to affect HFMD epidemiology: urban area being major land cover type (incidence risk ratio, IRR 2.08; 95% CI 1.50, 2.89), higher gross domestic product per capita (IRR 1.14; 95% CI 1.11, 1.16), rise in monthly average temperature (IRR 1.65; 95% CI 1.61, 1.69) and monthly accumulative precipitation (IRR 1.20; 95% CI 1.16, 1.24) predicted increase in the incidence of HFMD; farmland being major land cover type (IRR 0.72; 95% CI 0.64, 0.81), an increase of percentage of the minority (IRR 0.91; 95% CI 0.89, 0.93) and population density (IRR 0.98; 95% CI 0.98, 0.99) were related to a decrease in the incidence of HFMD. Conclusions/Significance In conclusion, the epidemic status of HFMD in Xinjiang is characterized by low morbidity and fatality. Multiple factors have significant influences on the occurrence and transmission of HFMD in Xinjiang.

scholarly journals Epidemic dynamics, interactions and predictability of enteroviruses associated with hand, foot and mouth disease in Japan

2018 ◽  
Vol 15 (146) ◽  
pp. 20180507 ◽  
Author(s):  
Saki Takahashi ◽  
C. Jessica E. Metcalf ◽  
Yuzo Arima ◽  
Tsuguto Fujimoto ◽  
Hiroyuki Shimizu ◽  
...  
Keyword(s):  
Time Series ◽  
Time Series Data ◽  
Vaccine Development ◽  
Foot And Mouth Disease ◽  
Mouth Disease ◽  
Asia Pacific ◽  
Series Data ◽  
Inhibitory Interaction ◽  
Epidemic Dynamics ◽  
Foot And Mouth

Outbreaks of hand, foot and mouth disease have been documented in Japan since 1963. This disease is primarily caused by the two closely related serotypes of Enterovirus A71 (EV-A71) and Coxsackievirus A16 (CV-A16). Here, we analyse Japanese virologic and syndromic surveillance time-series data from 1982 to 2015. As in some other countries in the Asia Pacific region, EV-A71 in Japan has a 3 year cyclical component, whereas CV-A16 is predominantly annual. We observe empirical signatures of an inhibitory interaction between the serotypes; virologic lines of evidence suggest they may indeed interact immunologically. We fit the time series to mechanistic epidemiological models: as a first-order effect, we find the data consistent with single-serotype susceptible–infected–recovered dynamics. We then extend the modelling to incorporate an inhibitory interaction between serotypes. Our results suggest the existence of a transient cross-protection and possible asymmetry in its strength such that CV-A16 serves as a stronger forcing on EV-A71. Allowing for asymmetry yields accurate out-of-sample predictions and the directionality of this effect is consistent with the virologic literature. Confirmation of these hypothesized interactions would have important implications for understanding enterovirus epidemiology and informing vaccine development. Our results highlight the general implication that even subtle interactions could have qualitative impacts on epidemic dynamics and predictability.

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