Lidong Gao1, Gang Zou2, Qiaohong Liao3,4, Yonghong Zhou4, Fengfeng Liu3, Bingbing Dai5, Jia Liu2, Zhiyong Chen5, Weijia Xing3,6, Le Yang7, Hong Liang8, Yi Zhang9, Zhenhua Chen10, Li Luo3, Qing Li11, Kaiwei Luo1, Peng Wu12, Xiaowei Mo2, Lili Wang2,4, Ke Lan2,13, Peter W Horby14, Benjamin J Cowling12, Peter Simmonds15, Ralf Altmeyer2,16, H Rogier van Doorn15,17, Hongjie Yu3,4. 1. Hunan Provincial Center for Disease Control and Prevention, Changsha, China. 2. Institut Pasteur of Shanghai, Chinese Academy of Sciences, Beijing, China. 3. Division of Infectious Disease, Key Laboratory of Surveillance and Early Warning on Infectious Disease, Chinese Centre for Disease Control and Prevention, Beijing, China. 4. School of Public Health, Fudan University, Key Laboratory of Public Health Safety, Ministry of Education, Shanghai, China. 5. Anhua County Center for Disease Control and Prevention, Hunan Province, China. 6. School of Public Health, Taishan Medical College, Taian, Shandong Province, China. 7. Anhua People's Hospital, Hunan Province, China. 8. Anhua Hospital of Traditional Chinese Medicine, Hunan Province, China. 9. Anhua Second People's Hospital, Hunan Province, China. 10. Chengdu Center for Disease Control and Prevention, Sichuan Province, China. 11. Yiyang Center for Disease Control and Prevention, Hunan Province, China. 12. World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong Special Administrative Region. 13. State Key Laboratory of Virology, College of Life Sciences, Wuhan University, China. 14. Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, United Kingdom. 15. Nuffield Department of Medicine, University of Oxford, United Kingdom. 16. Qingdao Center for Disease Control and Prevention, China. 17. Oxford University Clinical Research Unit, Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam.
Abstract
Background: Hand, foot, and mouth disease (HFMD) represents a substantial disease burden in the Western Pacific region. We investigated the spectrum of causative enteroviruses of HFMD, and evaluated different clinical samples' diagnostic yield for enteroviruses. Methods: We enrolled pediatric patients hospitalized for HFMD among 6 hospitals in Anhua County, Hunan Province, China between October 2013 and September 2016. Throat swabs and stool samples (or rectal swabs) were collected to detect the enterovirus serotypes by real-time reverse-transcription polymerase chain reaction (PCR) or nested PCR. Results: Among the 2836 patients, only 1 developed severe illness. Seventeen serotypes were identified in 2401 patients (85%), with the most frequently detected being CV-A16 (29% [814]), CV-A6 (28% [784]), EV-A71 (17% [491]), CV-A10 (4% [114]), and CV-A4 (2% [53]). Children were younger in CV-A6, CV-A10, and CV-A4 infections (median, 12 months; interquartile range [IQR], 12-24 months) than EV-A71 and CV-A16 infections (median, 24 months; IQR, 12-36 months; P < .05). The predominant enterovirus serotype shifted between CV-A16 and CV-A6 during the 3 years. Stool had a higher diagnostic yield (89%) than rectal (77%) and throat swabs (74%). Detection rates reached 93% when testing stools followed by throat swabs if stools were negative, and 89% when testing rectal swabs followed by throat swabs if rectal swabs were negative. Conclusions: Our results provide a virological benchmark for future surveillance and diagnostics. Continuous comprehensive virological surveillance is essential, especially after implementation of the EV-A71 vaccine in China, to monitor serotype replacement and the vaccine's impact.
Background: Hand, foot, and mouth disease (HFMD) represents a substantial disease burden in the Western Pacific region. We investigated the spectrum of causative enteroviruses of HFMD, and evaluated different clinical samples' diagnostic yield for enteroviruses. Methods: We enrolled pediatric patients hospitalized for HFMD among 6 hospitals in Anhua County, Hunan Province, China between October 2013 and September 2016. Throat swabs and stool samples (or rectal swabs) were collected to detect the enterovirus serotypes by real-time reverse-transcription polymerase chain reaction (PCR) or nested PCR. Results: Among the 2836 patients, only 1 developed severe illness. Seventeen serotypes were identified in 2401 patients (85%), with the most frequently detected being CV-A16 (29% [814]), CV-A6 (28% [784]), EV-A71 (17% [491]), CV-A10 (4% [114]), and CV-A4 (2% [53]). Children were younger in CV-A6, CV-A10, and CV-A4 infections (median, 12 months; interquartile range [IQR], 12-24 months) than EV-A71 and CV-A16 infections (median, 24 months; IQR, 12-36 months; P < .05). The predominant enterovirus serotype shifted between CV-A16 and CV-A6 during the 3 years. Stool had a higher diagnostic yield (89%) than rectal (77%) and throat swabs (74%). Detection rates reached 93% when testing stools followed by throat swabs if stools were negative, and 89% when testing rectal swabs followed by throat swabs if rectal swabs were negative. Conclusions: Our results provide a virological benchmark for future surveillance and diagnostics. Continuous comprehensive virological surveillance is essential, especially after implementation of the EV-A71 vaccine in China, to monitor serotype replacement and the vaccine's impact.
Authors: Jennifer R Head; Philip A Collender; Joseph A Lewnard; Nicholas K Skaff; Ling Li; Qu Cheng; Julia M Baker; Charles Li; Dehao Chen; Alison Ohringer; Song Liang; Changhong Yang; Alan Hubbard; Benjamin Lopman; Justin V Remais Journal: Clin Infect Dis Date: 2020-12-15 Impact factor: 9.079
Authors: Yonghong Zhou; Le Van Tan; Kaiwei Luo; Qiaohong Liao; Lili Wang; Qi Qiu; Gang Zou; Ping Liu; Nguyen To Anh; Nguyen Thi Thu Hong; Min He; Xiaoman Wei; Shuanbao Yu; Tommy Tsan-Yuk Lam; Jie Cui; H Rogier van Doorn; Hongjie Yu Journal: Virol Sin Date: 2020-07-28 Impact factor: 4.327
Authors: Le Nguyen Thanh Nhan; Nguyen Thi Thu Hong; Le Nguyen Truc Nhu; Lam Anh Nguyet; Nguyen Thi Han Ny; Tran Tan Thanh; Do Duong Kim Han; Hoang Minh Tu Van; C Louise Thwaites; Tran Tinh Hien; Phan Tu Qui; Pham Van Quang; Ngo Ngoc Quang Minh; H Rogier van Doorn; Truong Huu Khanh; Nguyen Van Vinh Chau; Guy Thwaites; Nguyen Thanh Hung; Le Van Tan Journal: Euro Surveill Date: 2018-11