Effect of enterovirus 71 vaccination on the epidemiological characteristics and etiology in hospitalized children with hand-foot-and-mouth disease: A retrospective study from a tertiary children’s hospital

Abstract

Enterovirus 71 (EV71) vaccine for hand-foot-and-mouth disease (HFMD) prevention has been available for several years. However, as a new vaccine, the impact of EV71 vaccination on the epidemiology and etiology of HFMD is currently unclear. The purpose of this study was to compare and analyze the changes of epidemiological characteristics and etiology of HFMD patients after the introduction of EV71 vaccine. The data of hospitalized children with HFMD from 2014 to 2020 were collected from the case record department of a tertiary children hospital of Anhui Province. The changes of epidemiological characteristics, time distribution, disease severity and enterovirus serotypes in hospitalized children were analyzed. A total of 7373 cases of HFMD were reported during 2014 to 2020, including 634 (8.6%) severe cases. The number of cases reached the peak in 2016 (n = 1783) and decreased gradually after EV71 vaccination. The results of etiological test showed the positive rate was 80.5%, in which EV71 accounted for 1599 (21.7%) and CV-A16 accounted for 1028 (13.9%) respectively. The number of patients showed a bimodal distribution throughout the year, which were April to June and October to November. The age distribution changed significantly following the introduction of EV71 vaccine. The proportion of 1-year-old group of post-vaccination was significantly higher than that of pre-vaccination (61.9% vs 50.8%, P < .001). The proportion of HFMD caused by EV71 and severe cases decreased significantly after the vaccination ( P < .001 for both). While the comparison of epidemiological characteristics and enterovirus serotypes between unvaccinated and vaccinated cases during 2017 to 2020 showed no significant difference. The dominant enterovirus serotypes of hospitalized HFMD changed significantly after the introduction of EV71 vaccine. The proportion of severe cases decreased significantly after the vaccination, but EV71 was still a major pathogen in patients with severe HFMD. More age-appropriate children are recommended to get vaccinated to establish stronger herd immunity in the population.

Update on nonpolio enterovirus and parechovirus infections in neonates and young infants

“…The proportion of severe cases decreased significantly after vaccination, but EV71 was still a major pathogen in patients with severe HFMD. The authors concluded that enhanced surveillance for other enteroviruses, as well as the development of a multivalent vaccine with broader protection for HFMD, is still required [57]. There are other two inactivated EV71 vaccines approved in China.…”

Exploration of the in vitro Antiviral Effects and the Active Components of Changyanning Tablets Against Enterovirus 71

“…Enterovirus 71 (EV71) is the main pathogen causing hand, foot, and mouth disease (HFMD). 1 Since 1997, HFMD has emerged as a serious childhood infection in the Asia-Pacific region. 2 From 2008 to July 2022, up to 26.1 million cases of HFMD and 3727 deaths had been reported in China.…”

“… 3 Although the main manifestations of HFMD are low-grade fever, maculopapular or papular blistering rash on the hands, feet, and mouth ulcers, 4 there were growing evidences that a large number of patients with HFMD have atypical presentations, especially those infected with the EV71, and may rapidly develop serious complications such as encephalitis, pulmonary edema, and myocarditis. 5 , 6 With the use of EV71 vaccine, 1 , 7 severe HFMD cases had significantly decreased in China. 8 However, vaccination does not completely prevent viral infection, and some children who were vaccinated may still be infected and develop complications such as encephalitis.…”

Viral meningitis and encephalitis: an update

“…EV71 has caused large epidemics in southeast Asia and has been a serious health hazard in many Asian and pacific island countries [15 ▪▪ ]. One study done in Anhui China showed that a new and improved EV71 vaccine has increased efficacy and it efficient at preventing serious illness due to hand foot and mouth disease [16 ▪ ].…”