51
|
Yang Z, Rui J, Qi L, Ye W, Niu Y, Luo K, Deng B, Zhang S, Yu S, Liu C, Li P, Wang R, Wei H, Zhang H, Huang L, Zuo S, Zhang L, Zhang S, Yang S, Guo Y, Zhao Q, Wu S, Li Q, Chen Y, Chen T. Study on the interaction between different pathogens of Hand, foot and mouth disease in five regions of China. Front Public Health 2022; 10:970880. [PMID: 36238254 PMCID: PMC9552780 DOI: 10.3389/fpubh.2022.970880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 08/22/2022] [Indexed: 01/25/2023] Open
Abstract
Objectives This study aims to explore the interaction of different pathogens in Hand, foot and mouth disease (HFMD) by using a mathematical epidemiological model and the reported data in five regions of China. Methods A cross-regional dataset of reported HFMD cases was built from four provinces (Fujian Province, Jiangsu province, Hunan Province, and Jilin Province) and one municipality (Chongqing Municipality) in China. The subtypes of the pathogens of HFMD, including Coxsackievirus A16 (CV-A16), enteroviruses A71 (EV-A71), and other enteroviruses (Others), were included in the data. A mathematical model was developed to fit the data. The effective reproduction number (R eff ) was calculated to quantify the transmissibility of the pathogens. Results In total, 3,336,482 HFMD cases were collected in the five regions. In Fujian Province, the R eff between CV-A16 and EV-A71&CV-A16, and between CV-A16 and CV-A16&Others showed statistically significant differences (P < 0.05). In Jiangsu Province, there was a significant difference in R eff (P < 0.05) between the CV-A16 and Total. In Hunan Province, the R eff between CV-A16 and EV-A71&CV-A16, between CV-A16 and Total were significant (P < 0.05). In Chongqing Municipality, we found significant differences of the R eff (P < 0.05) between CV-A16 and CV-A16&Others, and between Others and CV-A16&Others. In Jilin Province, significant differences of the R eff (P < 0.05) were found between EV-A71 and Total, and between Others and Total. Conclusion The major pathogens of HFMD have changed annually, and the incidence of HFMD caused by others and CV-A16 has surpassed that of EV-A71 in recent years. Cross-regional differences were observed in the interactions between the pathogens.
Collapse
Affiliation(s)
- Zimei Yang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Jia Rui
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Li Qi
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China
| | - Wenjing Ye
- Fujian Center for Disease Control and Prevention, Fuzhou, Fujian, China
| | - Yan Niu
- Chinese Center for Disease Control and Prevention, Beijing, China
| | - Kaiwei Luo
- Hunan Center for Disease Control and Prevention, Changsha, Hunan, China
| | - Bin Deng
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Shi Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Shanshan Yu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Chan Liu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Peihua Li
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Rui Wang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Hongjie Wei
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Hesong Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Lijin Huang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Simiao Zuo
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Lexin Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Shurui Zhang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Shiting Yang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Yichao Guo
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China
| | - Qinglong Zhao
- Jilin Center for Disease Control and Prevention, Changchun, Jilin, China
| | - Shenggen Wu
- Fujian Center for Disease Control and Prevention, Fuzhou, Fujian, China,Shenggen Wu
| | - Qin Li
- Chongqing Municipal Center for Disease Control and Prevention, Chongqing, China,Qin Li
| | - Yong Chen
- Department of Stomatology, School of Medicine, Xiamen University, Xiamen, China,Yong Chen
| | - Tianmu Chen
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, Fujian, China,*Correspondence: Tianmu Chen
| |
Collapse
|
52
|
Zhong X, Wang H, Chen C, Zou X, Li T. Epidemiological Characteristics of Hand, Foot and Mouth Disease Reinfection in Guangzhou, Southern China from 2012 to 2017. IRANIAN JOURNAL OF PUBLIC HEALTH 2022; 51:2078-2088. [PMID: 36743381 PMCID: PMC9884378 DOI: 10.18502/ijph.v51i9.10563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Accepted: 07/11/2021] [Indexed: 11/24/2022]
Abstract
Background Hand, foot and mouth disease (HFMD) reinfection is common because of the limited cross-protection from infections of different enterovirus. We aimed to investigate the epidemiological characteristics and its influential factors of HFMD reinfection in Guangzhou, China. Methods Data on HFMD patients aged ≤5 yr from 2012 to 2017 were extracted from surveillance system. Influential factors of reinfection were assessed using the logistic regression model. Results Of 369,054 HFMD patients, 11,321 patients (3.07%) were classified as reinfection. The reinfection rate in male was higher than in female (χ2=60.11, P<0.001). The reinfection rate in patients ≤1 yr was 3.86%, which showed a downward trend with age (Z=37.37, P trend<0.001). The highest reinfection rate was observed in the scattered children (3.38%), followed by nursery care children and others (χ2=514.75, P<0.001). Besides, higher risk of reinfection was detected among those who were male, lower age group, rural residence and other enteroviruses infection compared with their respective counterparts. Seasonality was illustrated according to the number of reinfections peaked from April to July. Time intervals curves revealed the number of reinfections gradually increased after 13 months from the initial infection. Conclusion Male ≤4 yr, living rural area, especially those lived scattered and infected with other enteroviruses were more likely to be reinfection.
Collapse
Affiliation(s)
- Xuan Zhong
- Shenzhen Nanshan Center for Chronic Disease Control, Shenzhen 518054, China,School of Public Health, Guangdong Pharmaceutical University, Guangzhou 510310, China
| | - Hui Wang
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China
| | - Chun Chen
- Guangzhou Center for Disease Control and Prevention, Guangzhou 510440, China
| | - Xiaoni Zou
- Guangdong Women and Children Hospital, Guangzhou 510010, China,Corresponding Authors: Emails: ;
| | - Tiegang Li
- Guangzhou Municipal Health Commission, Guangzhou 510062, China,Corresponding Authors: Emails: ;
| |
Collapse
|
53
|
Leung AKC, Lam JM, Barankin B, Leong KF, Hon KL. Hand, Foot, and Mouth Disease: A Narrative Review. RECENT ADVANCES IN INFLAMMATION & ALLERGY DRUG DISCOVERY 2022; 16:77-95. [PMID: 36284392 DOI: 10.2174/1570180820666221024095837] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 09/08/2022] [Accepted: 09/19/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Hand, foot, and mouth disease is a common viral disease in childhood. Because the disease has the potential to reach epidemic levels and mortality is high in some countries, early recognition of this disease is of paramount importance. OBJECTIVE This purpose of this article is to familiarize pediatricians with the clinical manifestations and management of hand, foot, and mouth disease. METHODS A search was conducted in February 2022 in PubMed Clinical Queries using the key term "hand, foot, and mouth disease". The search strategy included all clinical trials, observational studies, and reviews published within the past 10 years. Only papers published in English were included in this review. RESULTS Hand, foot, and mouth disease is characterized by a painful oral enanthem and asymptomatic exanthem on the palms and soles. Children younger than 5 years are most commonly affected. Hand, foot, and mouth disease caused by enterovirus A71 is more severe and has a higher rate of complications than that attributed to other viruses such as coxsackievirus A16. Circulatory failure secondary to myocardial impairment and neurogenic pulmonary edema secondary to brainstem damage are the main causes of death. Fortunately, the disease is usually benign and resolves in 7 to10 days without sequelae. Given the self-limited nature of most cases, treatment is mainly symptomatic and supportive. Intravenous immunoglobulin should be considered for the treatment of severe/complicated hand, foot, and mouth disease and has been recommended by several national and international guideline committees. Currently, there are no specific antiviral agents approved for the treatment of the disease. Drugs such as ribavirin, suramin, mulberroside C, aminothiazole analogs, and sertraline have emerged as potential candidates for the treatment of hand, foot, and mouth disease. Vaccination of susceptible individuals in high-risk areas and good personal hygiene are important preventative measures to combat the disease. CONCLUSION Familiarity of the disease including its atypical manifestations is crucial so that a correct diagnosis can be made, and appropriate treatment initiated. A timely diagnosis can help avoid contact with the affected individual and decrease the risk of an outbreak.
Collapse
Affiliation(s)
- Alexander K C Leung
- Department of Paediatrics, The University of Calgary, Alberta Children's Hospital, Calgary, Alberta, Canada
| | - Joseph M Lam
- Department of Pediatrics and Department of Dermatology and Skin Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Kin Fon Leong
- Pediatric Institute, Kuala Lumpur General Hospital, Kuala Lumpur, Malaysia
| | - Kam Lun Hon
- Department of Paediatrics, Hong Kong Institute of Integrative Medicine, and the Jockey Club School of Public Health and Primary Care, The Chinese University Hong Kong, Hong Kong
| |
Collapse
|
54
|
Cao Y, Li M, Haihambo N, Zhu Y, Zeng Y, Jin J, Qiu J, Li Z, Liu J, Teng J, Li S, Zhao Y, Zhao X, Wang X, Li Y, Feng X, Han C. Oscillatory properties of class C notifiable infectious diseases in China from 2009 to 2021. Front Public Health 2022; 10:903025. [PMID: 36033737 PMCID: PMC9402928 DOI: 10.3389/fpubh.2022.903025] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/19/2022] [Indexed: 01/22/2023] Open
Abstract
Background Epidemics of infectious diseases have a great negative impact on people's daily life. How it changes over time and what kind of laws it obeys are important questions that researchers are always interested in. Among the characteristics of infectious diseases, the phenomenon of recrudescence is undoubtedly of great concern. Understanding the mechanisms of the outbreak cycle of infectious diseases could be conducive for public health policies to the government. Method In this study, we collected time-series data for nine class C notifiable infectious diseases from 2009 to 2021 using public datasets from the National Health Commission of China. Oscillatory power of each infectious disease was captured using the method of the power spectrum analysis. Results We found that all the nine class C diseases have strong oscillations, which could be divided into three categories according to their oscillatory frequencies each year. Then, we calculated the oscillation power and the average number of infected cases of all nine diseases in the first 6 years (2009-2015) and the next 6 years (2015-2021) since the update of the surveillance system. The change of oscillation power is positively correlated to the change in the number of infected cases. Moreover, the diseases that break out in summer are more selective than those in winter. Conclusion Our results enable us to better understand the oscillation characteristics of class C infectious diseases and provide guidance and suggestions for the government's prevention and control policies.
Collapse
Affiliation(s)
- Yanxiang Cao
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Meijia Li
- Faculty of Psychology and Center for Neuroscience, Vrije Universiteit Brussel, Brussels, Belgium
| | - Naem Haihambo
- Faculty of Psychology and Center for Neuroscience, Vrije Universiteit Brussel, Brussels, Belgium
| | - Yuyao Zhu
- College of Environmental Sciences and Engineering, Peking University, Beijing, China
| | - Yimeng Zeng
- State Key Laboratory of Cognitive Neuroscience and Learning & IDG/McGovern Institute for Brain Research, Beijing Normal University, Beijing, China
| | - Jianhua Jin
- Zhongshan School of Medicine, Sun Yat-sen University, Guangzhou, China
| | - Jinyi Qiu
- School of Artificial Intelligence, Beijing Normal University, Beijing, China
| | - Zhirui Li
- Baoding First Central Hospital, Baoding, China
| | - Jiaxin Liu
- Department of Psychology, University of Washington, Washington, SA, United States
| | - Jiayi Teng
- School of Psychology, Philosophy and Language Science, University of Edinburgh, Edinburgh, United Kingdom
| | - Sixiao Li
- Faculty of Arts, Humanities and Cultures, School of Music, University of Leeds, Leeds, United Kingdom
| | - Yanan Zhao
- China Academy of Chinese Medical Sciences, Institute of Acupuncture and Moxibustion, Beijing, China
| | - Xixi Zhao
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Xuemei Wang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Yaqiong Li
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
- Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Xiaoyang Feng
- Institute of Mental Health, Peking University Sixth Hospital, Beijing, China
| | - Chuanliang Han
- Shenzhen Key Laboratory of Neuropsychiatric Modulation and Collaborative Innovation Center for Brain Science, Guangdong Provincial Key Laboratory of Brain Connectome and Behavior, CAS Center for Excellence in Brain Science and Intelligence Technology, Chinese Academy of Sciences, Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Shenzhen–Hong Kong Institute of Brain Science, Shenzhen Fundamental Research Institutions, Shenzhen, China
| |
Collapse
|
55
|
Chen W, Li J, Li J, Zhang J, Zhang J. Roles of Non-Coding RNAs in Virus-Host Interaction About Pathogenesis of Hand-Foot-Mouth Disease. Curr Microbiol 2022; 79:247. [PMID: 35834056 PMCID: PMC9281230 DOI: 10.1007/s00284-022-02928-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Accepted: 06/06/2022] [Indexed: 11/28/2022]
Abstract
Noncoding RNAs (ncRNAs) represent the largest and main transcriptome products and play various roles in the biological activity of cells and pathological processes. Accumulating evidence shows that microRNA (miRNA), long non-coding RNA (lncRNA), and circular RNA (circRNA) are important ncRNAs that play vital regulatory roles during viral infection. Hand-foot-mouth disease (HFMD) virus causes hand-foot-mouth disease, and is also associated with various serious complications and high mortality. However, there is currently no effective treatment. In this review, we focus on advances in the understanding of the modulatory role of ncRNAs during HFMD virus infection. Specifically, we discuss the generation, classification, and regulatory mechanisms of miRNA, lncRNA, and circRNA in the interaction between virus and host, with a particular focus on their influence with viral replication and infection. Analysis of these underlying mechanisms can help provide a foundation for the development of ncRNA-based antiviral therapies.
Collapse
Affiliation(s)
- Wei Chen
- Medical School, Kunming University of Science and Technology, Chenggong District, No. 727, Southern Jingming Road, Kunming, Yunnan Province, 650500, People's Republic of China.
| | - Jinwei Li
- Medical School, Kunming University of Science and Technology, Chenggong District, No. 727, Southern Jingming Road, Kunming, Yunnan Province, 650500, People's Republic of China
| | - Jing Li
- Medical School, Kunming University of Science and Technology, Chenggong District, No. 727, Southern Jingming Road, Kunming, Yunnan Province, 650500, People's Republic of China
| | - Jiayu Zhang
- Medical School, Kunming University of Science and Technology, Chenggong District, No. 727, Southern Jingming Road, Kunming, Yunnan Province, 650500, People's Republic of China
| | - Jihong Zhang
- Medical School, Kunming University of Science and Technology, Chenggong District, No. 727, Southern Jingming Road, Kunming, Yunnan Province, 650500, People's Republic of China.
| |
Collapse
|
56
|
Li W, Wang J, Zhou K, Tian Y, Wei F, Zhang M, Wang X. Association of PM 2.5 and its components with lengths of hospital stay for hand foot and mouth disease in children. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2022; 29:50598-50607. [PMID: 35237913 DOI: 10.1007/s11356-022-19448-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 02/22/2022] [Indexed: 06/14/2023]
Abstract
Hand foot and mouth disease (HFMD) is a widespread public health concern but the studies on air pollution and the lengths of hospital stay (LOS) of HFMD are scarce nevertheless. Clinic demographic features among 5135 hospitalized HFMD cases in Nanjing, China, had been characterized from 2012 to 2017. Then, we had analyzed the association between PM2.5 short-term exposure as well as its components (OM, BC, SO42-, NH4+, NIT, SOIL, and SS) and the LOS of HFMD. Among these cases that were involved in our study, 98.62% were aged 0-6 years old, and 3772 (73.46%) were hospitalized within 1 week or less. The LOS of HFMD patients was different in various age ranges, illness onset years, and illness onset seasons (P < 0.01). For per IQR increase in PM2.5 concentrations, LOS of HFMD increased by 0.52 (0.33, 0.71), 0.50 (95% CI, 0.31-0.69) and 0.46 (95% CI, 0.28-0.65) day in adjusted models at lag 3 days, lag 7 days, and lag 14 days, respectively. In addition, per IQR increase of BC, SO42-, NH4+, NIT, and SOIL was also significantly associated with the LOS of HFMD. Our findings corroborated that short-term PM2.5 exposure was associated with the increased LOS of HFMD, and its components (BC, SO42-, NH4+, NIT, and SOIL) of PM2.5 might play a key role in prolonged LOS of HFMD.
Collapse
Affiliation(s)
- Wei Li
- Department of Quality Management, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Jieguo Wang
- Department of Emergency, Pediatric Intensive Care Unit, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Kai Zhou
- Department of Infection, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Ye Tian
- Department of Infection, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China
| | - Feiran Wei
- Division of Rheumatology, Zhongda Hospital Southeast University, Nanjing, 210008, China
| | - Mingzhi Zhang
- Institute of Toxicology, School of Public Health, Nanjing Medical University, Nanjing, 211166, China.
| | - Xu Wang
- Department of Endocrinology, Children's Hospital of Nanjing Medical University, Nanjing, 210008, China.
| |
Collapse
|
57
|
Li Y, Liu M, Yan Y, Wang Z, Dai Q, Yang X, Guo X, Li W, Chen X, Cao R, Zhong W. Molnupiravir and Its Active Form, EIDD-1931, Show Potent Antiviral Activity against Enterovirus Infections In Vitro and In Vivo. Viruses 2022; 14:v14061142. [PMID: 35746614 PMCID: PMC9227765 DOI: 10.3390/v14061142] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/16/2022] [Accepted: 05/23/2022] [Indexed: 02/04/2023] Open
Abstract
Enterovirus infections can cause hand, foot, and mouth disease (HFDM), aseptic meningitis, encephalitis, myocarditis, and acute flaccid myelitis, leading to death of infants and young children. However, no specific antiviral drug is currently available for the treatment of this type of infection. The Unites States and United Kingdom health authorities recently approved a new antiviral drug, molnupiravir, for the treatment of COVID-19. In this study, we reported that molnupiravir (EIDD-2801) and its active form, EIDD-1931, have broad-spectrum anti-enterovirus potential. Our data showed that EIDD-1931 could significantly reduce the production of EV-A71 progeny virus and the expression of EV-A71 viral protein at non-cytotoxic concentrations. The results of the time-of-addition assay suggest that EIDD-1931 acts at the post-entry step, which is in accordance with its antiviral mechanism. The intraperitoneal administration of EIDD-1931 and EIDD-2801 protected 1-day-old ICR suckling mice from lethal EV-A71 challenge by reducing the viral load in various tissues of the infected mice. The pharmacokinetics analysis indicated that the plasma drug concentration overwhelmed the EC50 for enteroviruses, suggesting the clinical potential of molnupiravir against enteroviruses. Thus, molnupiravir along with its active form, EIDD-1931, may be a promising drug candidate against enterovirus infections.
Collapse
Affiliation(s)
- Yuexiang Li
- National Engineering Research Center for the Emergency Drug, Beijing Institute of Pharmacology and Toxicology, Beijing 100850, China; (Y.L.); (M.L.); (Y.Y.); (Z.W.); (Q.D.); (X.Y.); (X.G.); (W.L.)
| | - Miaomiao Liu
- National Engineering Research Center for the Emergency Drug, Beijing Institute of Pharmacology and Toxicology, Beijing 100850, China; (Y.L.); (M.L.); (Y.Y.); (Z.W.); (Q.D.); (X.Y.); (X.G.); (W.L.)
| | - Yunzheng Yan
- National Engineering Research Center for the Emergency Drug, Beijing Institute of Pharmacology and Toxicology, Beijing 100850, China; (Y.L.); (M.L.); (Y.Y.); (Z.W.); (Q.D.); (X.Y.); (X.G.); (W.L.)
| | - Zhuang Wang
- National Engineering Research Center for the Emergency Drug, Beijing Institute of Pharmacology and Toxicology, Beijing 100850, China; (Y.L.); (M.L.); (Y.Y.); (Z.W.); (Q.D.); (X.Y.); (X.G.); (W.L.)
- Institute of Medical Research, Northwestern Polytechnical University, Xi’an 710072, China;
| | - Qingsong Dai
- National Engineering Research Center for the Emergency Drug, Beijing Institute of Pharmacology and Toxicology, Beijing 100850, China; (Y.L.); (M.L.); (Y.Y.); (Z.W.); (Q.D.); (X.Y.); (X.G.); (W.L.)
| | - Xiaotong Yang
- National Engineering Research Center for the Emergency Drug, Beijing Institute of Pharmacology and Toxicology, Beijing 100850, China; (Y.L.); (M.L.); (Y.Y.); (Z.W.); (Q.D.); (X.Y.); (X.G.); (W.L.)
| | - Xiaojia Guo
- National Engineering Research Center for the Emergency Drug, Beijing Institute of Pharmacology and Toxicology, Beijing 100850, China; (Y.L.); (M.L.); (Y.Y.); (Z.W.); (Q.D.); (X.Y.); (X.G.); (W.L.)
| | - Wei Li
- National Engineering Research Center for the Emergency Drug, Beijing Institute of Pharmacology and Toxicology, Beijing 100850, China; (Y.L.); (M.L.); (Y.Y.); (Z.W.); (Q.D.); (X.Y.); (X.G.); (W.L.)
| | - Xingjuan Chen
- Institute of Medical Research, Northwestern Polytechnical University, Xi’an 710072, China;
| | - Ruiyuan Cao
- National Engineering Research Center for the Emergency Drug, Beijing Institute of Pharmacology and Toxicology, Beijing 100850, China; (Y.L.); (M.L.); (Y.Y.); (Z.W.); (Q.D.); (X.Y.); (X.G.); (W.L.)
- Correspondence: (R.C.); (W.Z.); Tel.: +86-10-66930673 (R.C.); +86-10-66932624 (W.Z.)
| | - Wu Zhong
- National Engineering Research Center for the Emergency Drug, Beijing Institute of Pharmacology and Toxicology, Beijing 100850, China; (Y.L.); (M.L.); (Y.Y.); (Z.W.); (Q.D.); (X.Y.); (X.G.); (W.L.)
- Correspondence: (R.C.); (W.Z.); Tel.: +86-10-66930673 (R.C.); +86-10-66932624 (W.Z.)
| |
Collapse
|
58
|
Kang YJ, Shi C, Zhou J, Qian J, Qiu Y, Ge G. Multiple molecular characteristics of circulating enterovirus types among pediatric hand, foot and mouth disease patients after EV71 vaccination campaign in Wuxi, China. Epidemiol Infect 2022; 150:1-19. [PMID: 35473720 PMCID: PMC9128351 DOI: 10.1017/s0950268822000784] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 04/05/2022] [Accepted: 04/16/2022] [Indexed: 11/08/2022] Open
Abstract
The molecular properties of the circulating causative agents of hand, foot and mouth disease (HFMD) in Wuxi remain unclear, posing diagnostic and prevention challenges. Additionally, in several regions of mainland China, the EV71 immunisation drastically reduced related cases and altered the HFMD pathogen spectrum, while the precise situation in Wuxi remained unknown. To address these issues, paediatric HFMD cases diagnosed in the clinic were enrolled and anal swabs were acquired in the spring of 2019. The 5′-UTR and VP1 genes were interpreted using RT-nPCR with degenerate primers to confirm their genotypes. Following that, the entire genome sequences of each viral type were recovered, allowing for the interpretation of several molecular properties. A total of 249 clinically confirmed HFMD cases had their anal swabs taken for viral identification, from which the genome sequences of seven genotypes were recovered. Coxsackievirus A16 is the most prevalent type, followed by Coxsackievirus A6, A10, A2, A4, A5 and Echovirus 11, all of which were genetically determined for the first time in Wuxi. Phylogenetic and recombination analyses were used to evaluate their evolutionary relationships with other strains found in other regions. Noticeably, a CVA16 subtype, responsible for a large proportion of the observed cases, phylogenetically clustered within clade B1a along with some strains from other countries, was the first one to be reported in China. Furthermore, some recombination events were inferred from strains detected in sporadic cases, particularly the recombination between CVA2 and CVA5 strains. Our investigation elucidated the multiple molecular characteristics of the HFMD causal enterovirus strains in Wuxi, underlining the potential hazards associated with these circulating viral types in the population and aiding in future surveillance and prevention of this disease.
Collapse
Affiliation(s)
- Yan-Jun Kang
- Department of Pediatric Laboratory, Wuxi Children's Hospital, Wuxi, China
| | - Chao Shi
- Department of Disease Control, Wuxi Center for Disease Control and Prevention, Wuxi, China
| | - Jian Zhou
- Department of Pediatric Laboratory, Wuxi Children's Hospital, Wuxi, China
| | - Jun Qian
- Department of Pediatrics, Wuxi Children's Hospital, Wuxi 214023, China
| | - Yuanwang Qiu
- Department of Infectious Diseases, The Fifth People's Hospital of Wuxi, Wuxi, China
| | - Guizhi Ge
- Department of Infectious Disease, Wuxi Children's Hospital, Wuxi, China
| |
Collapse
|
59
|
Yi L, Zhang L, Feng L, Luan X, Zhao Q, Xu P, Wang Y, Tao L, Wu W. Genomic analysis of a recombinant coxsackievirus A19 identified in Xinxiang, China, in 2019. Arch Virol 2022; 167:1405-1420. [DOI: 10.1007/s00705-022-05433-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 02/21/2022] [Indexed: 11/29/2022]
|
60
|
Hu L, Maimaiti H, Zhou L, Gao J, Lu Y. Changing serotypes of hand, foot and mouth disease in Shanghai, 2017-2019. Gut Pathog 2022; 14:12. [PMID: 35313977 PMCID: PMC8935267 DOI: 10.1186/s13099-022-00485-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Accepted: 03/10/2022] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Hand, foot, and mouth disease (HFMD) is a common reportable infectious disease that is highly contagious among children in China. This study aimed to characterize the epidemics of HFMD and the serotypes of enterovirus (EV) after the introduction of EV-A71 vaccines in Shanghai, a city in Eastern China. RESULTS A total of 2271 HFMD cases were recruited in this study from May 2017 through October 2020. Among these cases, a male-to-female ratio of 1.6:1 was observed, and the cases were mainly in 1-4 years old (63.1%). Children of all ages had a relatively similar time span between the onset of HFMD and the initial medical visit (P = 0.5192). The cases were reported year-round with peaks in the summer (2018 and 2019) and fall (2017), which was consistent with previous epidemics of the reported HFMD cases in the Shanghai municipality. Among the specimens that tested positive for EV (n = 1855), CV-A6 was predominantly detected (71.1%), followed by CV-A16 (14.2%) and EV-A71 (7.0%). Notably, the number of HFMD cases infected with EV-A71 increased in 2019. Furthermore, 9.2% of the cases had comorbidities, mostly convulsion, bronchopneumonia, and pneumonia; however, they were not correlated with the EV serotypes. In addition, 31.2% (709/2271) of the cases were vaccinated with EV-A71 vaccines. The time span differed significantly between the time of vaccination and the onset of the disease across the groups based on whether the onset was before or after vaccination (P < 0.001). CONCLUSIONS CV-A6 is the predominant EV serotype in the epidemic of HFMD in Shanghai; in addition, CV-A16 and EV-A71 may be moderately prevalent. The changing trends in the presence of EV serotypes contributes to the periodicity of the HFMD epidemic. In addition, the minority of HFMD cases may have comorbidities, regardless of the EV serotype. The use of the EV-A71 vaccine has affected the HFMD epidemic. And serotype-specific protection by the EV-A71 vaccine may promote vaccination in children infected with EV-A71 compared to those infected with non-EV-A71 serotypes, which would further change the epidemic scenario of HFMD.
Collapse
Affiliation(s)
- Linjie Hu
- Department of Epidemiology, Ministry of Education Key Laboratory of Public Health Safety, School of Public Health, Fudan University, Fosun Tower, 131 Dong An Road, Shanghai, 200032, China
| | - Hairenguli Maimaiti
- Department of Epidemiology, Ministry of Education Key Laboratory of Public Health Safety, School of Public Health, Fudan University, Fosun Tower, 131 Dong An Road, Shanghai, 200032, China
| | - Lu Zhou
- Department of Epidemiology, Ministry of Education Key Laboratory of Public Health Safety, School of Public Health, Fudan University, Fosun Tower, 131 Dong An Road, Shanghai, 200032, China
| | - Jie Gao
- Department of Infection Control, Shanghai Children's Hospital, Shanghai Jiaotong University, 355 Luding Road, Shanghai, 200062, China.
| | - Yihan Lu
- Department of Epidemiology, Ministry of Education Key Laboratory of Public Health Safety, School of Public Health, Fudan University, Fosun Tower, 131 Dong An Road, Shanghai, 200032, China.
| |
Collapse
|
61
|
Shen L, Sun M, Song S, Hu Q, Wang N, Ou G, Guo Z, Jing D, Shao Z, Bai Y, Liu K. The impact of anti‐COVID‐19 non‐pharmaceutical interventions on hand, foot, and mouth disease—a spatiotemporal perspective in Xi'an, northwestern China. J Med Virol 2022; 94:3121-3132. [PMID: 35277880 PMCID: PMC9088661 DOI: 10.1002/jmv.27715] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/19/2022] [Accepted: 03/01/2022] [Indexed: 11/23/2022]
Abstract
Growing evidence has shown that anti‐COVID‐19 nonpharmaceutical interventions (NPIs) can support prevention and control of various infectious diseases, including intestinal diseases. However, most studies focused on the short‐term mitigating impact and neglected the dynamic impact over time. This study is aimed to investigate the dynamic impact of anti‐COVID‐19 NPIs on hand, foot, and mouth disease (HFMD) over time in Xi'an City, northwestern China. Based on the surveillance data of HFMD, meteorological and web search data, Bayesian Structural Time Series model and interrupted time series analysis were performed to quantitatively measure the impact of NPIs in sequent phases with different intensities and to predict the counterfactual number of HFMD cases. From 2013 to 2021, a total number of 172,898 HFMD cases were reported in Xi'an. In 2020, there appeared a significant decrease in HFMD incidence (−94.52%, 95% CI: −97.54% to −81.95%) in the first half of the year and the peak period shifted from June to October by a small margin of 6.74% compared to the previous years of 2013 to 2019. In 2021, the seasonality of HFMD incidence gradually returned to the bimodal temporal variation pattern with a significant average decline of 61.09%. In particular, the impact of NPIs on HFMD was more evident among young children (0–3 years), and the HFMD incidence reported in industrial areas had an unexpected increase of 51.71% in 2020 autumn and winter. Results suggested that both direct and indirect NPIs should be implemented as effective public health measures to reduce infectious disease and improve surveillance strategies, and HFMD incidence in Xi'an experienced a significant rebound to the previous seasonality after a prominent decline influenced by the anti‐COVID‐19 NPIs. HFMD transmission changed during the COVID‐19 pandemic; The impact of anti‐COVID‐19 NPIs on HFMD varied between different populations; The responsive NPIs indeed affected the HFMD incidence at different stages with potential long‐term impact.
Collapse
Affiliation(s)
- Li Shen
- School of Remote Sensing and Information EngineeringWuhan UniversityWuhanChina
| | - Minghao Sun
- School of Remote Sensing and Information EngineeringWuhan UniversityWuhanChina
| | - Shuxuan Song
- Department of EpidemiologyMinistry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Air Force Medical UniversityXi'anChina
| | - Qingwu Hu
- School of Remote Sensing and Information EngineeringWuhan UniversityWuhanChina
| | - Nuoya Wang
- School of Remote Sensing and Information EngineeringWuhan UniversityWuhanChina
| | - Guangyu Ou
- School of Remote Sensing and Information EngineeringWuhan UniversityWuhanChina
| | - Zhaohui Guo
- School of Remote Sensing and Information EngineeringWuhan UniversityWuhanChina
| | - Du Jing
- School of Resource and Environmental ScienceWuhan UniversityWuhanChina
| | - Zhongjun Shao
- Department of EpidemiologyMinistry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Air Force Medical UniversityXi'anChina
| | - Yao Bai
- Department of Infectious Disease Control and PreventionXi'an Center for Disease Prevention and ControlXi'anChina
| | - Kun Liu
- Department of EpidemiologyMinistry of Education Key Lab of Hazard Assessment and Control in Special Operational Environment, School of Public Health, Air Force Medical UniversityXi'anChina
| |
Collapse
|
62
|
A novel subgenotype C6 Enterovirus A71 originating from the recombination between subgenotypes C4 and C2 strains in mainland China. Sci Rep 2022; 12:593. [PMID: 35022489 PMCID: PMC8755819 DOI: 10.1038/s41598-021-04604-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 12/21/2021] [Indexed: 12/18/2022] Open
Abstract
Recombination plays important roles in the genetic diversity and evolution of Enterovirus A71 (EV-A71). The phylogenetics of EV-A71 in mainland China found that one strain DL71 formed a new subgenotype C6 with unknown origin. This study investigated the detailed genetic characteristics of the new variant. DL71 formed a distinct cluster within genotype C based on the genome and individual genes (5′UTR, VP4, VP1, 2A, 2B, 2C, 3D, and 3′UTR). The average genetic distances of the genome and individual genes (VP3, 2A, 2B, 2C, 3A, 3C, and 3D) between DL71 and reference strains were greater than 0.1. Nine recombination events involving smaller fragments along DL71 genome were detected. The strains Fuyang-0805a (C4) and Tainan/5746/98 (C2) were identified as the parental strains of DL71. In the non-recombination regions, DL71 had higher identities with Fuyang-0805a than Tainan/5746/98, and located in the cluster with C4 strains. However, in the recombination regions, DL71 had higher identities with Tainan/5746/98 than Fuyang-0805a, and located in the cluster with C2 strains. Thus, DL71 was a novel multiple inter-subgenotype recombinant derived from the dominant subgenotype C4 and the sporadic subgenotype C2 strains. Monitoring the emergence of new variants by the whole-genome sequencing remains essential for preventing disease outbreaks and developing new vaccines.
Collapse
|
63
|
Li YP, Liu CR, Deng HL, Wang MQ, Tian Y, Chen Y, Zhang YF, Dang SS, Zhai S. DNA methylation and single-nucleotide polymorphisms in DDX58 are associated with hand, foot and mouth disease caused by enterovirus 71. PLoS Negl Trop Dis 2022; 16:e0010090. [PMID: 35041675 PMCID: PMC8765647 DOI: 10.1371/journal.pntd.0010090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 12/14/2021] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND This research aimed to explore the association between the RIG-I-like receptor (RIG-I and MDA5 encoded by DDX58 and IFIH1, respectively) pathways and the risk or severity of hand, foot, and mouth disease caused by enterovirus 71 (EV71-HFMD). In this context, we explored the influence of gene methylation and polymorphism on EV71-HFMD. METHODOLOGY/PRINCIPAL FINDINGS 60 healthy controls and 120 EV71-HFMD patients, including 60 mild EV71-HFMD and 60 severe EV71-HFMD patients, were enrolled. First, MiSeq was performed to explore the methylation of CpG islands in the DDX58 and IFIH1 promoter regions. Then, DDX58 and IFIH1 expression were detected in PBMCs using RT-qPCR. Finally, imLDR was used to detect DDX58 and IFIH1 single-nucleotide polymorphism (SNP) genotypes. Severe EV71-HFMD patients exhibited higher DDX58 promoter methylation levels than healthy controls and mild EV71-HFMD patients. DDX58 promoter methylation was significantly associated with severe HFMD, sex, vomiting, high fever, neutrophil abundance, and lymphocyte abundance. DDX58 expression levels were significantly lower in mild patients than in healthy controls and lower in severe patients than in mild patients. Binary logistic regression analysis revealed statistically significant differences in the genotype frequencies of DDX58 rs3739674 between the mild and severe groups. GeneMANIA revealed that 19 proteins displayed correlations with DDX58, including DHX58, HERC5, MAVS, RAI14, WRNIP1 and ISG15, and 19 proteins displayed correlations with IFIH1, including TKFC, IDE, MAVS, DHX58, NLRC5, TSPAN6, USP3 and DDX58. CONCLUSIONS/SIGNIFICANCE DDX58 expression and promoter methylation were associated with EV71 infection progression, especially in severe EV71-HFMD patients. The effect of DDX58 in EV71-HFMD is worth further attention.
Collapse
MESH Headings
- Child
- Child, Preschool
- CpG Islands/genetics
- DEAD Box Protein 58/genetics
- DEAD Box Protein 58/metabolism
- DNA Methylation/genetics
- Enterovirus A, Human
- Female
- Genetic Predisposition to Disease/genetics
- Hand, Foot and Mouth Disease/pathology
- Hand, Foot and Mouth Disease/virology
- Humans
- Infant
- Interferon-Induced Helicase, IFIH1/genetics
- Interferon-Induced Helicase, IFIH1/metabolism
- Male
- Polymorphism, Single Nucleotide/genetics
- Promoter Regions, Genetic/genetics
- Receptors, Immunologic/genetics
- Receptors, Immunologic/metabolism
- Severity of Illness Index
Collapse
Affiliation(s)
- Ya-Ping Li
- Department of Infectious Diseases, Xi’an Jiaotong University Second Affiliated Hospital, Xi’an, China
| | - Chen-Rui Liu
- 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
- Department of Pediatric, Xi’an Central Hospital, Xi’an, China
| | - Mu-Qi Wang
- Department of Infectious Diseases, Xi’an Jiaotong University Second Affiliated Hospital, Xi’an, China
| | - Yan Tian
- Department of Infectious Diseases, Xi’an Jiaotong University Second Affiliated Hospital, Xi’an, China
| | - Yuan Chen
- Department of Infectious Diseases, Xi’an Children’s Hospital, Xi’an, China
| | - Yu-Feng Zhang
- Department of Infectious Diseases, Xi’an Children’s 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
| |
Collapse
|
64
|
Zhu D, Song Y, Hu D, Li S, Liu G, Li P, Yang S. Characterization of Enterovirus Associated m6A RNA Methylation in Children With Neurological Symptoms: A Prospective Cohort Study. Front Neurosci 2021; 15:791544. [PMID: 34949987 PMCID: PMC8689127 DOI: 10.3389/fnins.2021.791544] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 11/08/2021] [Indexed: 11/14/2022] Open
Abstract
Little is known about the particular changes of N6-methyladenosine (m6A) RNA methylation in enterovirus (EV) infection among children with neurologic symptoms. Here, we determined the characterization of EV associated m6A RNA methylation in this population. A prospective cohort study was conducted from 2018/2 to 2019/12 at the Guangzhou Women and Children’s Medical Center. We included EV infected children with and without neurological symptoms. High-throughput m(6)A-RNA immunoprecipitation sequencing (MeRIP-seq) and RNA-seq analysis were used to evaluate the m6A RNA methylation and transcript expression of cerebrospinal fluid samples. The functional annotation and pathways of differentially methylated m6A genes with synchronously differential expression were analyzed by Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG). Seven patients were enrolled in the control group, and 13 cases were in the neurological symptoms (NS) group. A total of 3472 differentially expressed genes and 957 m6A modified genes were identified. A conjoint analysis of MeRIP-seq and RNA-seq data found 1064 genes with significant changes in both the m6A modifications and mRNA levels. The different m6A RNA methylation was increased in the transcriptome’s CDS regions but decreased in both the 3′UTRs and stop codon among the NS group. Functional annotation like the “oxidative phosphorylation” gene pathway, “Parkinson’s disease” and GO terms like “respiratory electron transport chain,” “cellular metabolic process,” and “oxidation-reduction process” was enriched in symptomatic patients. Our study elucidated the changes of RNA m6A methylation patterns and related cellular functions and signaling pathways in EV patients with neurologic symptoms.
Collapse
Affiliation(s)
- Danping Zhu
- Department of Pediatric Emergency, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Yongling Song
- Department of Pediatric Emergency, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Dandan Hu
- Department of Pediatric Neurology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Suyun Li
- Department of Pediatric Emergency, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Guangming Liu
- Department of Pediatric Emergency, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Peiqing Li
- Department of Pediatric Emergency, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| | - Sida Yang
- Department of Pediatric Neurology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
| |
Collapse
|
65
|
Ji H, Fan H, Ai J, Shi C, Bi J, Chen YH, Lu XP, Chen QH, Tian JM, Bao CJ, Zhang XF, Jin Y. Neurocognitive Deficits and Sequelae Following Severe hand, foot, and mouth disease from 2009 to 2017, in JiangSu Province, China: A Long-Term Follow-Up Study. Int J Infect Dis 2021; 115:245-255. [PMID: 34910955 DOI: 10.1016/j.ijid.2021.11.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/17/2021] [Accepted: 11/18/2021] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND To evaluate the long-term sequela and cognitive profile resulting from severe hand, foot and mouth disease (HFMD) with central nervous system (CNS) involvement. METHODS Two-hundred-and-ninety-four HFMD cases were included in a retrospective follow-up study. Physical examination were conducted. The Chinese Wechsler Preschool and Primary Scale of Intelligence, Fourth Edition (WPPSI-IV) was used to assess intelligence. RESULTS Fifty-eight mild HFMD cases and 99 severe HFMD cases with mild CNS involvement did not present any neurological sequelae. While the sequelae incidence of severe HFMD with more severe CNS complications were 50.0%. The proportion of full scale intelligence quotient (FSIQ) impairment was 45.0%. In the 2:6-3:11 age group, severe HFMD with more severe CNS complications and lower maternal education level were risk factors for verbal comprehension disorder. Urban-rural residence and lower paternal education level were risk factors for FSIQ disorder. Furthermore, in the 4:0-6:11 age group, severe HFMD with more severe CNS complication was a risk factor for visual spatial disorder and fluid reasoning disorder. Lower paternal education level was a risk factor for FSIQ disorder. CONCLUSION Early assessment and intervention among severe HFMD patients with more severe CNS involvement at a very young age will prove beneficial for their future performance.
Collapse
Affiliation(s)
- Hong Ji
- Department of Acute Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009; Medical School of Nanjing University, Nanjing 210093, China
| | - Huan Fan
- Department of Acute Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009
| | - Jing Ai
- Department of Acute Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009
| | - Chao Shi
- Wuxi Municipal Center for Disease Control and Prevention, Wuxi 214023, China
| | - Jun Bi
- Xuzhou Municipal Center for Disease Control and Prevention, Xuzhou 221006, China
| | - Yin-Hua Chen
- Children's Hospital of Nanjing Medical University, Nanjing 210008, China
| | - Xiao-Peng Lu
- Children's Hospital of Nanjing Medical University, Nanjing 210008, China
| | - Qin-Hui Chen
- Children's Hospital of Soochow University, Nanjing 211166, China
| | - Jian-Mei Tian
- Children's Hospital of Soochow University, Nanjing 211166, China
| | - Chang-Jun Bao
- Department of Acute Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009
| | - Xue-Feng Zhang
- Department of Acute Infectious Disease Control and Prevention, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, Jiangsu, China 210009.
| | - Yu Jin
- Medical School of Nanjing University, Nanjing 210093, China; Children's Hospital of Nanjing Medical University, Nanjing 210008, China.
| |
Collapse
|
66
|
Huang H, Deng L, Jia L, Zhu R. A clinical scoring system for pediatric hand-foot-mouth disease. BMC Infect Dis 2021; 21:722. [PMID: 34332544 PMCID: PMC8325785 DOI: 10.1186/s12879-021-06424-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 07/09/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND The aim of the present study was to develop a clinical scoring system for the diagnosis of hand-foot-mouth disease (HFMD) with improved accuracy. METHODS A retrospective analysis was performed on standardized patient history and clinical examination data obtained from 1435 pediatric patients under the age of three years who presented with acute rash illness and underwent enterovirus nucleic acid detection. Patients were then divided into the HFMD (1094 patients) group or non-HFMD (341 patients) group based on a positive or a negative result from the assay, respectively. We then divided the data into a training set (1004 cases, 70%) and a test set (431 cases, 30%) using a random number method. Multivariate logistic regression was performed on 15 clinical variables (e.g. age, exposure history, number of rash spots in a single body region) to identify variables highly predictive of a positive diagnosis in the training set. Using the variables with high impact on the diagnostic accuracy, we generated a scoring system for predicting HFMD and subsequently evaluated this system in the test set by receiver operating characteristic curve (ROC curve). RESULTS Using the logistic model, we identified seven clinical variables (age, exposure history, and rash density at specific regions of the body) to be included into the scoring system. The final scores ranged from - 5 to 24 (higher scores positively predicted HFMD diagnosis). Through our training set, a cutoff score of 7 resulted in a sensitivity of 0.76 and specificity of 0.68. The area under the receiver operating characteristic curve (AUC) was 0.804 (95% confidence interval [CI]: 0.773-0.835) (P < 0.001). Using the test set, we obtained an AUC of 0.76 (95% CI: 0.710-0.810) with a sensitivity of 0.76 and a specificity of 0.62. These results from the test set were consistent with those from the training set. CONCLUSIONS This study establishes an objective scoring system for the diagnosis of typical and atypical HFMD using measures accessible through routine clinical encounters. Due to the accuracy and sensitivity achieved by this scoring system, it can be employed as a rapid, low-cost method for establishing diagnoses in children with acute rash illness.
Collapse
Affiliation(s)
- Hui Huang
- Department of Infectious Diseases, The Affiliated Children's Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Li Deng
- Department of Infectious Diseases, The Affiliated Children's Hospital, Capital Institute of Pediatrics, Beijing, China.
| | - Liping Jia
- Department of Infectious Diseases, The Affiliated Children's Hospital, Capital Institute of Pediatrics, Beijing, China
| | - Runan Zhu
- Department of Infectious Diseases, The Affiliated Children's Hospital, Capital Institute of Pediatrics, Beijing, China
| |
Collapse
|
67
|
Yu C, Xu C, Li Y, Yao S, Bai Y, Li J, Wang L, Wu W, Wang Y. Time Series Analysis and Forecasting of the Hand-Foot-Mouth Disease Morbidity in China Using An Advanced Exponential Smoothing State Space TBATS Model. Infect Drug Resist 2021; 14:2809-2821. [PMID: 34321897 PMCID: PMC8312251 DOI: 10.2147/idr.s304652] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/26/2021] [Indexed: 12/11/2022] Open
Abstract
Objective The high morbidity, complex seasonality, and recurring risk of hand-foot-and-mouth disease (HFMD) exert a major burden in China. Forecasting its epidemic trends is greatly instrumental in informing vaccine and targeted interventions. This study sets out to investigate the usefulness of an advanced exponential smoothing state space framework by combining Box-Cox transformations, Fourier representations with time-varying coefficients and autoregressive moving average (ARMA) error correction (TBATS) method to assess the temporal trends of HFMD in China. Methods Data from January 2009 to December 2019 were drawn, and then they were split into two segments comprising the in-sample training data and out-of-sample testing data to develop and validate the TBATS model, and its fitting and forecasting abilities were compared with the most frequently used seasonal autoregressive integrated moving average (SARIMA) method. Results Following the modelling procedures of the SARIMA and TBATS methods, the SARIMA (1,0,1)(0,1,1)12 and TBATS (0.024, {1,1}, 0.855, {<12,4>}) specifications were recognized as being the optimal models, respectively, for the 12-step ahead forecasting, along with the SARIMA (1,0,1)(0,1,1)12 and TBATS (0.062, {1,3}, 0.86, {<12,4>}) models as being the optimal models, respectively, for the 24-step ahead forecasting. Among them, the optimal TBATS models produced lower error rates in both 12-step and 24-step ahead forecasting aspects compared to the preferred SARIMA models. Descriptive analysis of the data showed a significantly high level and a marked dual seasonal pattern in the HFMD morbidity. Conclusion The TBATS model has the capacity to outperform the most frequently used SARIMA model in forecasting the HFMD incidence in China, and it can be recommended as a flexible and useful tool in the decision-making process of HFMD prevention and control in China.
Collapse
Affiliation(s)
- Chongchong Yu
- Department of Epidemiology and Health Statistics, School of Public Health, Xinxiang Medical University, Xinxiang, Henan Province, People's Republic of China
| | - Chunjie Xu
- Department of Occupational and Environmental Health, School of Public Health, Capital Medical University, Beijing, 100069, People's Republic of China
| | - Yuhong Li
- National Center for Tuberculosis Control and Prevention, China Center for Disease Control and Prevention, Beijing, People's Republic of China
| | - Sanqiao Yao
- Department of Epidemiology and Health Statistics, School of Public Health, Xinxiang Medical University, Xinxiang, Henan Province, People's Republic of China
| | - Yichun Bai
- Department of Epidemiology and Health Statistics, School of Public Health, Xinxiang Medical University, Xinxiang, Henan Province, People's Republic of China
| | - Jizhen Li
- Department of Epidemiology and Health Statistics, School of Public Health, Xinxiang Medical University, Xinxiang, Henan Province, People's Republic of China
| | - Lei Wang
- Center for Musculoskeletal Surgery, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Weidong Wu
- Department of Epidemiology and Health Statistics, School of Public Health, Xinxiang Medical University, Xinxiang, Henan Province, People's Republic of China
| | - Yongbin Wang
- Department of Epidemiology and Health Statistics, School of Public Health, Xinxiang Medical University, Xinxiang, Henan Province, People's Republic of China
| |
Collapse
|
68
|
刘 立, 刘 志, 张 良, 李 宁, 方 挺, 张 栋, 许 国, 詹 思. [Epidemiological and etiological characteristics of hand, foot and mouth disease among children aged 5 years and younger in Ningbo (2016 to 2019)]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2021; 53:491-497. [PMID: 34145850 PMCID: PMC8220059 DOI: 10.19723/j.issn.1671-167x.2021.03.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To describe the epidemiological and etiological characteristics of hand, foot and mouth disease (HFMD) among children aged 5 years and younger in Ningbo after the access of entero-virus-A71 vaccine (2016 to 2019). METHODS A retrospective cohort study were performed in children aged 5 years and younger in Ningbo from 2016 to 2019. Data for incidence of HFMD was collected from the National Notifiable Disease Surveillance Reporting System and the Electronic Medical Records (EMRs) System, while the demographic information was derived from the Immunization Information System. Speci-mens were detected by real-time fluorescence quantitative PCR and the Wilson method was used to estimate the incidence rate and 95% confidence interval. RESULTS From 2016 to 2019, a total of 1 044 800 residential children were observed in this population-based cohort. In the study, 102 471 cases of HFMD were diagnosed in 2 651 081 person-years, revealing an overall incidence density of 3 865.25/100 000 person-years. There was no significant decline in the number of the cases after the vaccine was available. The number of the patients of hand foot mouth disease during the four years was 93 421, of whom 84 875 (90.85%) had only one incident record, while 8 946 (9.15%) had 2 or more cases in this period; there were 69 771 (66.06%) patients who only needed to see a doctor once for each disease, 19.92% of the patients needed to be treated twice, and 14 801 (14.02%) patients needed to go to the hospital or clinic three times or more. The incidence of HFMD showed obvious seasonality and periodicity, which mainly concentrated in April to July each year, and the epidemic cycle was 2 years; most of the cases were 1 to 3-year old children, with more cases in male. The incidence density varied across the region, with the highest density observed in Ninghai (4 524.76/100 000 person-years), followed by Xiangshan (3 984.22/100 000 person-years). In 3 748 library-conformed cases, 2 834(75.61%) were detected positive, among which enterovirus-A71, Cox-A16 and other enteroviruses accounted for 9.03%, 31.55% and 59.42%, respectively. During the study period, the cumulative coverage of enterovirus-A71 vaccine increased year by year, with the proportion of enterovirus-A71 and severe cases both gradually decreasing. CONCLUSION The current status of hand, foot and mouth disease in Ningbo is still serious. Children under 3-year old (especially male children aged 1 year) were the key population for prevention and control. Vaccination might lead to changes in major pathogenic virus type, of which more attention should be paid to the potential impact on disease surveillance, prevention and control.
Collapse
Affiliation(s)
- 立立 刘
- 北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 志科 刘
- 北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 良 张
- 宁波市疾病控制与预防中心,浙江宁波 315010Ningbo Municipal Center for Disease Control and Prevention, Ningbo 315010, Zhejiang, China
| | - 宁 李
- 宁波市疾病控制与预防中心,浙江宁波 315010Ningbo Municipal Center for Disease Control and Prevention, Ningbo 315010, Zhejiang, China
| | - 挺 方
- 宁波市疾病控制与预防中心,浙江宁波 315010Ningbo Municipal Center for Disease Control and Prevention, Ningbo 315010, Zhejiang, China
| | - 栋梁 张
- 宁波市疾病控制与预防中心,浙江宁波 315010Ningbo Municipal Center for Disease Control and Prevention, Ningbo 315010, Zhejiang, China
| | - 国章 许
- 宁波市疾病控制与预防中心,浙江宁波 315010Ningbo Municipal Center for Disease Control and Prevention, Ningbo 315010, Zhejiang, China
| | - 思延 詹
- 北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| |
Collapse
|
69
|
刘 立, 刘 志, 张 良, 李 宁, 方 挺, 张 栋, 许 国, 詹 思. [Epidemiological and etiological characteristics of hand, foot and mouth disease among children aged 5 years and younger in Ningbo (2016 to 2019)]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2021; 53:491-497. [PMID: 34145850 PMCID: PMC8220059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Indexed: 09/21/2023]
Abstract
OBJECTIVE To describe the epidemiological and etiological characteristics of hand, foot and mouth disease (HFMD) among children aged 5 years and younger in Ningbo after the access of entero-virus-A71 vaccine (2016 to 2019). METHODS A retrospective cohort study were performed in children aged 5 years and younger in Ningbo from 2016 to 2019. Data for incidence of HFMD was collected from the National Notifiable Disease Surveillance Reporting System and the Electronic Medical Records (EMRs) System, while the demographic information was derived from the Immunization Information System. Speci-mens were detected by real-time fluorescence quantitative PCR and the Wilson method was used to estimate the incidence rate and 95% confidence interval. RESULTS From 2016 to 2019, a total of 1 044 800 residential children were observed in this population-based cohort. In the study, 102 471 cases of HFMD were diagnosed in 2 651 081 person-years, revealing an overall incidence density of 3 865.25/100 000 person-years. There was no significant decline in the number of the cases after the vaccine was available. The number of the patients of hand foot mouth disease during the four years was 93 421, of whom 84 875 (90.85%) had only one incident record, while 8 946 (9.15%) had 2 or more cases in this period; there were 69 771 (66.06%) patients who only needed to see a doctor once for each disease, 19.92% of the patients needed to be treated twice, and 14 801 (14.02%) patients needed to go to the hospital or clinic three times or more. The incidence of HFMD showed obvious seasonality and periodicity, which mainly concentrated in April to July each year, and the epidemic cycle was 2 years; most of the cases were 1 to 3-year old children, with more cases in male. The incidence density varied across the region, with the highest density observed in Ninghai (4 524.76/100 000 person-years), followed by Xiangshan (3 984.22/100 000 person-years). In 3 748 library-conformed cases, 2 834(75.61%) were detected positive, among which enterovirus-A71, Cox-A16 and other enteroviruses accounted for 9.03%, 31.55% and 59.42%, respectively. During the study period, the cumulative coverage of enterovirus-A71 vaccine increased year by year, with the proportion of enterovirus-A71 and severe cases both gradually decreasing. CONCLUSION The current status of hand, foot and mouth disease in Ningbo is still serious. Children under 3-year old (especially male children aged 1 year) were the key population for prevention and control. Vaccination might lead to changes in major pathogenic virus type, of which more attention should be paid to the potential impact on disease surveillance, prevention and control.
Collapse
Affiliation(s)
- 立立 刘
- 北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 志科 刘
- 北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| | - 良 张
- 宁波市疾病控制与预防中心,浙江宁波 315010Ningbo Municipal Center for Disease Control and Prevention, Ningbo 315010, Zhejiang, China
| | - 宁 李
- 宁波市疾病控制与预防中心,浙江宁波 315010Ningbo Municipal Center for Disease Control and Prevention, Ningbo 315010, Zhejiang, China
| | - 挺 方
- 宁波市疾病控制与预防中心,浙江宁波 315010Ningbo Municipal Center for Disease Control and Prevention, Ningbo 315010, Zhejiang, China
| | - 栋梁 张
- 宁波市疾病控制与预防中心,浙江宁波 315010Ningbo Municipal Center for Disease Control and Prevention, Ningbo 315010, Zhejiang, China
| | - 国章 许
- 宁波市疾病控制与预防中心,浙江宁波 315010Ningbo Municipal Center for Disease Control and Prevention, Ningbo 315010, Zhejiang, China
| | - 思延 詹
- 北京大学公共卫生学院流行病与卫生统计学系,北京 100191Department of Epidemiology and Biostatistics, Peking University School of Public Health, Beijing 100191, China
| |
Collapse
|
70
|
Ji W, Qin L, Tao L, Zhu P, Liang R, Zhou G, Chen S, Zhang W, Yang H, Duan G, Jin Y. Neonatal Murine Model of Coxsackievirus A2 Infection for the Evaluation of Antiviral Therapeutics and Vaccination. Front Microbiol 2021; 12:658093. [PMID: 34122374 PMCID: PMC8192712 DOI: 10.3389/fmicb.2021.658093] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 04/30/2021] [Indexed: 01/08/2023] Open
Abstract
Coxsackievirus (CV) A2 has emerged as an important etiological agent in the pathogen spectrum of hand, foot, and mouth disease (HFMD). The symptoms of CVA2 infections are generally mild, but worsen rapidly in some people, posing a serious threat to children's health. However, compared with enterovirus 71 detected frequently in fatal cases, limited attention has been paid to CVA2 infections because of its benign clinical course. In the present study, we identified three CVA2 strains from HFMD infections and used the cell-adapted CVA2 strain HN202009 to inoculate 5-day-old BALB/c mice intramuscularly. These mice developed remarkably neurological symptoms such as ataxia, hind-limb paralysis, and death. Histopathological determination showed neuronophagia, pulmonary hemorrhage, myofiberlysis and viral myocarditis. Viral replication was detected in multiple organs and tissues, and CVA2 exhibited strong tropism to muscle tissue. The severity of illness was associated with abnormally high levels of inflammatory cytokines, including interleukin (IL)-6, IL-10, tumor necrosis factor α, and monocyte chemotactic protein 1, although the blockade of these proinflammatory cytokines had no obvious protection. We also tested whether an experimental formaldehyde-inactivated CVA2 vaccine could induce protective immune response in adult mice. The CVA2 antisera from the vaccinated mice were effective against CVA2 infection. Moreover, the inactivated CVA2 vaccine could successfully generate immune protection in neonatal mice. Our results indicated that the neonatal mouse model could be a useful tool to study CVA2 infection and to develop CVA2 vaccines.
Collapse
Affiliation(s)
- Wangquan Ji
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Luwei Qin
- Henan Province Center for Disease Control and Prevention, Zhengzhou, China
| | - Ling Tao
- School of Public Health, Xinxiang Medical University, Xinxiang, China
| | - Peiyu Zhu
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Ruonan Liang
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Guangyuan Zhou
- School of Public Health, Xinxiang Medical University, Xinxiang, China
| | - Shuaiyin Chen
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Weiguo Zhang
- Department of Immunology, Duke University Medical Center, Durham, NC, United States
| | - Haiyan Yang
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Guangcai Duan
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
| | - Yuefei Jin
- Department of Epidemiology, College of Public Health, Zhengzhou University, Zhengzhou, China
| |
Collapse
|
71
|
Incidence of Infection of Enterovirus 71 and Coxsackieviruses A6 and A16 among Household Contacts of Index Cases in Dong Thap Province, Southern Vietnam. BIOMED RESEARCH INTERNATIONAL 2021; 2020:9850351. [PMID: 33274234 PMCID: PMC7695493 DOI: 10.1155/2020/9850351] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/23/2020] [Revised: 09/03/2020] [Accepted: 11/03/2020] [Indexed: 11/30/2022]
Abstract
Background Scarce information exists about immunity to hand, foot, and mouth disease (HFMD) among household contacts of index cases in Vietnam and what that means for reducing ongoing HFMD transmission in the community. Methods We analyzed neutralizing antibodies (NT) and the incidence of enterovirus (EVs) infection among household contacts of index cases in a province where HFMD remains endemic. Throat swab and 2 mL blood samples from household contacts were collected at enrollment, during and after 2 weeks follow-up. Results The incidence of EV-A71 infection among household contacts was 40/84 (47.6%, 95% Cl: 36.9-58.3%), compared with 106/336 (31.5%, 95% Cl: 26.6-36.5%) for CV-A6 and 36/107 (33.6%, 95% Cl: 24.7-42.6%) for CV-A16. The incidence of CV-A6 infection was fairly constant across ages; in contrast, CV-A71 and CV-A16 had some variation across ages. At baseline, higher geometric mean titer (GMT) of EV-A71, CV-A6, and CV-A16 antibody titers was found for 25-34-year groups (range 216.3 to 305.0) compared to the other age groups. There was a statistically significant difference in GMT values of CV-A6 and CV-A16 between those who had an infection or did not have infection among households with an index case of these serotypes. Conclusions Our results indicated that adults were becoming infected with HFMD and could be contributing to the transmission. There is, therefore, a need for considering the household setting as an additional target for intervention programs for HFMD.
Collapse
|
72
|
Kang HJ, Yoon Y, Lee YP, Kim HJ, Lee DY, Lee JW, Hyeon JY, Yoo JS, Lee S, Kang C, Choi W, Han MG. A Different Epidemiology of Enterovirus A and Enterovirus B Co-circulating in Korea, 2012-2019. J Pediatric Infect Dis Soc 2021; 10:398-407. [PMID: 33150450 DOI: 10.1093/jpids/piaa111] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/01/2020] [Indexed: 01/07/2023]
Abstract
BACKGROUND Enteroviruses (EVs) occur frequently worldwide and are known to be associated with a broad spectrum of clinical manifestations from mild syndromes to neurological disease. To understand the epidemiology of EV in Korea, we characterized EV-infected cases during 2012-2019 based on national surveillance. METHODS We collected specimens from patients with suspected EV infections and analyzed the data using real-time reverse-transcription polymerase chain reaction and VP1 gene sequencing. RESULTS Among the 18 261 specimens collected, EVs were detected in 6258 (34.3%) cases. Although the most common EV types changed annually, EV-A71, echovirus 30, coxsackievirus B5, coxsackievirus A6, and coxsackievirus A10 were commonly identified. Among the human EVs, the case numbers associated with the 2 major epidemic species (EV-A and EV-B) peaked in the summer. While EV-A species affected 1-year-old children and were associated with herpangina and hand, foot, and mouth disease, EV-B species were mostly associated with neurologic manifestations. The highest incidence of EV-B species was observed in infants aged <12 months. Feces and respiratory specimens were the most predictive of EV infection. Specimens collected within 5 days of symptom onset allowed for timely virus detection. CONCLUSIONS EV-A and EV-B species co-circulating in Korea presented different epidemiologic trends in clinical presentation, affected subjects, and seasonality trends. This study could provide information for the characterization of EVs circulating in Korea to aid the development of EV antivirals and vaccines, as well as public health measures to control enteroviral diseases.
Collapse
Affiliation(s)
- Hae Ji Kang
- Division of Viral Diseases, Center for Laboratory Control of Infectious Diseases, Korea Centers for Disease Control and Prevention, Osong, Republic of Korea
| | - Youngsil Yoon
- Division of Viral Diseases, Center for Laboratory Control of Infectious Diseases, Korea Centers for Disease Control and Prevention, Osong, Republic of Korea
| | - Young-Pyo Lee
- Division of Viral Diseases, Center for Laboratory Control of Infectious Diseases, Korea Centers for Disease Control and Prevention, Osong, Republic of Korea
| | - Hye-Jin Kim
- Division of Infectious Diseases Control, Center for Laboratory Control of Infectious Diseases, Korea Centers for Disease Control and Prevention, Osong, Republic of Korea
| | - Deog-Yong Lee
- Division of Viral Diseases, Center for Laboratory Control of Infectious Diseases, Korea Centers for Disease Control and Prevention, Osong, Republic of Korea
| | - June-Woo Lee
- Division of Vaccine Research, National Institute of Health, Korea Centers for Disease Control and Prevention, Osong, Republic of Korea
| | - Ji-Yeon Hyeon
- Division of Vaccine Research, National Institute of Health, Korea Centers for Disease Control and Prevention, Osong, Republic of Korea
| | - Jung Sik Yoo
- Division of Vaccine Research, National Institute of Health, Korea Centers for Disease Control and Prevention, Osong, Republic of Korea
| | - Sangwon Lee
- Division of Infectious Diseases Control, Center for Laboratory Control of Infectious Diseases, Korea Centers for Disease Control and Prevention, Osong, Republic of Korea
| | - Chun Kang
- Division of Viral Diseases, Center for Laboratory Control of Infectious Diseases, Korea Centers for Disease Control and Prevention, Osong, Republic of Korea
| | - Wooyoung Choi
- Division of Viral Diseases, Center for Laboratory Control of Infectious Diseases, Korea Centers for Disease Control and Prevention, Osong, Republic of Korea
| | - Myung-Guk Han
- Division of Viral Diseases, Center for Laboratory Control of Infectious Diseases, Korea Centers for Disease Control and Prevention, Osong, Republic of Korea
| |
Collapse
|
73
|
Verma S, Razzaque MA, Sangtongdee U, Arpnikanondt C, Tassaneetrithep B, Arthan D, Paratthakonkun C, Soonthornworasiri N. Hand, Foot, and Mouth Disease in Thailand: A Comprehensive Modelling of Epidemic Dynamics. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2021; 2021:6697522. [PMID: 33747118 PMCID: PMC7954635 DOI: 10.1155/2021/6697522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 02/05/2021] [Accepted: 02/20/2021] [Indexed: 01/16/2023]
Abstract
Hand, foot, and mouth disease (HFMD) is a highly contagious disease with several outbreaks in Asian-Pacific countries, including Thailand. With such epidemic characteristics and potential economic impact, HFMD is a significant public health issue in Thailand. Generally, contagious/infectious diseases' transmission dynamics vary across geolocations due to different socioeconomic situations, demography, and lifestyles. Hence, a nationwide comprehensive model of the disease's epidemic dynamics can provide information to understand better and predict a potential outbreak of this disease and efficiently and effectively manage its impact. However, there is no nationwide and comprehensive (i.e., the inclusion of reinfections in the model) model of HFDM dynamics for Thailand. This paper has endeavoured to promote nationwide comprehensive modelling of HFMD's epidemic dynamics and comprehend the reinfection cases. We have formulated the SEIRS epidemiological model with dynamic vitals, including reinfections, to explore this disease's prevalence. We also introduced periodic seasonality to reproduce the seasonal effect. The pattern of spread of this disease is uneven across the provinces in Thailand, so we used K-means clustering algorithm to cluster those provinces into three groups (i.e., highly, moderately, and least affected levels). We also analysed health records collected from district hospitals, which suggest significant reinfection cases. For example, we found that 11% (approximately) of infectious patients return for repeat treatment within the study period. We also performed sensitivity analysis which indicates that the basic reproduction number (R 0) is sensitive to the rate of transmission (β) and the rate at which infected people recover (γ). By fitting the model with HFMD confirmed data for the provinces in each cluster, the basic reproduction number (R 0) was estimated to be 2.643, 1.91, and 3.246 which are greater than 1. Based on this high R 0, this study recommends that this disease will persist in the coming years under identical cultural and environmental conditions.
Collapse
Affiliation(s)
- Suraj Verma
- School of Computing, Engineering & Digital Technologies, Teesside University, Southfield Rd, Middlesbrough, UK
| | - M. A. Razzaque
- School of Computing, Engineering & Digital Technologies, Teesside University, Southfield Rd, Middlesbrough, UK
| | - U. Sangtongdee
- School of Computing, Engineering & Digital Technologies, Teesside University, Southfield Rd, Middlesbrough, UK
| | - C. Arpnikanondt
- King Mongkut's University of Technology Thonburi, Bangkok, Thailand
| | - B. Tassaneetrithep
- Center of Research Excellence in Immunoregulation, Research Department, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - D. Arthan
- Department of Tropical Nutrition and Food Science, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - C. Paratthakonkun
- College of Sports Science and Technology, Mahidol University, Nakhon Pathom, Thailand
| | - N. Soonthornworasiri
- Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| |
Collapse
|
74
|
Yi S, Wang H, Yang S, Xie L, Gao Y, Ma C. Spatial and Temporal Characteristics of Hand-Foot-and-Mouth Disease and Its Response to Climate Factors in the Ili River Valley Region of China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18041954. [PMID: 33671423 PMCID: PMC7923010 DOI: 10.3390/ijerph18041954] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 02/07/2021] [Accepted: 02/13/2021] [Indexed: 12/13/2022]
Abstract
Background: As the global climate changes, the number of cases of hand-foot-and-mouth disease (HFMD) is increasing year by year. This study comprehensively considers the association of time and space by analyzing the temporal and spatial distribution changes of HFMD in the Ili River Valley in terms of what climate factors could affect HFMD and in what way. Methods: HFMD cases were obtained from the National Public Health Science Data Center from 2013 to 2018. Monthly climate data, including average temperature (MAT), average relative humidity (MARH), average wind speed (MAWS), cumulative precipitation (MCP), and average air pressure (MAAP), were obtained from the National Meteorological Information Center. The temporal and spatial distribution characteristics of HFMD from 2013 to 2018 were obtained using kernel density estimation (KDE) and spatiotemporal scan statistics. A regression model of the incidence of HFMD and climate factors was established based on a geographically and temporally weighted regression (GTWR) model and a generalized additive model (GAM). Results: The KDE results show that the highest density was from north to south of the central region, gradually spreading to the whole region throughout the study period. Spatiotemporal cluster analysis revealed that clusters were distributed along the Ili and Gongnaisi river basins. The fitted curves of MAT and MARH were an inverted V-shape from February to August, and the fitted curves of MAAP and MAWS showed a U-shaped change and negative correlation from February to May. Among the individual climate factors, MCP coefficient values varied the most while MAWS values varied less from place to place. There was a partial similarity in the spatial distribution of coefficients for MARH and MAT, as evidenced by a significant degree of fit performance in the whole region. MCP showed a significant positive correlation in the range of 15–35 mm, and MAAP showed a positive correlation in the range of 925–945 hPa. HFMD incidence increased with MAT in the range of 15–23 °C, and the effective value of MAWS was in the range of 1.3–1.7 m/s, which was positively correlated with incidences of HFMD. Conclusions: HFMD incidence and climate factors were found to be spatiotemporally associated, and climate factors are mostly non-linearly associated with HFMD incidence.
Collapse
Affiliation(s)
- Suyan Yi
- College of Resources and Environmental Sciences, Xinjiang University, Urumqi 830046, China; (S.Y.); (L.X.); (Y.G.); (C.M.)
| | - Hongwei Wang
- College of Resources and Environmental Sciences, Xinjiang University, Urumqi 830046, China; (S.Y.); (L.X.); (Y.G.); (C.M.)
- Correspondence: ; Tel.: +86-135-7920-8666
| | - Shengtian Yang
- Beijing Key Laboratory of Urban Hydrological Cycle and Sponge City Technology, College of Water Sciences, Beijing Normal University, Beijing 100875, China;
| | - Ling Xie
- College of Resources and Environmental Sciences, Xinjiang University, Urumqi 830046, China; (S.Y.); (L.X.); (Y.G.); (C.M.)
| | - Yibo Gao
- College of Resources and Environmental Sciences, Xinjiang University, Urumqi 830046, China; (S.Y.); (L.X.); (Y.G.); (C.M.)
| | - Chen Ma
- College of Resources and Environmental Sciences, Xinjiang University, Urumqi 830046, China; (S.Y.); (L.X.); (Y.G.); (C.M.)
| |
Collapse
|
75
|
Min N, Ong YHB, Han AX, Ho SX, Yen EWP, Ban KHK, Maurer-Stroh S, Chong CY, Chu JJH. An epidemiological surveillance of hand foot and mouth disease in paediatric patients and in community: A Singapore retrospective cohort study, 2013-2018. PLoS Negl Trop Dis 2021; 15:e0008885. [PMID: 33566802 PMCID: PMC7901731 DOI: 10.1371/journal.pntd.0008885] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 02/23/2021] [Accepted: 10/13/2020] [Indexed: 11/30/2022] Open
Abstract
Background While hand, foot and mouth disease (HFMD) is primarily self-resolving—soaring incidence rate of symptomatic HFMD effectuates economic burden in the Asia-Pacific region. Singapore has seen a conspicuous rise in the number of HFMD cases from 2010s. Here, we aims to identify the serology and genotypes responsible for such outbreaks in hospitals and childcare facilities. Methods We studied symptomatic paediatric HFMD cases from 2013 to 2018 in Singapore. Surveillance for subclinical enterovirus infections was also performed in childcares at the same time period. Results Genotyping 101 symptomatic HFMD samples revealed CV-A6 as the major etiological agent for recent outbreaks. We detected infections with CV-A6 (41.0%), EV-A71 (7%), CV-A16 (3.0%), coxsackievirus A2, CV-A2 (1.0%) and coxsackievirus A10, CV-A10 (1.0%). Phylogenetic analysis of local CV-A6 strains revealed a high level of heterogeneity compared against others worldwide, dissimilar to other HFMD causative enteroviruses for which the dominant strains and genotypes are highly region specific. We detected sub-clinical enterovirus infections in childcare centres; 17.1% (n = 245) tested positive for enterovirus in saliva, without HFMD indicative symptoms at the point of sample collection. Conclusions CV-A6 remained as the dominant HFMD causative strain in Singapore. Silent subclinical enteroviral infections were detected and warrant further investigations. In most cases, Hand Foot and Mouth Disease or HFMD typically manifest in mild fever along with sore throat and rashes on the body. From 2010 onwards, Singapore has seen a steady increase in the case number of HFMD reaching tens of thousands in recent years. HFMD is caused by intestinal viruses and in this study, we established with molecular surveillance methods that one of the causative serotypes, CV-A6 is the major etiological agent for HFMD in Singapore for the current decade. We discovered that circulating enterovirus, CV-A6 in Singapore share similarities in genetic make-up to those currently circulating strains found worldwide and found to be especially close to the ones in neighbouring countries. HFMD spreads from person to person, especially in high-risk areas such as childcare centers where children congregate. Therefore, we conducted saliva collections routinely from childcare centers across Singapore and found that subclinical enterovirus infections have also been prevailing in clusters, occurring silently and unnoticed.
Collapse
Affiliation(s)
- Nyo Min
- Laboratory of Molecular RNA Virology and Antiviral Strategies, Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Yasmin Hui Binn Ong
- Laboratory of Molecular RNA Virology and Antiviral Strategies, Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Alvin X. Han
- Protein Sequence Analysis Group, Bioinformatics Institute, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
| | - Si Xian Ho
- Laboratory of Molecular RNA Virology and Antiviral Strategies, Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Emmerie Wong Phaik Yen
- Infectious Disease Service, Department of Pediatrics, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Kenneth Hon Kim Ban
- Department of Biochemistry, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Sebastian Maurer-Stroh
- Protein Sequence Analysis Group, Bioinformatics Institute, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- Department of Biological Sciences (DBS), National University of Singapore (NUS), Singapore, Singapore, Singapore
| | - Chia Yin Chong
- Infectious Disease Service, Department of Pediatrics, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Justin Jang Hann Chu
- Laboratory of Molecular RNA Virology and Antiviral Strategies, Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Collaborative and Translation Unit for HFMD, Institute of Molecular and Cell Biology, Agency for Science, Technology and Research (A*STAR), Singapore, Singapore
- * E-mail:
| |
Collapse
|
76
|
Gao J, Tang F, Wang Z, Yu J, Hu R, Liu L, Kang G. Post-marketing safety surveillance for inactivated Enterovirus 71 vaccines in Jiangsu, China from 2017 to 2019. Vaccine 2021; 39:1415-1419. [PMID: 33541795 DOI: 10.1016/j.vaccine.2021.01.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 01/05/2021] [Accepted: 01/16/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Two types of enterovirus 71 (EV71) vaccines, manufactured using human diploid (H2) and Vero cells, have been administered in Jiangsu Province, China since 2017. In this study, we evaluated their safety profiles using records collected from the Chinese National Adverse Events Following Immunization (AEFIs) Information System (CNAEFIS) and Electronic Immunization Registries System (EIRS) between 2017 and 2019. METHODS Demographic characteristics of the patients, AEFI incidence rates(IRs), symptoms, and time intervals were summarized from the reported AEFI data in the CNAEFIS. Also, the administered doses of the two vaccines were exported from the EIRS to calculate the IRs of AEFIs and thus compare the AEFIs between the two types of EV71 vaccines. RESULTS In total, 209, 407, and 344 AEFIs cases following EV71 vaccine administration were reported during 2017, 2018, and 2019, respectively, yielding IRs of 59.2, 48.2, and 54.2 per 100,000 doses, respectively. Fever, irritability, allergic eruptions, fatigue, loss of appetite, redness and induration at the injection site were the most commonly reported AEFIs. No significant differences in rare reactions were found between the two types of EV71 vaccinations. The majority of AEFIs were developed within 30 min to 3 days after administration. CONCLUSION EV71 vaccines showed satisfactory safety profiles since their first use 3 years ago in the Jiangsu Province. The AEFI profiles were identical to those in pre-marketing studies; most AEFIs after vaccination were mild and common. More active surveillance studies should be performed to provide more comprehensive post-marketing safety data.
Collapse
Affiliation(s)
- Jun Gao
- Jiangsu Provincial Centre of Disease Control and Prevention, Jiangsu Province, China
| | - Fenyang Tang
- Jiangsu Provincial Centre of Disease Control and Prevention, Jiangsu Province, China
| | - Zhiguo Wang
- Jiangsu Provincial Centre of Disease Control and Prevention, Jiangsu Province, China
| | - Jing Yu
- Jiangsu Provincial Centre of Disease Control and Prevention, Jiangsu Province, China
| | - Ran Hu
- Jiangsu Provincial Centre of Disease Control and Prevention, Jiangsu Province, China
| | - Li Liu
- Jiangsu Provincial Centre of Disease Control and Prevention, Jiangsu Province, China
| | - Guodong Kang
- Jiangsu Provincial Centre of Disease Control and Prevention, Jiangsu Province, China.
| |
Collapse
|
77
|
Pan Q, Liu F, Zhang J, Zhao X, Hu Y, Fan C, Yang F, Chang Z, Xiao X. Regional-level risk factors for severe hand-foot-and-mouth disease: an ecological study from mainland China. Environ Health Prev Med 2021; 26:4. [PMID: 33419405 PMCID: PMC7792012 DOI: 10.1186/s12199-020-00927-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 12/21/2020] [Indexed: 12/27/2022] Open
Abstract
Background Severe hand-foot-and-mouth disease (HFMD) is a life-threatening contagious disease among young children and infants. Although enterovirus A71 has been well acknowledged to be the dominant cause of severe HFMD, there still remain other unidentified risk factors for severe HFMD. Previous studies mainly focused on identifying the individual-level risk factors from a clinical perspective, while rare studies aimed to clarify the association between regional-level risk factors and severe HFMD, which may be more important from a public health perspective. Methods We retrieved the clinical HFMD counts between 2008 and 2014 from the Chinese Center for Disease Control and Prevention, which were used to calculated the case-severity rate in 143 prefectural-level cities in mainland China. For each of those 143 cities, we further obtained city-specific characteristics from the China City Statistical Yearbook (social and economic variables) and the national meteorological monitoring system (meteorological variables). A Poisson regression model was then used to estimate the associations between city-specific characteristics (reduced by the principal component analysis to avoid multicollinearity) and the case-severity rate of HFMD. The above analysis was further stratified by age and gender to examine potential modifying effects and vulnerable sub-populations. Results We found that the case-severity rate of HFMD varied dramatically between cities, ranging from 0 to 8.09%. Cities with high case-severity rates were mainly clustered in Central China. By relating the case-severity rate to city-specific characteristics, we found that both the principal component characterized by a high level of social and economic development (RR = 0.823, 95%CI 0.739, 0.916) and another that characterized by warm and humid climate (RR = 0.771, 95%CI 0.619, 0.960) were negatively associated with the case-severity rate of HFMD. These estimations were consistent across age and gender sub-populations. Conclusion Except for the type of infected pathogen, the case-severity rate of HFMD was closely related to city development and meteorological factor. These findings suggest that social and environmental factors may also play an important role in the progress of severe HFMD. Supplementary Information The online version contains supplementary material available at 10.1186/s12199-020-00927-9.
Collapse
Affiliation(s)
- Qing Pan
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
| | - Fengfeng Liu
- Division of Infectious Disease & Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, 102206, PR China
| | - Juying Zhang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
| | - Xing Zhao
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
| | - Yifan Hu
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
| | - Chaonan Fan
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
| | - Fan Yang
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China
| | - Zhaorui Chang
- Division of Infectious Disease & Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Center for Disease Control and Prevention, Beijing, 102206, PR China.
| | - Xiong Xiao
- Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, Sichuan, 610041, PR China.
| |
Collapse
|
78
|
Nguyet LA, Thanh TT, Nhan LNT, Hong NTT, Nhu LNT, Van HMT, Ny NTH, Anh NT, Han DDK, Tuan HM, Huy VQ, Viet HL, Cuong HQ, Thao NTT, Viet DC, Khanh TH, Thwaites L, Clapham H, Hung NT, Chau NVV, Thwaites G, Ha DQ, van Doorn HR, Tan LV. Neutralizing Antibodies against Enteroviruses in Patients with Hand, Foot and Mouth Disease. Emerg Infect Dis 2021; 26:298-306. [PMID: 31961293 PMCID: PMC6986819 DOI: 10.3201/eid2602.190721] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
Hand, foot and mouth disease (HFMD) is an emerging infection with pandemic potential. Knowledge of neutralizing antibody responses among its pathogens is essential to inform vaccine development and epidemiologic research. We used 120 paired-plasma samples collected at enrollment and >7 days after the onset of illness from HFMD patients infected with enterovirus A71 (EV-A71), coxsackievirus A (CVA) 6, CVA10, and CVA16 to study cross neutralization. For homotypic viruses, seropositivity increased from <60% at enrollment to 97%-100% at follow-up, corresponding to seroconversion rates of 57%-93%. Seroconversion for heterotypic viruses was recorded in only 3%-23% of patients. All plasma samples from patients infected with EV-A71 subgenogroup B5 could neutralize the emerging EV-A71 subgenogroup C4. Collectively, our results support previous reports about the potential benefit of EV-A71 vaccine but highlight the necessity of multivalent vaccines to control HFMD.
Collapse
|
79
|
Gao Q, Liu Z, Xiang J, Tong M, Zhang Y, Wang S, Zhang Y, Lu L, Jiang B, Bi P. Forecast and early warning of hand, foot, and mouth disease based on meteorological factors: Evidence from a multicity study of 11 meteorological geographical divisions in mainland China. ENVIRONMENTAL RESEARCH 2021; 192:110301. [PMID: 33069698 DOI: 10.1016/j.envres.2020.110301] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Revised: 09/24/2020] [Accepted: 10/05/2020] [Indexed: 05/14/2023]
Abstract
BACKGROUND Hand, foot, and mouth disease (HFMD) is a significant public health issue in China. Early warning and forecasting are one of the most cost-effective ways for HFMD control and prevention. However, relevant research is limited, especially in China with a large population and diverse climatic characteristics. This study aims to identify local specific HFMD epidemic thresholds and construct a weather-based early warning model for HFMD control and prevention across China. METHODS Monthly notified HFMD cases and meteorological data for 22 cities selected from different climate zones from 2014 to 2018 were extracted from the National Notifiable Disease Surveillance System and the Meteorological Data Sharing Service System, respectively. A generalized additive model (GAM) based on meteorological factors was conducted to forecast HFMD epidemics. The receiver operator characteristic curve (ROC) was generated to determine the value of optimal warning threshold. RESULTS The developed model was solid in forecasting the epidemic of HFMD with all R square (R2) in the 22 cities above 85%, and mean absolute percentage error (MAPE) less than 1%. The warning thresholds varied by cities with the highest threshold observed in Shenzhen (n = 7195) and the lowest threshold in Liaoyang (n = 12). The areas under the curve (AUC) was greater than 0.9 for all regions, indicating a satisfied discriminating ability in epidemics detection. CONCLUSIONS The weather-based HFMD forecasting and early warning model we developed for different climate zones provides needed information on occurrence time and size of HFMD epidemics. An effective early warning system for HFMD could provide sufficient time for local authorities to implement timely interventions to minimize the HFMD morbidity and mortality.
Collapse
Affiliation(s)
- Qi Gao
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, People's Republic of China; Shandong University Climate Change and Health Center, Jinan, Shandong Province, People's Republic of China
| | - Zhidong Liu
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, People's Republic of China; Shandong University Climate Change and Health Center, Jinan, Shandong Province, People's Republic of China
| | - Jianjun Xiang
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia; School of Public Health, Fujian Medical University, Fuzhou, 350108, People's Republic of China
| | - Michael Tong
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - Ying Zhang
- School of Public Health, China Studies Centre, The University of Sydney, New South Wales, Australia
| | - Shuzi Wang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, People's Republic of China; Shandong University Climate Change and Health Center, Jinan, Shandong Province, People's Republic of China
| | - Yiwen Zhang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, People's Republic of China; Shandong University Climate Change and Health Center, Jinan, Shandong Province, People's Republic of China
| | - Liang Lu
- Shandong University Climate Change and Health Center, Jinan, Shandong Province, People's Republic of China; State Key Laboratory of Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, 102206, People's Republic of China
| | - Baofa Jiang
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, Shandong Province, People's Republic of China; Shandong University Climate Change and Health Center, Jinan, Shandong Province, People's Republic of China.
| | - Peng Bi
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| |
Collapse
|
80
|
Efficacy of an inactivated bivalent vaccine for enterovirus 71 and coxsackievirus A16 in mice immunized intradermally. Vaccine 2020; 39:596-604. [PMID: 33342637 DOI: 10.1016/j.vaccine.2020.11.070] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Revised: 11/06/2020] [Accepted: 11/29/2020] [Indexed: 01/20/2023]
Abstract
Human hand, foot, and mouth disease (HFMD), an important infectious disease in children, is caused mainly by enterovirus 71 (EV71) and coxsackievirus A16 (CA16). In this study, a bivalent inactivated EV71/CA16 vaccine is developed and evaluated in immunized BALB/c mice injected through the intradermal route. Q-RT-PCR detection of the mRNA of immune signal molecules in local epithelial tissues inoculated with the vaccine indicates activation of innate immunity, which includes upregulation of immune-related chemokines, interferons and CD molecules. Further, the finding that neutralizing antibodies and specific T cellular responses were elicited in adult mice after two immunizations with the vaccine at a 28-day interval, which endowed offspring mice to defend a viral challenge, suggests the successful induction of specific protective antiviral immunity. All these data suggest that immunization with this bivalent EV71/CA16 vaccine via the intradermal route elicits effective immunity against EV71 and CA16 infection.
Collapse
|
81
|
Yang YJ, Liu JN, Pan XD. Synthesis and antiviral activity of lycorine derivatives. JOURNAL OF ASIAN NATURAL PRODUCTS RESEARCH 2020; 22:1188-1196. [PMID: 33176482 DOI: 10.1080/10286020.2020.1844674] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [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.
Collapse
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
| |
Collapse
|
82
|
Brown DM, Zhang Y, Scheuermann RH. Epidemiology and Sequence-Based Evolutionary Analysis of Circulating Non-Polio Enteroviruses. Microorganisms 2020; 8:microorganisms8121856. [PMID: 33255654 PMCID: PMC7759938 DOI: 10.3390/microorganisms8121856] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/13/2020] [Accepted: 11/17/2020] [Indexed: 02/07/2023] Open
Abstract
Enteroviruses (EVs) are positive-sense RNA viruses, with over 50,000 nucleotide sequences publicly available. While most human infections are typically associated with mild respiratory symptoms, several different EV types have also been associated with severe human disease, especially acute flaccid paralysis (AFP), particularly with endemic members of the EV-B species and two pandemic types—EV-A71 and EV-D68—that appear to be responsible for recent widespread outbreaks. Here we review the recent literature on the prevalence, characteristics, and circulation dynamics of different enterovirus types and combine this with an analysis of the sequence coverage of different EV types in public databases (e.g., the Virus Pathogen Resource). This evaluation reveals temporal and geographic differences in EV circulation and sequence distribution, highlighting recent EV outbreaks and revealing gaps in sequence coverage. Phylogenetic analysis of the EV genus shows the relatedness of different EV types. Recombination analysis of the EV-A species provides evidence for recombination as a mechanism of genomic diversification. The absence of broadly protective vaccines and effective antivirals makes human enteroviruses important pathogens of public health concern.
Collapse
Affiliation(s)
- David M Brown
- Department of Synthetic Biology, J. Craig Venter Institute, Rockville, MD 20850, USA
| | - Yun Zhang
- Department of Informatics, J. Craig Venter Institute, La Jolla, CA 92037, USA
| | - Richard H Scheuermann
- Department of Informatics, J. Craig Venter Institute, La Jolla, CA 92037, USA
- Department of Pathology, University of California San Diego, La Jolla, CA 92093, USA
- La Jolla Institute for Immunology, La Jolla, CA 92065, USA
| |
Collapse
|
83
|
Han Z, Song Y, Xiao J, Jiang L, Huang W, Wei H, Li J, Zeng H, Yu Q, Li J, Yu D, Zhang Y, Li C, Zhan Z, Shi Y, Xiong Y, Wang X, Ji T, Yang Q, Zhu S, Yan D, Xu W, Zhang Y. Genomic epidemiology of coxsackievirus A16 in mainland of China, 2000-18. Virus Evol 2020; 6:veaa084. [PMID: 33343924 PMCID: PMC7733612 DOI: 10.1093/ve/veaa084] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Hand, foot, and mouth disease (HFMD), which is a frequently reported and concerning disease worldwide, is a severe burden on societies globally, especially in the countries of East and Southeast Asia. Coxsackievirus A16 (CV-A16) is one of the most important causes of HFMD and a severe threat to human health, especially in children under 5 years of age. To investigate the epidemiological characteristics, spread dynamics, recombinant forms (RFs), and other features of CV-A16, we leveraged the continuous surveillance data of CV-A16-related HFMD cases collected over an 18-year period. With the advent of the EV-A71 vaccine since 2016, which targeted the EV-A71-related HFMD cases, EV-A71-related HFMD cases decreased dramatically, whereas the CV-A16-related HFMD cases showed an upward trend from 2017 to October 2019. The CV-A16 strains observed in this study were genetically related and widely distributed in the mainland of China. Our results show that three clusters (B1a-B1c) existed in the mainland of China and that the cluster of B1b dominates the diffusion of CV-A16 in China. We found that eastern China played a decisive role in seeding the diffusion of CV-A16 in China, with a more complex and variant transmission trend. Although EV-A71 vaccine was launched in China in 2016, it did not affect the genetic diversity of CV-A16, and its genetic diversity did not decline, which confirmed the epidemiological surveillance trend of CV-A16. Two discontinuous clusters (2000-13 and 2014-18) were observed in the full-length genome and arranged along the time gradient, which revealed the reason why the relative genetic diversity of CV-A16 increased and experienced more complex fluctuation model after 2014. In addition, the switch from RFs B (RF-B) and RF-C co-circulation to RF-D contributes to the prevalence of B1b cluster in China after 2008. The correlation between genotype and RFs partially explained the current prevalence of B1b. This study provides unprecedented full-length genomic sequences of CV-A16 in China, with a wider geographic distribution and a long-term time scale. The study presents valuable information about CV-A16, aimed at developing effective control strategies, as well as a call for a more robust surveillance system, especially in the Asia-Pacific region.
Collapse
Affiliation(s)
- Zhenzhi Han
- WHO WPRO Regional Polio Reference Laboratory and National Laboratory for Poliomyelitis, NHC Key Laboratory of Biosafety, NHC Key Laboratory of 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, People's Republic of China
| | - Yang Song
- WHO WPRO Regional Polio Reference Laboratory and National Laboratory for Poliomyelitis, NHC Key Laboratory of Biosafety, NHC Key Laboratory of 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, People's Republic of China
| | - Jinbo Xiao
- WHO WPRO Regional Polio Reference Laboratory and National Laboratory for Poliomyelitis, NHC Key Laboratory of Biosafety, NHC Key Laboratory of 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, People's Republic of China
| | - Lili Jiang
- Yunnan Center for Disease Control and Prevention, Kunming, Yunnan Province, People's Republic of China
| | - Wei Huang
- Chongqing Center for Disease Control and Prevention, Chongqing City, People's Republic of China
| | - Haiyan Wei
- Henan Center for Disease Control and Prevention, Zhengzhou, Henan Province, People's Republic of China
| | - Jie Li
- Beijing Center for Disease Control and Prevention, Beijing City, People's Republic of China
| | - Hanri Zeng
- Guangdong Center for Disease Control and Prevention, Guangzhou, Guangdong Province, People's Republic of China
| | - Qiuli Yu
- Hebei Center for Disease Control and Prevention, Shijiazhuang, Hebei Province, People's Republic of China
| | - Jiameng Li
- Tianjin Center for Disease Control and Prevention, Tianjin City, People's Republic of China
| | - Deshan Yu
- Gansu Center for Disease Control and Prevention, Lanzhou, Gansu Province, People's Republic of China
| | - Yanjun Zhang
- Zhejiang Center for Disease Control and Prevention, Hangzhou, Zhejiang Province, People's Republic of China
| | - Chonghai Li
- Qinghai Center for Disease Control and Prevention, Xining, Qinghai Province, People's Republic of China
| | - Zhifei Zhan
- Hunan Center for Disease Control and Prevention, Changsha, Hunan Province, People's Republic of China
| | - Yonglin Shi
- Anhui Center for Disease Control and Prevention, Hefei, Anhui Province, People's Republic of China
| | - Ying Xiong
- Jiangxi Center for Disease Control and Prevention, Nanchang, Jiangxi Province, People's Republic of China
| | - Xianjun Wang
- Shandong Center for Disease Control and Prevention, Jinan, Shandong Province, People's Republic of China
| | - Tianjiao Ji
- WHO WPRO Regional Polio Reference Laboratory and National Laboratory for Poliomyelitis, NHC Key Laboratory of Biosafety, NHC Key Laboratory of 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, People's Republic of China
| | - Qian Yang
- WHO WPRO Regional Polio Reference Laboratory and National Laboratory for Poliomyelitis, NHC Key Laboratory of Biosafety, NHC Key Laboratory of 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, People's Republic of China
| | - Shuangli Zhu
- WHO WPRO Regional Polio Reference Laboratory and National Laboratory for Poliomyelitis, NHC Key Laboratory of Biosafety, NHC Key Laboratory of 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, People's Republic of China
| | - Dongmei Yan
- WHO WPRO Regional Polio Reference Laboratory and National Laboratory for Poliomyelitis, NHC Key Laboratory of Biosafety, NHC Key Laboratory of 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, People's Republic of China
| | - Wenbo Xu
- WHO WPRO Regional Polio Reference Laboratory and National Laboratory for Poliomyelitis, NHC Key Laboratory of Biosafety, NHC Key Laboratory of 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, People's Republic of China.,Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, Hubei Province, People's Republic of China
| | - Yong Zhang
- WHO WPRO Regional Polio Reference Laboratory and National Laboratory for Poliomyelitis, NHC Key Laboratory of Biosafety, NHC Key Laboratory of 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, People's Republic of China.,Center for Biosafety Mega-Science, Chinese Academy of Sciences, Wuhan, Hubei Province, People's Republic of China
| |
Collapse
|
84
|
Deng J, Gao X, Xiao C, Xu S, Ma Y, Yang J, Wu M, Pan F. Association between diurnal temperature range and outpatient visits for hand, foot, and mouth disease in Hefei, China: a distributed lag nonlinear analysis. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2020; 27:35618-35625. [PMID: 32613503 DOI: 10.1007/s11356-020-09878-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 06/23/2020] [Indexed: 06/11/2023]
Abstract
We aimed to quantify the relationship between the outpatient visits of hand, foot, and mouth disease (HFMD) and diurnal temperature range (DTR). The data of daily HFMD outpatient visits and meteorological parameters were obtained. A distributed lag nonlinear model combined with generalized linear model was used to estimate simultaneously nonlinear and delayed effects between DTR and daily HFMD outpatient visits after controlling confounding factors. A total of 15,275 HFMD visits were enrolled. DTR was significantly associated with HFMD outpatient visits in children. High DTR (P75: 11.4 °C) and extreme DTR (P95: 15.3 °C) were compared with 8.5 °C, and HFMD visits increased by a maximum of 3.93% (95% CI: 1.82 to 6.07%) and 4.47% (95% CI: 0.45 to 8.65%) in single-day lag effect, respectively. Furthermore, the extreme DTR effect decreased with the lag time and lasted for 10 days. Cumulative lag effects with markedly increasing percent of visits are over 64.88%. Furthermore, the effects were most pronounced among female children and children aged 0-2 years. Our study suggested that DTR changes were associated with HFMD outpatient visits, and populations of female and aged 0-2 years were more sensitive.
Collapse
Affiliation(s)
- Jixiang Deng
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui Province, China
| | - Xing Gao
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui Province, China
| | - Changchun Xiao
- Hefei Center for Disease Control and Prevention, 86 Luan Road, Hefei, 230032, Anhui Province, China
| | - Shanshan Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui Province, China
| | - Yubo Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui Province, China
| | - Jiajia Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui Province, China
| | - Meng Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui Province, China
| | - Faming Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, 81 Meishan Road, Hefei, 230032, Anhui Province, China.
| |
Collapse
|
85
|
Nhan LNT, Khanh TH, Hong NTT, Van HMT, Nhu LNT, Ny NTH, Nguyet LA, Thanh TT, Anh NT, Hang VTT, Qui PT, Viet HL, Tung TH, Ha DQ, Tuan HM, Thwaites G, Chau NVV, Thwaites L, Hung NT, van Doorn HR, Tan LV. Clinical, etiological and epidemiological investigations of hand, foot and mouth disease in southern Vietnam during 2015 - 2018. PLoS Negl Trop Dis 2020; 14:e0008544. [PMID: 32804980 PMCID: PMC7451980 DOI: 10.1371/journal.pntd.0008544] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 08/27/2020] [Accepted: 06/30/2020] [Indexed: 11/19/2022] Open
Abstract
Hand, foot and mouth disease (HFMD) continues to challenge Asia with pandemic potential. In Vietnam, there have been two major outbreaks occurring during 2011-2012 (>200,000 hospitalizations and >200 deaths) and more recently in 2018 (>130,000 hospitalizations and 17 deaths). Given the high burden and the complex epidemic dynamics of HFMD, synthesizing its clinical and epidemiological data remains essential to inform the development of appropriate interventions and design public health measures. We report the results of a hospital-based study conducted during 2015-2018, covering the severe HFMD outbreak recently documented in Vietnam in 2018. The study was conducted at three major hospitals responsible for receiving HFMD patients from southern Vietnam with a population of over 40 million. A total of 19 enterovirus serotypes were detected in 1196 HFMD patients enrolled in the clinical study during 2015-2018, with enterovirus A71 (EV-A71), coxsackievirus A6 (CV-A6), CV-A10 and CV-A16 being the major causes. Despite the emergence of coxsackieviruses, EV-A71 remains the leading cause of severe HFMD in Vietnam. EV-A71 was consistently detected at a higher frequency during the second half of the years. The emergence of EV-A71 subgenogroup C4 in late 2018 was preceded by its low activity during 2017-early 2018. Compared with EV-A71 subgenogroup B5, C4 was more likely to be associated with severe HFMD, representing the first report demonstrating the difference in clinical severity between subgenogroup C4 and B5, the two predominant EV-A71 subgenogroups causing HFMD worldwide. Our data have provided significant insights into important aspects of HFMD over four years (2015-2018) in Vietnam, and emphasize active surveillance for pathogen circulation remains essential to inform the local public health authorities in the development of appropriate intervention strategies to reduce the burden of this emerging infections. Multivalent vaccines are urgently needed to control HFMD.
Collapse
Affiliation(s)
- Le Nguyen Thanh Nhan
- Children’s Hospital 1, Ho Chi Minh City, Vietnam
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | | | | | | | | | | | - Lam Anh Nguyet
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Tran Tan Thanh
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Nguyen To Anh
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Vu Thi Ty Hang
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Phan Tu Qui
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Ho Lu Viet
- Children’s Hospital 2, Ho Chi Minh City, Vietnam
| | | | - Do Quang Ha
- Children’s Hospital 1, Ho Chi Minh City, Vietnam
| | - Ha Manh Tuan
- University of Medicine and Pharmacy, Ho Chi Minh City, Vietnam
| | - Guy Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | | - Louise Thwaites
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | | | - H. Rogier van Doorn
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
| | - Le Van Tan
- Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| |
Collapse
|
86
|
Zou Z, Tsang JOL, Yan B, Chik KKH, Chan CCY, Cao J, Liang R, Tang K, Yin F, Ye ZW, Chu H, Chan JFW, Yuan S, Yuen KY. Metabolic Profiling Reveals Significant Perturbations of Intracellular Glucose Homeostasis in Enterovirus-Infected Cells. Metabolites 2020; 10:metabo10080302. [PMID: 32717953 PMCID: PMC7466099 DOI: 10.3390/metabo10080302] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 07/20/2020] [Accepted: 07/21/2020] [Indexed: 02/08/2023] Open
Abstract
Enterovirus A71 (EV-A71) is a common cause of hand, foot, and mouth disease. Severe EV-A71 infections may be associated with life-threatening neurological complications. However, the pathogenic mechanisms underlying these severe clinical and pathological features remain incompletely understood. Metabolites are known to play critical roles in multiple stages of the replication cycles of viruses. The metabolic reprogramming induced by viral infections is essential for optimal virus replication and may be potential antiviral targets. In this study, we applied targeted metabolomics profiling to investigate the metabolic changes of induced pluripotent human stem cell (iPSC)-derived neural progenitor cells (NPCs) upon EV-A71 infection. A targeted quantitation of polar metabolites identified 14 candidates with altered expression profiles. A pathway enrichment analysis pinpointed glucose metabolic pathways as being highly perturbed upon EV-A71 infection. Gene silencing of one of the key enzymes of glycolysis, 6-phosphofructo-2-kinase (PFKFB3), significantly suppressed EV-A71 replication in vitro. Collectively, we demonstrated the feasibility to manipulate EV-A71-triggered host metabolic reprogramming as a potential anti-EV-A71 strategy.
Collapse
Affiliation(s)
- Zijiao Zou
- State Key Laboratory of Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China; (Z.Z.); (J.O.-L.T.); (B.Y.); (K.K.-H.C.); (C.C.-Y.C.); (J.C.); (R.L.); (K.T.); (Z.-W.Y.); (H.C.); (K.-Y.Y.)
| | - Jessica Oi-Ling Tsang
- State Key Laboratory of Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China; (Z.Z.); (J.O.-L.T.); (B.Y.); (K.K.-H.C.); (C.C.-Y.C.); (J.C.); (R.L.); (K.T.); (Z.-W.Y.); (H.C.); (K.-Y.Y.)
| | - Bingpeng Yan
- State Key Laboratory of Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China; (Z.Z.); (J.O.-L.T.); (B.Y.); (K.K.-H.C.); (C.C.-Y.C.); (J.C.); (R.L.); (K.T.); (Z.-W.Y.); (H.C.); (K.-Y.Y.)
| | - Kenn Ka-Heng Chik
- State Key Laboratory of Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China; (Z.Z.); (J.O.-L.T.); (B.Y.); (K.K.-H.C.); (C.C.-Y.C.); (J.C.); (R.L.); (K.T.); (Z.-W.Y.); (H.C.); (K.-Y.Y.)
| | - Chris Chun-Yiu Chan
- State Key Laboratory of Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China; (Z.Z.); (J.O.-L.T.); (B.Y.); (K.K.-H.C.); (C.C.-Y.C.); (J.C.); (R.L.); (K.T.); (Z.-W.Y.); (H.C.); (K.-Y.Y.)
| | - Jianli Cao
- State Key Laboratory of Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China; (Z.Z.); (J.O.-L.T.); (B.Y.); (K.K.-H.C.); (C.C.-Y.C.); (J.C.); (R.L.); (K.T.); (Z.-W.Y.); (H.C.); (K.-Y.Y.)
| | - Ronghui Liang
- State Key Laboratory of Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China; (Z.Z.); (J.O.-L.T.); (B.Y.); (K.K.-H.C.); (C.C.-Y.C.); (J.C.); (R.L.); (K.T.); (Z.-W.Y.); (H.C.); (K.-Y.Y.)
| | - Kaiming Tang
- State Key Laboratory of Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China; (Z.Z.); (J.O.-L.T.); (B.Y.); (K.K.-H.C.); (C.C.-Y.C.); (J.C.); (R.L.); (K.T.); (Z.-W.Y.); (H.C.); (K.-Y.Y.)
| | - Feifei Yin
- Hainan Medical University-The University of Hong Kong Joint Laboratory of Tropical Infectious Diseases, The University of Hong Kong, Pokfulam, Hong Kong, China;
| | - Zi-Wei Ye
- State Key Laboratory of Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China; (Z.Z.); (J.O.-L.T.); (B.Y.); (K.K.-H.C.); (C.C.-Y.C.); (J.C.); (R.L.); (K.T.); (Z.-W.Y.); (H.C.); (K.-Y.Y.)
| | - Hin Chu
- State Key Laboratory of Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China; (Z.Z.); (J.O.-L.T.); (B.Y.); (K.K.-H.C.); (C.C.-Y.C.); (J.C.); (R.L.); (K.T.); (Z.-W.Y.); (H.C.); (K.-Y.Y.)
| | - Jasper Fuk-Woo Chan
- State Key Laboratory of Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China; (Z.Z.); (J.O.-L.T.); (B.Y.); (K.K.-H.C.); (C.C.-Y.C.); (J.C.); (R.L.); (K.T.); (Z.-W.Y.); (H.C.); (K.-Y.Y.)
- Hainan Medical University-The University of Hong Kong Joint Laboratory of Tropical Infectious Diseases, The University of Hong Kong, Pokfulam, Hong Kong, China;
- Correspondence: (J.F.-W.C.); (S.Y.)
| | - Shuofeng Yuan
- State Key Laboratory of Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China; (Z.Z.); (J.O.-L.T.); (B.Y.); (K.K.-H.C.); (C.C.-Y.C.); (J.C.); (R.L.); (K.T.); (Z.-W.Y.); (H.C.); (K.-Y.Y.)
- Correspondence: (J.F.-W.C.); (S.Y.)
| | - Kwok-Yung Yuen
- State Key Laboratory of Emerging Infectious Diseases, Carol Yu Centre for Infection, Department of Microbiology, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong, China; (Z.Z.); (J.O.-L.T.); (B.Y.); (K.K.-H.C.); (C.C.-Y.C.); (J.C.); (R.L.); (K.T.); (Z.-W.Y.); (H.C.); (K.-Y.Y.)
- Hainan Medical University-The University of Hong Kong Joint Laboratory of Tropical Infectious Diseases, The University of Hong Kong, Pokfulam, Hong Kong, China;
| |
Collapse
|
87
|
Meng Y, Xiong T, Zhao R, Liu J, Yu G, Xiao J, Wang K, Wu T, Fu W, Guo H, Huang J, Wei S. Genome-wide association study identifies TPH2 variant as a novel locus for severe CV-A6-associated hand, foot, and mouth disease in Han Chinese. Int J Infect Dis 2020; 98:268-274. [PMID: 32634583 DOI: 10.1016/j.ijid.2020.06.104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2020] [Revised: 06/29/2020] [Accepted: 06/29/2020] [Indexed: 10/23/2022] Open
Abstract
BACKGROUND Little is known about the association between genetic susceptibility and the severity of hand, foot, and mouth disease (HFMD) infected with coxsackievirus A6 (CV-A6). METHODS Three hundred and sixty-four CV-A6 HFMD patients were enrolled, including 115 severe and 249 mild patients. A genome-wide association study (GWAS) was performed involving eight DNA pools of 115 severe and 115 mild CV-A6 HFMD patients pair-matched by age and gender. Differences in relative allele signal scores of SNPs in Illumina Human OmniZhongHua-8 BeadChips were compared between the two groups. The tag SNPS for potentially functional SNPs or their high linked SNPs were selected for individual genotyping in all 364 patients and assessed for their associations with severe CV-A6 HFMD using multivariable logistic regression analyses. RESULTS The top 30 significant SNPs obtained from pooled DNA GWAS analysis were checked for biological functions and their high linkage disequilibrium (LD) SNPs. Four tag SNPs (rs1558206, rs6927647, rs9375728 and rs10879355) were selected for further individual genotyping in 364 CV-A6 patients. Only SNP rs10879355 was associated with severe CV-A6 HFMD, with CC genotype having a greater risk of severe illness than TT+TC genotypes (OR=2.48, 95%CI: 1.34, 4.56). SNP rs4290270 is in complete LD with rs10879355 in Chinese Han children. CONCLUSIONS This is the first report that one potentially functional SNP rs4290270 in the TPH2 gene may be associated with the risk of severe CV-A6 HFMD.
Collapse
Affiliation(s)
- Yu Meng
- Department of Epidemiology and Biostatistics, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Tiantian Xiong
- Baoan District Center for Disease Control and Prevention, Shenzhen, China
| | - Rongxian Zhao
- Department of Epidemiology and Biostatistics, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jian Liu
- People's Hospital of Baoan District, Shenzhen, China
| | - Guangqing Yu
- Baoan District Center for Disease Control and Prevention, Shenzhen, China
| | - Jinrong Xiao
- Department of Epidemiology and Biostatistics, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ke Wang
- Department of Epidemiology and Biostatistics, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Taishun Wu
- Baoan District Center for Disease Control and Prevention, Shenzhen, China
| | - Wenshan Fu
- Department of Occupational and Environmental Health, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huan Guo
- Department of Occupational and Environmental Health, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Jiao Huang
- Department of Epidemiology and Biostatistics, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Sheng Wei
- Department of Epidemiology and Biostatistics, State Key Laboratory of Environmental Health (Incubating), School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| |
Collapse
|
88
|
Du Z, Huang Y, Bloom MS, Zhang Z, Yang Z, Lu J, Xu J, Hao Y. Assessing the vaccine effectiveness for hand, foot, and mouth disease in Guangzhou, China: a time-series analysis. Hum Vaccin Immunother 2020; 17:217-223. [PMID: 32530733 DOI: 10.1080/21645515.2020.1763076] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objective: Hand, foot, and mouth disease (HFMD) is an important public health issue in China. Although efficacy has been demonstrated by randomized controlled trials, the evidence for effectiveness of the monovalent Enterovirus 71 (EV71) vaccine against HFMD remains unknown. This study aimed to assess the vaccine effectiveness for HFMD in Guangzhou, China. Methods: Routinely collected vaccination and HFMD surveillance data were captured from the China Information System for Disease Control and Prevention. We estimated the EV71 vaccine effectiveness using spatial ecologic and time-series analysis approaches. Results: A total of 174,002 HFMD cases under 5 years of age were reported to the Guangzhou, China surveillance system from January 2016 to December 2018. A total of 408,664 children completed a two-dose EV71 vaccination series. In an ecologic analysis, a two-dose EV71 vaccination rate above the median conferred lower HFMD risk relative to a vaccination rate below the median (ratio ratio = 0.955, 95% confidence interval (CI): 0.949, 0.962; P < .001). In the time-series approach, 0.9% fewer HFMD cases were associated with a 1% increase in the two-dose EV71 vaccination rate, but without statistical significance (P = .094). However, we detected statistically significant protective associations for HFMD among children 3 years of age (0.9% fewer HFMD cases with a 1% increased vaccination rate; P = .046), and for EV71 (1.4%; P = .012) and "other viruses" (1.3%; P = .002), although not for Coxsackievirus A16 (CVA16). Conclusion: Our findings, based on real-world data, provide evidence of EV71 vaccine effectiveness for preventing EV71 and "other" viruses associated with HFMD. An expanded program of EV71 vaccination is urgently needed.
Collapse
Affiliation(s)
- Zhicheng Du
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University , Guangzhou, China
| | - Yong Huang
- Department of Immunization Programme Planning, Guangzhou Center for Disease Control and Prevention , Guangzhou, China
| | - Michael S Bloom
- Departments of Environmental Health Sciences and Epidemiology and Biostatistics, School of Public Health, University at Albany, State University of New York , Albany, New York, USA
| | - Zhoubin Zhang
- Department of Communicable Disease Control and Prevention, Guangzhou Center for Disease Control and Prevention , Guangzhou, China
| | - Zhicong Yang
- Department of Communicable Disease Control and Prevention, Guangzhou Center for Disease Control and Prevention , Guangzhou, China
| | - Jianyun Lu
- Department of Communicable Disease Control and Prevention, Guangzhou Center for Disease Control and Prevention , Guangzhou, China
| | - Jianxiong Xu
- Department of Immunization Programme Planning, Guangzhou Center for Disease Control and Prevention , Guangzhou, China
| | - Yuantao Hao
- Department of Medical Statistics and Epidemiology, School of Public Health, Sun Yat-sen University , Guangzhou, China
| |
Collapse
|
89
|
Chen J, Han Z, Wu H, Xu W, Yu D, Zhang Y. A Large-Scale Outbreak of Echovirus 30 in Gansu Province of China in 2015 and Its Phylodynamic Characterization. Front Microbiol 2020; 11:1137. [PMID: 32587581 PMCID: PMC7297909 DOI: 10.3389/fmicb.2020.01137] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 05/05/2020] [Indexed: 12/29/2022] Open
Abstract
Background Echovirus 30 (E-30) has been investigated and reported worldwide and is closely associated with several infectious diseases, including encephalitis; myocarditis; and hand, foot, and mouth disease. Although many E-30 outbreaks associated with encephalitis have been reported around the world, it was not reported in northwest China until 2015. Methods The clinical samples, including the feces, serum, throat swabs, and cerebrospinal fluid, were collected for this study and were analyzed for diagnosis. E-30 was isolated and processed according to the standard procedures. The epidemiological and phylogenetic analysis were performed to indicate the characteristics of E-30 outbreaks and phylodynamics of E-30 in China. Results The E-30 outbreaks affected nine towns of Gansu Province in 2015, starting at a school of Nancha town and spreading to other towns within 1 month. The epidemiological features showed that children aged 6–15 years were more susceptible to E-30 infection. The genotypes B and C cocirculated in the world, whereas the latter dominated the circulation of E-30 in China. The genome sequences of this outbreak present 99.3–100% similarity among these strains, indicating a genetic-linked aggregate outbreak of E-30 in this study. Two larger genetic diversity expansions and three small fluctuations of E-30 were observed from 1987 to 2016 in China, which revealed the oscillating patterns of E-30 in China. In addition, the coastal provinces of China, such as Zhejiang, Fujian, and Shandong, were initially infected, followed by other parts of the country. The E-30 strains isolated from mainland of China may have originated from Taiwan of China in the last century. Conclusion The highly similar E-30 genomes in this outbreak showed an aggregate outbreak of E-30, with nine towns affected. Our results suggested that, although the genetic diversity of E-30 oscillates, the dominant lineages of E-30 in China has complex genetic transmission. The coastal provinces played an important role in E-30 spread, which implied further development of effective countermeasures. This study provides a further insight into the E-30 outbreak and transmission and illustrates the importance of valuable surveillance in the future.
Collapse
Affiliation(s)
- Jianhua Chen
- Key Laboratory of Infectious Diseases in Gansu Province, Gansu Center for Disease Control and Prevention, Lanzhou, China
| | - Zhenzhi Han
- WHO WPRO Regional Polio Reference Laboratory and National Health Commission Key Laboratory of Biosafety, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Haizhuo Wu
- Key Laboratory of Infectious Diseases in Gansu Province, Gansu Center for Disease Control and Prevention, Lanzhou, China
| | - Wenbo Xu
- WHO WPRO Regional Polio Reference Laboratory and National Health Commission Key Laboratory of Biosafety, 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
| | - Deshan Yu
- Key Laboratory of Infectious Diseases in Gansu Province, Gansu Center for Disease Control and Prevention, Lanzhou, China
| | - Yong Zhang
- WHO WPRO Regional Polio Reference Laboratory and National Health Commission Key Laboratory of Biosafety, 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
| |
Collapse
|
90
|
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: 0.2] [Reference Citation Analysis] [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.
Collapse
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
| |
Collapse
|
91
|
Liu Z, Xia S, Wang X, Lan Q, Li P, Xu W, Wang Q, Lu L, Jiang S. Sodium Copper Chlorophyllin Is Highly Effective against Enterovirus (EV) A71 Infection by Blocking Its Entry into the Host Cell. ACS Infect Dis 2020; 6:882-890. [PMID: 32233455 DOI: 10.1021/acsinfecdis.0c00096] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Human enteroviruses (HEVs) pose an ongoing threat to global public health. Particularly, enterovirus-A71 (EV-A71), the main pathogen causing hand-foot-and-mouth disease (HFMD), has caused ongoing outbreaks globally in recent years associated with severe neurological manifestations and several deaths. Currently, no effective antivirals are available for the prevention or treatment of EV-A71 infection. In this study, we found that sodium copper chlorophyllin (CHL), a health food additive and an over-the-counter anticancer medicine or treatment to reduce the odor of urine or feces, exhibited potent inhibitory activity against infection by divergent EV-A71 and coxsackievirus-A16 (CV-A16) isolates at a low micromolar concentration with excellent safety. The antiviral activity of each was confirmed by colorimetric viral infection and qRT-PCR assays. A series of mechanistic studies showed that CHL did not target the host cell but blocked the entry of EV-A71 and CV-A16 into the host cell at the postattachment stage. In the mouse model, CHL could significantly reduce the viral titer in the lungs and muscles. Since CHL has been used in clinics for many years with excellent safety, it has the potential to be further developed into a prophylactic or therapeutic to prevent or treat HFMD caused by EV-A71 or CV-A16 infection.
Collapse
Affiliation(s)
- Zezhong Liu
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), School of Basic Medical Sciences, Fudan University, Shanghai 200032, China
| | - Shuai Xia
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), School of Basic Medical Sciences, Fudan University, Shanghai 200032, China
| | - Xinling Wang
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), School of Basic Medical Sciences, Fudan University, Shanghai 200032, China
| | - Qiaoshuai Lan
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), School of Basic Medical Sciences, Fudan University, Shanghai 200032, China
| | - Peiyu Li
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), School of Basic Medical Sciences, Fudan University, Shanghai 200032, China
| | - Wei Xu
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), School of Basic Medical Sciences, Fudan University, Shanghai 200032, China
| | - Qian Wang
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), School of Basic Medical Sciences, Fudan University, Shanghai 200032, China
| | - Lu Lu
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), School of Basic Medical Sciences, Fudan University, Shanghai 200032, China
| | - Shibo Jiang
- Key Laboratory of Medical Molecular Virology (MOE/NHC/CAMS), School of Basic Medical Sciences, Fudan University, Shanghai 200032, China
- Lindsley F. Kimball Research Institute, New York Blood Center, New York, New York 10065, United States
| |
Collapse
|
92
|
Isolation and molecular characterization of coxsackievirus A6 and coxsackievirus A16 from a case of recurrent Hand, Foot and Mouth Disease in Mumbai, Maharashtra, India, 2018. Virusdisease 2020; 31:56-60. [PMID: 32206699 DOI: 10.1007/s13337-020-00567-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/09/2020] [Indexed: 01/08/2023] Open
Abstract
Hand, Foot and Mouth Disease (HFMD) is caused by multiple Enterovirus (EV) serotypes mainly coxsackievirus A6 (CV-A6), coxsackievirus A16 (CV-A16) and Enterovirus 71 (EV-A71). Recurrent HFMD infections are rarely reported. An unusual rise in HFMD cases was reported in Mumbai during May-June 2018. Stool and throat swab specimens were referred from seven children from two hospitals for laboratory diagnosis. The age group of cases ranged from 9 months to 5 years with median age 13 months. Out of seven cases, three were males and four females. One 13-month-old female case was reported twice within 21 days. Stool, throat swab specimens were tested by pan enterovirus RT-PCR and also by virus isolation using human rhabdomyosarcoma cell line for detection of Enteroviruses. Out of seven HFMD cases, CV-A6 and CV-A16 viruses were isolated from five and two cases respectively. The phylogenetic analysis of CV-A6 viruses showed their similarity with CV-A6 viruses from Finland and China, whereas the two CV-A16 isolates showed similarity with those from Japan, France, China, Sarawak and Thailand. For the recurrent HFMD case, CV-A6 and CV-A16 were isolated from the stool specimens collected during the first and second episodes, respectively. There are no reports of isolation and molecular characterization of CV-A6 and CV-A16 viruses from recurrent HFMD cases. The present study reports molecular characterization of two Enterovirus serotypes CV-A6 and CV-A16 from a recurrent HFMD case, highlighting need of virological and molecular surveillance of HFMD.
Collapse
|
93
|
Hu Y, Xu L, Pan H, Shi X, Chen Y, Lynn H, Mao S, Zhang H, Cao H, Zhang J, Zhang J, Xiao S, Hu J, Li X, Yao S, Zhang Z, Zhao G. Transmission center and driving factors of hand, foot, and mouth disease in China: A combined analysis. PLoS Negl Trop Dis 2020; 14:e0008070. [PMID: 32150558 PMCID: PMC7062235 DOI: 10.1371/journal.pntd.0008070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Accepted: 01/17/2020] [Indexed: 11/18/2022] Open
Abstract
Hand, foot, and mouth disease (HFMD) has become a major public health issue in China. The disease incidence varies substantially over time and across space. To understand the heterogeneity of HFMD transmission, we compare the spatiotemporal dynamics of HFMD in Qinghai and Shanghai by conducting combined analysis of epidemiological, wavelet time series, and mathematical methods to county-level data from 2009 to 2016. We observe hierarchical epidemic waves in Qinghai, emanating from Huangzhong and in Shanghai from Fengxian. Besides population, we also find that the traveling waves are significantly associated with socio-economic and geographical factors. The population mobility also varies between the two regions: long-distance movement in Qinghai and between-neighbor commuting in Shanghai. Our findings provide important evidence for characterizing the heterogeneity of HFMD transmission and for the design and implementation of interventions, such as deploying optimal vaccine and changing local driving factors in the transmission center, to prevent or limit disease spread in these areas.
Collapse
Affiliation(s)
- Yi Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
- Laboratory for Spatial Analysis and Modeling, School of Public Health, Fudan University, Shanghai, China
| | - Lili Xu
- Institute for Infectious Disease Control and Prevention, Qinghai Provincial Center for Disease Control and Prevention, Qinghai, China
| | - Hao Pan
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Xun Shi
- Department of Geography, Dartmouth College, Hanover, New Hampshire, United States of America
| | - Yue Chen
- Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ontario, Canada
| | - Henry Lynn
- Department of Epidemiology and Biostatistics, School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
- Laboratory for Spatial Analysis and Modeling, School of Public Health, Fudan University, Shanghai, China
| | - Shenghua Mao
- Shanghai Municipal Center for Disease Control and Prevention, Shanghai, China
| | - Huayi Zhang
- Institute for Infectious Disease Control and Prevention, Qinghai Provincial Center for Disease Control and Prevention, Qinghai, China
| | - Hailan Cao
- Institute for Infectious Disease Control and Prevention, Qinghai Provincial Center for Disease Control and Prevention, Qinghai, China
| | - Jun Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
- Laboratory for Spatial Analysis and Modeling, School of Public Health, Fudan University, Shanghai, China
| | - Jing Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
- Laboratory for Spatial Analysis and Modeling, School of Public Health, Fudan University, Shanghai, China
| | - Shuang Xiao
- Department of Epidemiology and Biostatistics, School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
- Laboratory for Spatial Analysis and Modeling, School of Public Health, Fudan University, Shanghai, China
| | - Jian Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
- Laboratory for Spatial Analysis and Modeling, School of Public Health, Fudan University, Shanghai, China
| | - Xiande Li
- Department of Geography, Shanghai Normal University, Shanghai, China
| | - Shenjun Yao
- Key Laboratory of Geographic Information Science, Ministry of Education, East China Normal University, Shanghai, China
- School of Geographic Sciences, East China Normal University, Shanghai, China
| | - Zhijie Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
- Laboratory for Spatial Analysis and Modeling, School of Public Health, Fudan University, Shanghai, China
- * E-mail:
| | - Genming Zhao
- Department of Epidemiology and Biostatistics, School of Public Health, Fudan University, Shanghai, China
- Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| |
Collapse
|
94
|
Liu D, Leung K, Jit M, Yu H, Yang J, Liao Q, Liu F, Zheng Y, Wu JT. Cost-effectiveness of bivalent versus monovalent vaccines against hand, foot and mouth disease. Clin Microbiol Infect 2020; 26:373-380. [PMID: 31279839 PMCID: PMC6942242 DOI: 10.1016/j.cmi.2019.06.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Revised: 06/20/2019] [Accepted: 06/22/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Enterovirus 71 (EV71) and coxsackievirus A16 (CA16) were responsible for 43.3% (235 123/543 243) and 24.8% (134 607/543 243) of all laboratory-confirmed hand, foot and mouth disease (HFMD) cases during 2010-2015 in China. Three monovalent EV71 vaccines have been licensed in China while bivalent EV71/CA16 vaccines are under development. A comparative cost-effectiveness analysis of bivalent EV71/CA16 versus monovalent EV71 vaccination would be useful for informing the additional value of bivalent HFMD vaccines in China. METHODS We used a static model parameterized with the national HFMD surveillance data during 2010-2013, virological HFMD surveillance records from all 31 provinces in mainland China during 2010-2013 and caregiver survey data of costs and health quality of life during 2012-2013. We estimated the threshold vaccine cost (TVC), defined as the maximum additional cost that could be paid for a cost-effective bivalent EV71/CA16 vaccine over a monovalent EV71 vaccine, as the outcome. The base case analysis was performed from a societal perspective. Several sensitivity analyses were conducted by varying assumptions governing HFMD risk, costs, discounting and vaccine efficacy. RESULTS In the base case, choosing the bivalent EV71/CA16 over monovalent EV71 vaccination would be cost-effective only if the additional cost of the bivalent EV71/CA16 compared with the monovalent EV71 vaccine is less than €4.7 (95% CI 4.2-5.2). Compared with the TVC in the base case, TVC increased by up to €8.9 if all the test-negative cases were CA16-HFMD; decreased by €1.1 with an annual discount rate of 6% and exclusion of the productivity loss; and increased by €0.14 and €0.3 with every 1% increase in bivalent vaccine efficacy against CA16-HFMD and differential vaccine efficacy against EV71-HFMD, respectively. CONCLUSIONS Bivalent EV71/CA16 vaccines can be cost-effective compared with monovalent EV71 vaccines, if suitably priced. Our study provides further evidence for determining the optimal use of HFMD vaccines in routine paediatric vaccination programme in China.
Collapse
Affiliation(s)
- D Liu
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - K Leung
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China
| | - M Jit
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China; Modelling and Economics Unit, Public Health England, London, UK; Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
| | - H Yu
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - J Yang
- School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China
| | - Q Liao
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - F Liu
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - Y Zheng
- Key Laboratory of Surveillance and Early-warning on Infectious Disease, Division of Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing, China
| | - J T Wu
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong SAR, China.
| |
Collapse
|
95
|
Dang H, Li J, Liu C, Xu F. Chromogranin A provides additional prognostic information in children with severe hand, foot, and mouth disease: A prospective observational study. Int J Infect Dis 2020; 93:367-374. [PMID: 32109626 DOI: 10.1016/j.ijid.2020.02.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 02/15/2020] [Accepted: 02/19/2020] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE Severe hand, foot, and mouth disease (HFMD) is associated with high mortality in children, and persistent sympathetic activation is a common presentation. The aim of this study was to prospectively investigate serum chromogranin A (CHGA) levels and their prognostic role in this condition. METHODS Serum CHGA, creatine kinase myocardial band (CK-MB), serum D-dimer, norepinephrine, blood glucose, lactate, and C-reactive protein levels, white blood cell (WBC) counts, usage of vasopressors, pediatric risk of mortality Ⅲ (PRISM-Ⅲ) scores, and viral etiology were measured upon pediatric intensive care unit (PICU) admission. The correlation between clinical outcomes and the indicators listed above were analyzed, and the ability of CHGA as a biomarker to predict mortality was evaluated. RESULTS Serum CHGA levels were higher in the non-survivors group than in the survivors group (median (interquartile range): 434.8 (374.3-502.4) vs 183.3 (131.9-246.9) μg/l; p < 0.001) and were correlated with norepinephrine (r = 0.37. p < 0.001), blood glucose (r = 0.32, p = 0.001), lactate (r = 0.25, p = 0.009), WBC (r = 0.20, p = 0.039), and PRISM-Ⅲ scores (r = 0.748, p < 0.0001). Patients suffering neurogenic pulmonary edema, those infected with enterovirus A71, and those requiring more vasopressors had higher serum CHGA levels (median (interquartile range): 385 (239.9-488.8) vs 161 (115.6-222.9), 340.6 (190.6-436.0) vs 150.5 (112.1-210.0), 395.6 (209.1-487.0) vs 167.7 (110.5-240.5) μg/l, respectively; p < 0.0001). The CHGA level upon PICU admission in severe HFMD could be an independent risk factor for mortality (adjusted odds ratio 2.459, 95% confidence interval 1.054-5.906, p = 0.038) with high specificity (87.5%) and sensitivity (82.6%) (cut-off value at 339.6 μg/l). CONCLUSIONS The CHGA level in severe HFMD was found to be associated with cardiopulmonary failure. If measured upon PICU admission, CHGA may provide additional prognostic information in this disease.
Collapse
Affiliation(s)
- Hongxing Dang
- Department of PICU, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, 136 Zhongshan No. 2 Road, Yu Zhong District, Chongqing 400014, China; National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, 136 Zhongshan No. 2 Road, Yu Zhong District, Chongqing 400014, China; Chongqing Key Laboratory of Child Infection and Immunity, 136 Zhongshan No. 2 Road, Yu Zhong District, Chongqing 400014, China
| | - Jing Li
- Department of PICU, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, 136 Zhongshan No. 2 Road, Yu Zhong District, Chongqing 400014, China; National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, 136 Zhongshan No. 2 Road, Yu Zhong District, Chongqing 400014, China; Chongqing Key Laboratory of Child Infection and Immunity, 136 Zhongshan No. 2 Road, Yu Zhong District, Chongqing 400014, China
| | - Chengjun Liu
- Department of PICU, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, 136 Zhongshan No. 2 Road, Yu Zhong District, Chongqing 400014, China; National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, 136 Zhongshan No. 2 Road, Yu Zhong District, Chongqing 400014, China; Chongqing Key Laboratory of Child Infection and Immunity, 136 Zhongshan No. 2 Road, Yu Zhong District, Chongqing 400014, China
| | - Feng Xu
- Department of PICU, Ministry of Education Key Laboratory of Child Development and Disorders, Children's Hospital of Chongqing Medical University, 136 Zhongshan No. 2 Road, Yu Zhong District, Chongqing 400014, China; National Clinical Research Center for Child Health and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, 136 Zhongshan No. 2 Road, Yu Zhong District, Chongqing 400014, China; Chongqing Key Laboratory of Child Infection and Immunity, 136 Zhongshan No. 2 Road, Yu Zhong District, Chongqing 400014, China.
| |
Collapse
|
96
|
Zhang Z, Liang Z, Zeng J, Zhang J, He P, Su J, Zeng Y, Fan R, Zhao D, Ma W, Zeng G, Zhang Q, Zheng H. Immunogenicity and Safety of an Inactivated Enterovirus 71 Vaccine Administered Simultaneously With Hepatitis B Vaccine and Group A Meningococcal Polysaccharide Vaccine: A Phase 4, Open-Label, Single-Center, Randomized, Noninferiority Trial. J Infect Dis 2020; 220:392-399. [PMID: 30891604 DOI: 10.1093/infdis/jiz129] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 03/19/2019] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND This study tested the hypothesis that the immunogenicity and safety of the simultaneous administration of enterovirus 71 (EV71) vaccine (dose 1) with recombinant hepatitis B vaccine (HepB) on day 1 and EV71 vaccine (dose 2) with group A meningococcal polysaccharide vaccine (MenA) on day 30 is not inferior to separate administration of each vaccine. METHODS The study was designed as a randomized, open-label, noninferiority trial. A total of 775 healthy infants aged 6 months were randomly assigned in a ratio of 1:1:1 to receive simultaneous administration of EV71 vaccine (dose 1) and HepB on day 1 and EV71 vaccine (dose 2) and MenA on day 30 (the SI group); administration of doses 1 and 2 of EV71 vaccine on days 1 and 30, respectively (the SE1 group); or administration of HepB and MenA on days 1 and 30, respectively (the SE2 group). RESULTS According to the per protocol set, antibody responses against EV71, hepatitis B virus (HBV), and group A meningococcal polysaccharide were similar regardless of administration schedule. With the non-inferiority margin setting at 10%, the seroconversion rates of the three pathogens in the SI group (100% [98.25, 100], 44.84% [38.20, 51.63] and 27.83% [21.91, 34.38]) were not inferior to those in SE1 or SE2 group (100% [98.31, 100], 44.35% [37.82, 51.02] and 29.17% [23.20, 35.72], respectively). Frequencies of adverse reactions to each vaccination regimen were comparable (60.62% in the SI group vs 52.33% in the SE1 group and 56.98% in the SE2 group; P = .16). CONCLUSIONS Simultaneous administration of combined EV71 vaccine with HepB and MenA has noninferior immunogenicity and safety, compared with separate administration of these vaccines. CLINICAL TRIALS REGISTRATION NCT03274102.
Collapse
Affiliation(s)
- Zewu Zhang
- Center for Disease Control and Prevention of Dongguan City, Dongguan
| | | | | | - Jikai Zhang
- Guangdong Province Institute of Biological Products and Materia Medica
| | - Peng He
- National Institutes for Food and Drug Control
| | - Jiali Su
- Guangdong Province Institute of Biological Products and Materia Medica
| | - Yaoming Zeng
- Center for Disease Control and Prevention of Dongguan City, Dongguan
| | - Renfeng Fan
- Guangdong Province Institute of Biological Products and Materia Medica
| | - Dan Zhao
- National Institutes for Food and Drug Control
| | - Wenjun Ma
- Guangdong Provincial Institute of Public Health
| | | | - Qiaoli Zhang
- Center for Disease Control and Prevention of Dongguan City, Dongguan
| | - Huizhen Zheng
- Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China
| |
Collapse
|
97
|
Xu Q, Cao Q, Yang W, Liu X, Liu H, Tian X, Li J, Fang X, Jia N, Zeng G, Xu A. Interchangeability of two Enterovirus 71 inactivated vaccines in Chinese children: A phase IV, open-label, and randomized controlled trial. Vaccine 2020; 38:2671-2677. [PMID: 32067817 DOI: 10.1016/j.vaccine.2020.02.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 01/11/2020] [Accepted: 02/05/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND In China, three inactivated Enterovirus 71 (EV71) vaccines have been approved. Although the vaccines in an immunization series should be from a single manufacture, children sometimes have to receive EV71 vaccines from more than one manufacturers. The aim of this study was to evaluate the interchangeability and safety of vaccination with EV71 vaccines from two manufacturers among Chinese children. METHODS We conducted an open label and randomized controlled study among children aged 6-35 months from November 2018 to January 2019. The participants were randomly assigned (1:1:1:1) to receive EV71 vaccines in one of the four different schedules (two using a single vaccine for all doses from one manufacture, and two mixed schedules using vaccines from two manufactures). Blood samples were collected pre-vaccination (Day 0) and one month after the second dose (Day 60) for neutralizing antibody assay. Immunogenicity was assessed in the per-protocol cohort and safety was assessed in the total vaccinated cohort. RESULTS A total of 300 children were enrolled and randomized, of whom 89.0% (267/300) were included in the per-protocol cohort for immunogenicity analysis. The seroconversion rates of the EV71 neutralizing antibody in four groups ranged from 98.4% to 100.0%, and were not significantly different among the groups. Compared with other groups, geometric mean titer was higher in group D, in which the participants received Institute of Medical Biology Chinese Academy of Medical Sciences (CAMS) vaccine in the first dose and the Sinovac vaccine in the second dose. Safety profiles were similar among the four groups and no serious adverse events related to the vaccination were reported. CONCLUSIONS Interchangeability of EV71 vaccines from two manufactures to complete an immunization series showed good immunogenicity and safety. The antibody response levels may vary by vaccination sequences of EV71 vaccines from the two manufacturers. TRIAL REGISTRATION ClinicalTrials.govNCT03873740.
Collapse
Affiliation(s)
- Qing Xu
- Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China; Academy of Preventive Medicine, Shandong University, Jinan, China
| | - Qingfan Cao
- Rushan City Center for Disease Control and Prevention, Rushan, Shandong, China
| | - Wanqi Yang
- Sinovac Biotech Co., Ltd., Beijing, China
| | - Xiaodong Liu
- Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China
| | - Haidong Liu
- Rushan City Center for Disease Control and Prevention, Rushan, Shandong, China
| | | | - Jing Li
- Sinovac Biotech Co., Ltd., Beijing, China
| | - Xueqiang Fang
- Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China
| | | | - Gang Zeng
- Sinovac Biotech Co., Ltd., Beijing, China.
| | - Aiqaing Xu
- Shandong Provincial Key Laboratory of Infectious Disease Control and Prevention, Shandong Center for Disease Control and Prevention, Jinan, China; Academy of Preventive Medicine, Shandong University, Jinan, China.
| |
Collapse
|
98
|
Li XN, Shen XX, Li MH, Qi JJ, Wang RH, Duan QX, Zhang RQ, Fan T, Bai XD, Fan GH, Xie Y, Ma XJ. Applicability of duplex real time and lateral flow strip reverse-transcription recombinase aided amplification assays for the detection of Enterovirus 71 and Coxsackievirus A16. Virol J 2019; 16:166. [PMID: 31888694 PMCID: PMC6937715 DOI: 10.1186/s12985-019-1264-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 12/02/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Enterovirus 71 (EV71) and coxsackievirus A16 (CA16) are the two main etiological agents of Hand, Foot and Mouth Disease (HFMD). Simple and rapid detection of EV71 and CA16 is critical in resource-limited settings. METHODS Duplex real time reverse-transcription recombinase aided amplification (RT-RAA) assays incorporating competitive internal amplification controls (IAC) and visible RT-RAA assays combined with lateral flow strip (LFS) for detection of EV71 and CA16 were developed respectively. Duplex real time RT-RAA assays were performed at 42 °C within 30 min using a portable real-time fluorescence detector, while LFS RT-RAA assays were performed at 42 °C within 30 min in an incubator. Recombinant plasmids containing conserved VP1 genes were used to analyze the sensitivities of these two methods. A total of 445 clinical specimens from patients who were suspected of being infected with HFMD were used to evaluate the performance of the assays. RESULTS The limit of detection (LoD) of the duplex real time RT-RAA for EV71 and CA16 was 47 copies and 38 copies per reaction, respectively. The LoD of the LFS RT-RAA for EV71 and CA16 were both 91 copies per reaction. There was no cross reactivity with other enteroviruses. Compared to reverse transcription-quantitative PCR (RT-qPCR), the clinical diagnostic sensitivities of the duplex real time RT-RAA assay were 92.3% for EV71 and 99.0% for CA16, and the clinical diagnostic specificities were 99.7 and 100%, respectively. The clinical diagnostic sensitivities of the LFS RT-RAA assay were 90.1% for EV71 and 94.9% for CA16, and the clinical diagnostic specificities were 99.7 and 100%, respectively. CONCLUSIONS The developed duplex real time RT-RAA and LFS RT-RAA assays for detection of EV71 and CA16 are potentially suitable in primary clinical settings.
Collapse
Affiliation(s)
- Xin-Na Li
- NHC Key Laboratory of Medical Virology and Viral Diseases, Chinese Center for Disease Control and Prevention, National Institute for Viral Disease Control and Prevention, No.155 Changbai Road, Changping district, Beijing, 102206, China
| | - Xin-Xin Shen
- NHC Key Laboratory of Medical Virology and Viral Diseases, Chinese Center for Disease Control and Prevention, National Institute for Viral Disease Control and Prevention, No.155 Changbai Road, Changping district, Beijing, 102206, China
| | - Ming-Hui Li
- Department of hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Jing Shun Dong Jie 8#, Beijing, 100015, China
| | - Ju-Ju Qi
- NHC Key Laboratory of Medical Virology and Viral Diseases, Chinese Center for Disease Control and Prevention, National Institute for Viral Disease Control and Prevention, No.155 Changbai Road, Changping district, Beijing, 102206, China
| | - Rui-Huan Wang
- NHC Key Laboratory of Medical Virology and Viral Diseases, Chinese Center for Disease Control and Prevention, National Institute for Viral Disease Control and Prevention, No.155 Changbai Road, Changping district, Beijing, 102206, China
| | - Qing-Xia Duan
- NHC Key Laboratory of Medical Virology and Viral Diseases, Chinese Center for Disease Control and Prevention, National Institute for Viral Disease Control and Prevention, No.155 Changbai Road, Changping district, Beijing, 102206, China
| | - Rui-Qing Zhang
- NHC Key Laboratory of Medical Virology and Viral Diseases, Chinese Center for Disease Control and Prevention, National Institute for Viral Disease Control and Prevention, No.155 Changbai Road, Changping district, Beijing, 102206, China
| | - Tao Fan
- NHC Key Laboratory of Medical Virology and Viral Diseases, Chinese Center for Disease Control and Prevention, National Institute for Viral Disease Control and Prevention, No.155 Changbai Road, Changping district, Beijing, 102206, China
| | - Xue-Ding Bai
- NHC Key Laboratory of Medical Virology and Viral Diseases, Chinese Center for Disease Control and Prevention, National Institute for Viral Disease Control and Prevention, No.155 Changbai Road, Changping district, Beijing, 102206, China
| | - Guo-Hao Fan
- NHC Key Laboratory of Medical Virology and Viral Diseases, Chinese Center for Disease Control and Prevention, National Institute for Viral Disease Control and Prevention, No.155 Changbai Road, Changping district, Beijing, 102206, China
| | - Yao Xie
- Department of hepatology Division 2, Beijing Ditan Hospital, Capital Medical University, Jing Shun Dong Jie 8#, Beijing, 100015, China.
| | - Xue-Jun Ma
- NHC Key Laboratory of Medical Virology and Viral Diseases, Chinese Center for Disease Control and Prevention, National Institute for Viral Disease Control and Prevention, No.155 Changbai Road, Changping district, Beijing, 102206, China.
| |
Collapse
|
99
|
Li J, Zhang X, Wang L, Xu C, Xiao G, Wang R, Zheng F, Wang F. Spatial-temporal heterogeneity of hand, foot and mouth disease and impact of meteorological factors in arid/ semi-arid regions: a case study in Ningxia, China. BMC Public Health 2019; 19:1482. [PMID: 31703659 PMCID: PMC6839228 DOI: 10.1186/s12889-019-7758-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 10/02/2019] [Indexed: 01/08/2023] Open
Abstract
Background The incidence of hand, foot and mouth disease (HFMD) varies over space and time and this variability is related to climate and social-economic factors. Majority of studies on HFMD were carried out in humid regions while few have focused on the disease in arid/semi-arid regions, more research in such climates would potentially make the mechanism of HFMD transmission clearer under different climate conditions. Methods In this paper, we explore spatial-temporal distribution of HFMD in Ningxia province, which has an arid/semi-arid climate in northwest China. We first employed a Bayesian space-time hierarchy model (BSTHM) to assess the spatial-temporal heterogeneity of the HFMD cases and its relationship with meteorological factors in Ningxia from 2009 to 2013, then used a novel spatial statistical software package GeoDetector to test the spatial-temporal heterogeneity of HFMD risk. Results The results showed that the spatial relative risks in northern part of Ningxia were higher than those in the south. The highest temporal risk of HFMD incidence was in fall season, with a secondary peak in spring. Meteorological factors, such as average temperature, relative humidity, and wind speed played significant roles in the spatial-temporal distribution of HFMD risk. Conclusions The study provide valuable information on HFMD distribution in arid/semi-arid areas in northwest China and facilitate understanding of the concentration of HFMD.
Collapse
Affiliation(s)
- Jie Li
- Department of Resources and Environment, Ningxia University, Yinchuan, 750021, China.,Ningxia (China-Arab) Key Laboratory of Resource Assessment and Environmental Regulation in Arid Region, Ningxia University, Yinchuan, 750021, China
| | - Xiangxue Zhang
- Faculty of Geographical Science, Beijing Normal University, Beijing, 100875, China.,State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, 11A, Datun Road, Beijing, 100101, China
| | - Li Wang
- College of Environment and Planning, Henan University, KaiFeng, 475001, China.,Key Laboratory of Geospatial Technology for the Middle and Lower Yellow River Regions (Henan University), Ministry of Education, Kai Feng, 475001, China
| | - Chengdong Xu
- State Key Laboratory of Resources and Environmental Information System, Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, 11A, Datun Road, Beijing, 100101, China.
| | - Gexin Xiao
- China National Center for Food Safety Risk Assessment, Beijing, 100022, China.
| | - Ran Wang
- Department of Resources and Environment, Ningxia University, Yinchuan, 750021, China
| | - Fang Zheng
- Department of Resources and Environment, Ningxia University, Yinchuan, 750021, China.,Ningxia (China-Arab) Key Laboratory of Resource Assessment and Environmental Regulation in Arid Region, Ningxia University, Yinchuan, 750021, China
| | - Fang Wang
- Department of Resources and Environment, Ningxia University, Yinchuan, 750021, China.,Ningxia (China-Arab) Key Laboratory of Resource Assessment and Environmental Regulation in Arid Region, Ningxia University, Yinchuan, 750021, China
| |
Collapse
|
100
|
Gonzalez G, Carr MJ, Kobayashi M, Hanaoka N, Fujimoto T. Enterovirus-Associated Hand-Foot and Mouth Disease and Neurological Complications in Japan and the Rest of the World. Int J Mol Sci 2019; 20:ijms20205201. [PMID: 31635198 PMCID: PMC6834195 DOI: 10.3390/ijms20205201] [Citation(s) in RCA: 82] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/17/2019] [Accepted: 10/18/2019] [Indexed: 12/12/2022] Open
Abstract
Enteroviruses (EVs) are responsible for extremely large-scale, periodic epidemics in pediatric cohorts, particularly in East and Southeast Asia. Clinical presentation includes a diverse disease spectrum, including hand-foot and mouth disease (HFMD), aseptic meningitis, encephalitis, acute flaccid paralysis, and acute flaccid myelitis. HFMD is predominantly attributable to EV-A types, including the major pathogen EV-A71, and coxsackieviruses, particularly CV-A6, CV-A16, and CV-A10. There have been multiple EV-A71 outbreaks associated with a profound burden of neurological disease and fatal outcomes in Asia since the early 1980s. Efficacious vaccines against EV-A71 have been developed in China but widespread pediatric vaccination programs have not been introduced in other countries. Encephalitis, as a consequence of complications arising from HFMD infection, leads to damage to the thalamus and medulla oblongata. Studies in Vietnam suggest that myoclonus is a significant indicator of central nervous system (CNS) complications in EV-A71-associated HFMD cases. Rapid response in HFMD cases in children is imperative to prevent the progression to a CNS infection; however, prophylactic and therapeutic agents have not been well established internationally, therefore surveillance and functional studies including development of antivirals and multivalent vaccines is critically important to reduce disease burden in pediatric populations.
Collapse
Affiliation(s)
- Gabriel Gonzalez
- Division of Bioinformatics, Research Center for Zoonosis Control, Hokkaido University, Sapporo 001-0020, Japan.
- National Advanced Computing Collaboratory, National Center for High Technology, San Jose 1174-1200, Costa Rica.
| | - Michael J Carr
- National Virus Reference Laboratory, School of Medicine, University College Dublin, D04 V1W8 Dublin, Ireland.
- Global Station for Zoonosis Control, Global Institution for Collaborative Research and Education (GI-CoRE), Hokkaido University, Sapporo 001-0020, Japan.
| | | | - Nozomu Hanaoka
- Division 4, Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan.
| | - Tsuguto Fujimoto
- Division 4, Infectious Disease Surveillance Center, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan.
| |
Collapse
|