The Population-Based Health Effect of Hand, Foot and Mouth Disease in Children in Shanghai

Xu, Zhiyin; Shen, Huigang; Wang, Zhong Lin; Altmeyer, Ralf; Xia, Ai; Mao, Shenghua; Zhen, Yaxu; Li, Weixi; Zhao, Yongqiang; Su, Hualin; Zhan, Longwen; Wang, Xiaohong; Pān, Hào; Hu, Jiayu; Zeng, Mei

doi:10.1097/inf.0000000000000136

Cited by 14 publications

(14 citation statements)

References 16 publications

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“…50 Indeed, children aged below two years were often found to be at a higher risk of developing severe complications. 51, 52, 53 We did not observe any difference in median age between the three clinical groups in the present study. The association of other factors with poor outcomes will be assessed in another article.…”

Section: Discussioncontrasting

confidence: 65%

Molecular epidemiology of human enterovirus 71 at the origin of an epidemic of fatal hand, foot and mouth disease cases in Cambodia

Duong

Mey

Éloit

et al. 2016

Emerging Microbes & Infections

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Human enterovirus 71 (EV-A71) causes hand, foot and mouth disease (HFMD). EV-A71 circulates in many countries and has caused large epidemics, especially in the Asia-Pacific region, since 1997. In April 2012, an undiagnosed fatal disease with neurological involvement and respiratory distress occurred in young children admitted to the Kantha Bopha Children's Hospital in Phnom Penh, Cambodia. Most died within a day of hospital admission, causing public panic and international concern. In this study, we describe the enterovirus (EV) genotypes that were isolated during the outbreak in 2012 and the following year. From June 2012 to November 2013, 312 specimens were collected from hospitalized and ambulatory patients and tested by generic EV and specific EV-A71 reverse transcription PCR. EV-A71 was detected in 208 clinical specimens while other EVs were found in 32 patients. The VP1 gene and/or the complete genome were generated. Our phylogenetic sequencing analysis demonstrated that 80 EV-A71 strains belonged to the C4a subgenotype and 3 EV-A71 strains belonged to the B5 genotype. Furthermore, some lineages of EV-A71 were found to have appeared in Cambodia following separate introductions from neighboring countries. Nineteen EV A (CV-A6 and CV-A16), 9 EV B (EV-B83, CV-B3, CV-B2, CV-A9, E-31, E-2 and EV-B80) and 4 EV C (EV-C116, EV-C96, CV-A20 and Vaccine-related PV-3) strains were also detected. We found no molecular markers of disease severity. We report here that EV-A71 genotype C4 was the main etiological agent of a large outbreak of HFMD and particularly of severe forms associated with central nervous system infections. The role played by other EVs in the epidemic could not be clearly established.

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Section: Discussioncontrasting

confidence: 65%

Molecular epidemiology of human enterovirus 71 at the origin of an epidemic of fatal hand, foot and mouth disease cases in Cambodia

Duong

Mey

Éloit

et al. 2016

Emerging Microbes & Infections

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“…Combined with our previous surveillance data, [22, 23] we reason that the principal strategy of controlling the HFMD outbreak in Shanghai is to prevent the EV71 circulation in children through mass EV71 vaccination. In line with previous studies, we also found that persistent fever >3 days, vomiting, startle, and myoclonus can be used as the warning signs for predicting the severe HFMD cases [8, 24].…”

Section: Discussionmentioning

confidence: 84%

Enterovirus 71 infection in children with hand, foot, and mouth disease in Shanghai, China: epidemiology, clinical feature and diagnosis

Wang

Zou

Xia

et al. 2015

Virol J

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BackgroundIn 2012 a large outbreak of hand, foot, and mouth disease (HFMD) widely spread over China, causing more than 2 million cases and 567 deaths. Our purpose was to characterize the major pathogens responsible for the 2012 HFMD outbreak and analyze the genetic characterization of the enterovirus 71 (EV71) strains in Shanghai; also, to analyze the dynamic patterns of neutralizing antibody (NAb) against EV71 and evaluate the diagnostic value of several methods for clinical detection of EV71.MethodsClinical samples including stool, serum and CSF were collected from 396 enrolled HFMD inpatients during the peak seasons in 2012. We analyzed the molecular epidemiology, clinical feature, and diagnostic tests of EV71 infection.ResultsEV71 was responsible for 60.35 % of HFMD inpatients and 88.46 % of severe cases. The circulating EV71 strains belonged to subgenogroup C4a. The nucleotide sequences of VP1 between severe cases and uncomplicated cases shared 99.2 ~ 100 % of homology. Among 218 cases with EV71 infection, 211 (96.79 %) serum samples showed NAb positive against EV71 and NAb titer reached higher level 3 days after disease onset. Of 92 cases with EV71-associated meningitis or encephalitis, 5 (5.43 %) of 92 had EV71 RNA detected in CSF samples. The blood anti-EV71 IgM assay showed a sensitivity of 93.30 % and a specificity of 50 %.ConclusionsEV71 C4a remained the predominant subgenotype circulating in Shanghai. The severity of the EV71 infection is not associated with the virulence determinants in VP1. RT-PCR together with IgM detection can enhance the early diagnosis of severe EV71-associated HFMD.Electronic supplementary materialThe online version of this article (doi:10.1186/s12985-015-0308-2) contains supplementary material, which is available to authorized users.

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“…10 Compared with local children, migrant children had a 100% higher risk for contracting HFMD, and an 81% higher risk for developing severe disease. 29 Due to the fact that the number of migrant children is enormous in urban area which may trigger an outbreak of HFMD or even the epidemic. This may provide targeted guidance assessing climate change-related human health in urban and rural areas for policymakers and medical institutions to better allocation the limited health resources.…”

Section: Discussionmentioning

confidence: 99%

Is high relative humidity associated with childhood hand, foot, and mouth disease in rural and urban areas?

Yang

Cheng

et al. 2017

Public Health

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The Population-Based Health Effect of Hand, Foot and Mouth Disease in Children in Shanghai

Abstract: HFMD and EV71 infections have a significant health effect on Shanghai children.

Cited by 14 publications

References 16 publications

Molecular epidemiology of human enterovirus 71 at the origin of an epidemic of fatal hand, foot and mouth disease cases in Cambodia

Molecular epidemiology of human enterovirus 71 at the origin of an epidemic of fatal hand, foot and mouth disease cases in Cambodia

Enterovirus 71 infection in children with hand, foot, and mouth disease in Shanghai, China: epidemiology, clinical feature and diagnosis

Is high relative humidity associated with childhood hand, foot, and mouth disease in rural and urban areas?

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