Risk factors for severe hand foot and mouth disease

Suzuki, Yoko; Taya, Keiko; Nakashima, Kazutoshi; Ohyama, Takaaki; Kobayashi, John M.; Ohkusa, Yasushi; Okabe, Nobuhiko

doi:10.1111/j.1442-200x.2009.02937.x

Cited by 31 publications

(27 citation statements)

References 5 publications

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“…Belonging to the picornaviridae family, this virus, associated with Enterovirus 71 (EV71), is responsible for nearly all of the HFMD epidemics in Southeast Asia [13,14]. In Japan, CA16 was reported to be a prevalent type, while EV71 recurrent every 3 years [10,15]. In Singapore, from 2001 to 2008, the predominant EV strains isolated from HFMD cases were CA16 and EV71 [16,17].…”

Section: Introductionmentioning

confidence: 99%

Seroepidemiology of human enterovirus71 and coxsackievirusA16 among children in Guangdong province, China

Liu

et al. 2013

BMC Infect Dis

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BackgroundHand, foot and mouth disease (HFMD) is a common pediatric illness. Mainly induced by the Enterovirus 71 and Coxsackievirus A 16 infections, the frequently occurred HFMD outbreaks have become a serious public health problem in Southeast Asia. Currently,only a few studies have investigated the human immunity to HFMD in China. In this study, we conducted a cohort study in Guangdong province, China.MethodsStored serum samples from children less than 10 years old were analyzed. The levels of EV71 and CA16 specific antibodies before, during and shortly after the 2008 large outbreak of HFMD were evaluated by the microneutralization test. The geometric mean titer (GMT) was calculated and compared. Statistical significance was taken as P < 0.05.ResultsThe seroprevalence data showed a continuous circulation of EV71 and CA16 in Guangdong province China in 2007–2009. The low positive rate in 2009 correlated well with the unprecedented outbreak of HFMD in 2010. Age related increase of seroprevalence was identified in 1–3 years old children for EV71 and in 1–5 years old children for CA16 in Guangdong province. High GMT of EV71 and CA16 antibody titers were also found for these age groups.ConclusionsAll of the above findings indicated common infections for these age groups. And they should clearly be at the top of the priority in periodical seroprevalence survey and future vaccination campaign.

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Section: Introductionmentioning

confidence: 99%

Seroepidemiology of human enterovirus71 and coxsackievirusA16 among children in Guangdong province, China

Liu

et al. 2013

BMC Infect Dis

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“…Although previous studies have identified possible predictors associated with increased probability of severity, such as children who attend child care centres 25 , has leukocytosis 17 , has limb weakness 26 , or has persistent fever 27 , there is still much uncertainty about the relative importance of these predictors. Limited studies have systematically evaluated the criteria for early screening of severe cases and some studies have only categorized severe and mild HFMD based on the length of hospitalization rather than a clinical measure of severity 25 .…”

Section: Discussionmentioning

confidence: 99%

“…Limited studies have systematically evaluated the criteria for early screening of severe cases and some studies have only categorized severe and mild HFMD based on the length of hospitalization rather than a clinical measure of severity 25 .…”

Section: Discussionmentioning

confidence: 99%

Machine Learning Algorithms for Risk Prediction of Severe Hand-Foot-Mouth Disease in Children

Zhang

Wan

Ouyang

et al. 2017

Sci Rep

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Hand-foot-mouth disease (HFMD) is a common infectious disease caused by a group of enteroviruses, with enterovirus 71 (EV-71) and Coxsackie virus A16 (CA-V16) being the most prevalent in China 1, 2 . Over the last decade, outbreaks of HFMD that were associated with EV71 have been reported in countries in the Western Pacific Region, including Japan, Malaysia, Singapore, and China 3, 4 . The cumulative total of the reported cases in China has reached approximately 1.7 million, 1.9 million, and 2.7 million in 2010, 2013, and 2014, respectively 5, 6 . The clinical manifestations of most HFMD cases were mild and limited to fever, rash, or herpes on hand, foot, and mouth 7 . In general, mild infections are self-limited and not life-threatening, while severe HFMD are often associated with neurological and systemic complications, such as aseptic meningitis, brainstem encephalitis, acute flaccid paralysis, myocarditis and pulmonary oedema that requires hospitalization, or even causing death 2, 8 . Unfortunately, the incidence of severe HFMD in mainland China is high.Evidences from global reports on HFMD epidemics have substantiated that the incidence of severe HFMD is elevating gradually, along with mortality rate 9 . Thus, identifying potential early indicators for severe HFMD is essential, which enable early medical interventions and alleviating the disease severity, subsequently reducing the mortality rate. Previous studies have found that the following conditions or practices were associated with the increased risk of severe HFMD: a duration of fever ≥3 days, body temperature ≥37.5 °C, fatigue, the use of glucocorticoids, the use of dehydrant drugs, maculopapular rash, hyperglycemia, vomiting, EV71 infection, attending home care, neutrophilia, and young age [10][11][12][13][14][15][16][17][18] . Although specific clinical manifestations have been identified using the Magnetic Resonance Imaging (MRI), the potential indicators of the disease severity were not validated.

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“…EV71 and coxsackievirus A16 (CA16) have been identified as the two major etiological agents of hand, foot and mouth disease (HFMD) [8,9]. Large outbreaks of HFMD have recently been reported in the Asia-Pacific region, which is becoming a common acute viral disease in these areas and posing a serious health threat to children [10-13].…”

Section: Introductionmentioning

confidence: 99%

Immunization of N terminus of enterovirus 71 VP4 elicits cross-protective antibody responses

Zhao

Xiao

et al. 2013

BMC Microbiol

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BackgroundEnterovirus 71 (EV71) is major cause of hand, foot and mouth disease. Large epidemics of EV71 infection have been recently reported in the Asian-Pacific region. Currently, no vaccine is available to prevent EV71 infection.ResultsThe peptide (VP4N20) consisting of the first 20 amino acids at the N-terminal of VP4 of EV71 genotype C4 were fused to hepatitis B core (HBcAg) protein. Expression of fusion proteins in E. coli resulted in the formation of chimeric virus-like particles (VLPs). Mice immunized with the chimeric VLPs elicited anti-VP4N20 antibody response. In vitro microneutralization experiments showed that anti-chimeric VLPs sera were able to neutralize not only EV71 of genotype C4 but also EV71 of genotype A. Neonatal mice model confirmed the neutralizing ability of anti-chimeric VLPs sera. Eiptope mapping led to the identification of a “core sequence” responsible for antibody recognition within the peptide.ConclusionsImmunization of chimeric VLPs is able to elicit antibodies displaying a broad neutralizing activity against different genotypes of EV71 in vitro. The “core sequence” of EV71-VP4 is highly conserved across EV71 genotypes. The chimeric VLPs have a great potential to be a novel vaccine candidate with a broad cross-protection against different EV71 genotypes.

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Risk factors for severe hand foot and mouth disease

Abstract: It is not clear why attending child care centers was associated with HFMD severity. Further study is needed.

Cited by 31 publications

References 5 publications

Seroepidemiology of human enterovirus71 and coxsackievirusA16 among children in Guangdong province, China

Seroepidemiology of human enterovirus71 and coxsackievirusA16 among children in Guangdong province, China

Machine Learning Algorithms for Risk Prediction of Severe Hand-Foot-Mouth Disease in Children

Immunization of N terminus of enterovirus 71 VP4 elicits cross-protective antibody responses

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