Abstract
BackgroundEnterovirus (EV)-related hand, foot, and mouth disease/herpangina (HFMD/HA) has been prevalent in Guangdong Province, China, since 2010.MethodsClinical data for EV-related HFMD/HA inpatients admitted to the Department of Paediatrics of Zhujiang Hospital from 2010 to 2013 were retrospectively reviewed. The corresponding EV serotypes were also determined by reverse transcription-polymerase chain reaction or BLAST analysis of the sequenced partial lengths of the viral protein1/5′-untranslated region.ResultsA total of 867 eligible inpatients admitted during 2010–2013 were included in the study. Of these, the serotype of the responsible EV was successfully identified in 824 cases. The incidence of enterovirus 71 (EV71) infection amongst pediatric HFMD/HA inpatients decreased dramatically from 55.5 % in 2010 to 8.1 % in 2013, with a similar decrease recorded for coxsackievirus A16 (CVA16). However, the incidence of non-EV71/CVA16 infection increased from 30.0 % in 2010 to 83.8 % in 2013. We noted that the types of infection caused by different EV serotypes varied: EV71 was responsible for 100 % of the paralysis cases (26/26), 84.6 % of the deaths (11/13), and 84.1 % of cases with severe central nervous system involvement (SCNSI) (74/88); echovirus contributed to 16.4 % of the deaths (2/13) and 4.4 % of the SCNSI cases; and coxsackievirus accounted for only 2.2 % of the SCNSI cases (2/90). The clinical features of HFMD/HA cases varied greatly during the time period examined, with drastic changes in the hospitalization rates (45.1, 63.7, 36.4, and 19.1 % for 2010, 2011, 2012, and 21013, respectively), mortality rates (2.3, 0.9, 2.5, and 0.0 %, respectively), paralysis (5.1, 1.2, 5.4, and 0.0 %, respectively), SCNSI (16.8, 7.1, 12.7, and 2.2 %, respectively), and acute respiratory infection (21.1, 22.0, 45.9, and 59.0 %, respectively).ConclusionsThe incidences of infection caused by different EV serotypes, along with the clinical features of HFMD/HA cases, changed drastically in Guangdong Province, China, from 2010 to 2013, with the biggest changes observed in 2013. The changed constituent ratios of the different EV serotypes might therefore be responsible for the differences in the observed clinical features of HFMD/HA during this period.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1690-0) contains supplementary material, which is available to authorized users.
Highlights
Enterovirus (EV)-related hand, foot, and mouth disease/herpangina (HFMD/HA) has been prevalent in Guangdong Province, China, since 2010
Of the 926 inpatients, 867 were deemed eligible and were included in the current study (2010 (212), 2011 (314), 2012 (201), 2013 (140)), and the numbers of eligible inpatients infected with enterovirus 71 (EV71), coxsackievirus A16 (CVA16) or non-EV71/CVA16 included to illustrate the clinical features of HFMD/HA were 384, 120 and 363, respectively
The EV serotypes were successfully ascertained from 320/363 inpatients with nonEV71/CVA16 infection, of which the numbers of cases identified by partial viral protein 1 (VP1) and 5′-untranslated region (UTR) sequencing were 295 and 25, respectively
Summary
Enterovirus (EV)-related hand, foot, and mouth disease/herpangina (HFMD/HA) has been prevalent in Guangdong Province, China, since 2010. Many enterovirus (EV) serotypes, including EV71, coxsackievirus A (CVA2, 4, 5, 7, 9, 10, 16), and coxsackievirus B (1, 2, 3, 4, 5), have been reported to cause hand, foot and mouth disease/herpangina (HFMD/HA) in humans. Some serotypes are more associated with particular diseases, such as EV71, which is associated with neurogenic pulmonary edema, brainstem encephalitis, and myelitis in young children [10,11,12,13]. The constituent ratios of EV serotypes change without cessation on a global basis, and monitoring their associated changes in the constituent ratios of circulating EV serotypes and their associated diseases is essential for public health and efficient allocation of medical resources
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