Epidemiology of hand, foot and mouth disease and genomic surveillance of coxsackievirus A10 circulating in Zhejiang Province, China during 2017 to 2022

Sun, Yi; Cai, Jian; Mao, Haiyan; Chen, Yin; Yan, Huan; Shi, Wen; Fang, Zhiguo; Su, Lingxuan; Wang, Xingxing; Zhou, Biaofeng; Pei, Zhichao; Cao, Yanli; Ge, Qi; Zhang, Yanjun

doi:10.1016/j.jcv.2023.105552

Cited by 4 publications

(7 citation statements)

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“…It was extremely high in 2018 and was lowest in 2021. Generally, the incidence of HFMD in Jiashan is seasonal, except in 2020 and 2022, which is consistent with other reports in China ( 12 , 17 ). HFMD epidemics were sporadic from January to March each year, and the incidence began to increase in April, with a major epidemic peak from May to August, which declined in September, followed by a small secondary peak from October to December ( Figure 1 ).…”

Section: Discussionsupporting

confidence: 90%

“…One plausible explanation for this phenomenon was that the interventions introduced in response to coronavirus disease (COVID-19) facilitated the control of HFMD. Self-quarantine, social distancing, wearing face masks and frequent hand hygiene may have indirectly reduced the incidence of HFMD and prevented the outbreaks that occurred in other years ( 12 , 19 , 20 ). Strict and wide implementation of nonspecific nonpharmaceutical interventions, which differed from the relatively relaxed policies for COVID-19 during 2021, may have affected the endemic pattern of HEVs, leading to the unusual pattern of incidence in 2020 and 2022 ( Figure 1 ).…”

Section: Discussionmentioning

confidence: 99%

“…No B1b genogroup CA16 were detected after 2017, indicating the need to strengthen molecular epidemiological surveillance. According to a previous study, HFMD had a peak incidence in Zhejiang Province in 2018 ( 12 ). Emergence of the B1a genogroup of CA16, a new genogroup in the Jiashan area, implies that lineage sorting for this serotype may be occurring in the Jiashan area.…”

Section: Discussionmentioning

confidence: 99%

“…Other sequences used in the phylogenetic trees were downloaded from GenBank and alignments were performed. The phylogenetic tree was constructed as described previously ( 12 ). The patients’ data, including sex, age, place of residence and onset of illness, were collected from the Chinese Information System for Disease Control and Prevention.…”

Section: Methodsmentioning

confidence: 99%

“…A molecular typing system based on enterovirus VP1 was established because VP1 sequences correlate well with antigenic typing and identification ( 6 , 11 ). A surveillance system for HEV was established during 2002 in Zhejiang Province ( 12 ). Therefore, both sporadic and outbreak cases of HFMD caused by HEVs had been reported in Zhejiang Province for several decades ( 13 ).…”

Section: Introductionmentioning

confidence: 99%

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Epidemiological and etiological investigations of hand, foot, and mouth disease in Jiashan, northeastern Zhejiang Province, China, during 2016 to 2022

Yuan,

Chen,

Huang

et al. 2024

Front. Public Health

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BackgroundHand, foot, and mouth disease (HFMD) is a common infectious disease in children. Enterovirus A71 (EV71) and coxsackievirus A16 (CA16) have been identified as the predominant pathogens for several decades. In recent years, coxsackievirus A6 (CA6) and coxsackievirus A10 (CA10) have played increasingly important roles in a series of HFMD outbreaks. We performed a retrospective analysis of the epidemiology of HFMD and the spectrum of different viral serotypes, to elucidate the genetic and phylogenetic characteristics of the main serotypes in the Jiashan area during 2016 to 2022.MethodsDescriptive epidemiological methods were used to analyze the time and population distribution of HFMD in Jiashan during 2016 to 2022 based on surveillance data. Molecular diagnostic methods were performed to identify the viral serotypes and etiological characteristics of HFMD. Phylogenetic analyses was based on VP1 region of CA16 and CA6.ResultsThe average annual incidence rate of HFMD fluctuated from 2016 to 2022. Children aged 1–5 years accounted for 81.65% of cases and boys were more frequently affected than girls. Except when HFMD was affected by the COVID-19 epidemic in 2020 and 2022, epidemics usually peak in June to July, followed by a small secondary peak from October to December and a decline in February. Urban areas had a high average incidence and rural areas had the lowest. Among 560 sample collected in Jiashan, 472 (84.29%) were positive for enterovirus. The most frequently identified serotypes were CA6 (296, 52.86%), CA16 (102, 18.21%), EV71 (16, 2.86%), CA10 (14, 2.50%) and other enteroviruses (44, 7.86%). There were 71 and 142 VP1 sequences from CA16 and CA6, respectively. Substitution of N218D, A220L and V251I was detected in CA16 and may have been related to viral infectivity. Phylogenetic analysis showed that CA16 could be assigned to two genogroups, B1a and B1b, while all the CA6 sequences belonged to the D3a genogroup.ConclusionCA6 and CA16 were the two major serotypes of enteroviruses circulating in the Jiashan area during 2016 to 2022. Continuous and comprehensive surveillance for HFMD is needed to better understand and evaluate the prevalence and evolution of the associated pathogens.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Epidemiological and etiological investigations of hand, foot, and mouth disease in Jiashan, northeastern Zhejiang Province, China, during 2016 to 2022

Yuan,

Chen,

Huang

et al. 2024

Front. Public Health

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Molecular Epidemiology of Human Norovirus Variants from Outbreaks in Zhejiang Province, China, during 2021

Sun,

Yuan,

Mao

et al. 2024

Advances in Virology

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Background. Noroviruses are the most frequent cause of epidemic acute viral gastroenteritis in China. Objectives. The aim of this study was to determine the molecular epidemiological characteristics of norovirus outbreaks and the molecular genetic features of norovirus in Zhejiang Province during 2021. Methods. First, the local Centers for Disease Control and Prevention in the outbreak area conducted on-site epidemiologic investigations and collected samples from ill patients for initial testing. The general epidemiologic characteristics of the demographic information are presented through descriptive analysis. Positive samples were sent to the Microbiology Laboratory of Zhejiang Provincial Center for Disease Control and Prevention for further verification. The presence of norovirus genogroups I (GI) and II (GII), along with sapovirus, was detected. Subsequently, the specimens positive for norovirus were sequenced for genotyping purposes. Furthermore, the whole genomes of positive samples were sequenced, enabling the characterization of both nucleotide and amino acid differences within the virus. Finally, phylogenetic trees were constructed to further analyze and understand the genetic relationships among the detected viruses. Result. 227 norovirus outbreaks were reported in Zhejiang Province, China, during 2021. Schools were the main setting while January was the peak month for outbreaks. A total of 17 diverse genotypes of norovirus were identified in 2021, and GII.P16-GII.2 was the most frequent genotype (30.19%). Seven genomes (five GI.P4-GI.5 and two GII.P16-GII.2) were obtained. Although GI.P4-GI.5 is considered to be a rare genotype of norovirus, the prevalence might have been underestimated. Capsid microvariation of GII.2 displayed histo-blood group antigen binding patterns compared to the GII.2 prototype, although VP1 sequences were considered to have a minimal impact on antigenicity. Conclusion. This study revealed the diversity of norovirus strains’ genotypes circulating in Zhejiang Province in 2021. Continued molecular surveillance of noroviruses should be strengthened in our further efforts to the development of vaccines.

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Genomic surveillance reveals low-level circulation of two subtypes of genogroup C coxsackievirus A10 in Nanchang, Jiangxi Province, China, 2015–2023

He,

Zhu,

et al. 2024

Front. Microbiol.

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IntroductionIn recent years, coxsackievirus (CV) A10 has been associated with increasing sporadic hand, foot, and mouth disease (HFMD) cases and outbreaks globally. In addition to mild symptoms such as pharyngitis and herpangina, CVA10-related complications or even fatality can occur. Currently, systematic phylogenetic studies of CVA10 are limited.MethodsIn this study, we first explored the epidemiological and genetic characteristics of CVA10 in Nanchang, an inland southeastern city of China, based on the HFMD surveillance network from 2015-2023.ResultsAmong 3429 enterovirus-positive cases, 110 (3.04%) were associated with CVA10, with a male-to-female ratio of 1.62. The median age of the CVA10 patients was 2.3 years (interquartile range, IQR 1.0-4.0), with 94.55% (104/110) of the patients aged less than 5 years. Phylogenetic analyses using the full-length VP1, 5’UTR, P1, P2, P3 sequences and near full-length genomes indicated that CVA10 strains (n = 57) isolated in Nanchang belonged to genogroup C; two strains identified in 2017 belonged to C1 subtypes clustered with strains from Vietnam, Madagascar, France and Spain; and the others belonged to C2 subtypes interdigitating with CVA10 isolates from mainland China, the United States and Australia. Through extensive analysis, we identified a rare F168Y mutation in epitope 4 of VP1 in a Madagascar strain of genogroup F and a Chinese strain of genogroup C. Based on Bayesian evolutionary analyses, the average nucleotide substitution rate for the VP1 gene of CV10 strains was 3.07×10–3 substitutions/site/year. The most recent common ancestor (tMRCA) of genogroup C was dated 1990.84, and the tMRCA of CVA10 strains from Nanchang was dated approximately 2003.16, similar to strains circulating in other regions of China, suggesting that the viruses were likely introduced and cryptically circulated in China before the establishment of the HFMD surveillance network. Recombination analysis indicated intertypic recombination of the Nanchang strain with the genogroup G strain in the 3D region.DiscussionGiven the shifting dominance of viral genotypes and frequent recombination events, the existing surveillance system needs to be regulated to enhance genomic surveillance efforts on a more diverse spectrum of genotypes in the future.

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Epidemiology of hand, foot and mouth disease and genomic surveillance of coxsackievirus A10 circulating in Zhejiang Province, China during 2017 to 2022

Cited by 4 publications

References 23 publications

Epidemiological and etiological investigations of hand, foot, and mouth disease in Jiashan, northeastern Zhejiang Province, China, during 2016 to 2022

Epidemiological and etiological investigations of hand, foot, and mouth disease in Jiashan, northeastern Zhejiang Province, China, during 2016 to 2022

Molecular Epidemiology of Human Norovirus Variants from Outbreaks in Zhejiang Province, China, during 2021

Genomic surveillance reveals low-level circulation of two subtypes of genogroup C coxsackievirus A10 in Nanchang, Jiangxi Province, China, 2015–2023

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