Hand, foot and mouth disease and herpangina caused by enterovirus A71 infections: a review of enterovirus A71 molecular epidemiology, pathogenesis, and current vaccine development

Abstract

Enterovirus A71 (EV-A71) infections are one of the main etiological agents of hand, foot and mouth disease (HFMD) and herpangina worldwide. EV-A71 infection is a life-threatening communicable disease and there is an urgent global need for the development of vaccines for its prevention and control. The morbidity rate of EV-A71 infection differs between countries. The pathogen’s genetic lineages are undergoing rapid evolutionary changes. An association between the occurrence of EV-A71 infection and the circulation of different genetic strains of EV-A71 virus has been identified around the world. In this review, we present and discuss the molecular epidemiology and pathogenesis of the human disease caused by EV-A71 infection, as well as current prospects for the development of an EV-A71 vaccine.

A review and meta‐analysis of the epidemiology and clinical presentation of coxsackievirus A6 causing hand‐foot‐mouth disease in China and global implications

“…This may be due to the use of EV‐A71 vaccines in China, which have been shown to prevent more than 90% of HFMD and 80% of other disease symptoms caused by EV‐A71. Furthermore, the proportion of people who were immunized is increasing, as stimulated by previous large outbreaks of EV‐A71 HFMD, which also exhibited a relatively stable serotype and hence a reliably vaccine efficacy …”

“…Furthermore, the proportion of people who were immunized is increasing, as stimulated by previous large outbreaks of EV-A71 HFMD, which also exhibited a relatively stable serotype and hence a reliably vaccine efficacy. 69 Thus, in recent years, CV-A6 has gradually become the predominant EV serotype causing HFMD globally, [70][71][72][73] showing a peak incidence in every other year, and overtaking EV-A71. The incidence of CV-A6 has gradually increased from less than 5% to more than 50%.…”

The epidemiological risk factors of hand, foot, mouth disease among children in Singapore: A retrospective case-control study

“…Frequent variations in the viral genome of enteroviruses and lack of evidence on cross-protection from different strains remains a challenge in the development of effective vaccines for HFMD [40]. Inactivated monovalent EV-A71 vaccines have been approved in China with supporting studies proven that the vaccine can prevent more than 90% of EV-A71 infections and symptoms [41]. However, EV-A71 vaccination may lead to an increase in HFMD caused by other co-circulating serotypes during epidemics [40].…”

Co-circulation of coxsackieviruses A-6, A-10, and A-16 causes hand, foot, and mouth disease in Guangzhou city, China

“…Hand, foot, and mouth disease (HFMD), a common contagious disorder in children under 5 years of age, is characterised by a brief, generally mild, febrile illness with multiple oral ulcers, and eruption of vesiculo-papular rashes over the hands, feet, mouth, and buttocks [1][2][3]. Some cases can develop severe neurological and systemic complications, such as aseptic meningitis, acute flaccid paralysis, encephalitis, cardiorespiratory failure, and severe pulmonary oedema, and can even lead to death [4,5]. HFMD is mainly caused by human enteroviruses (EVs) of the family Picornaviridae.…”