Abstract
Recent outbreaks of human enterovirus 71 (EV71) infection and EV71-associated hand, foot, and mouth disease (HFMD) in China have affected millions and potentially lead to life-threatening complications in newborns. Furthermore, these outbreaks represent a significant global public health issue in the world. Understanding the epidemiology of HFMD and EV71 infection and their transmission patterns in China is essential for controlling outbreaks. However, no studies on the outbreaks of HFMD and EV71 infection in China during 2010 have been reported. In this report, we carried out an epidemiological analysis to study an outbreak of HFMD and EV71 infection in 2010 in the city of Nanchang in the Jiangxi province of People's Republic of China. From April 7 to May 11, 2010, a total of 109 HFMD cases were reported, and in this report the HFMD cases were studied by both epidemiological and laboratory analyses. The epidemiological study indicates that children aged younger than 8 years old represented more than 90% of the reported cases, with the age group of 1–3 years containing the highest number of cases. Laboratory studies detected a high prevalence of EV71 amongst the cases in our study, suggesting EV71 as a common enterovirus found in HFMD cases in Nanchang. Phylogenetic analysis of the sequence of the VP1 region of four EV71 isolates indicated that the Nanchang strains belong to the C4 subgenotype commonly found in China during outbreaks in 2008 but contain distinct variations from these strains. Our study for the first time characterizes the epidemiology of HFMD and EV71 infection in China in 2010 and furthermore, provides the first direct evidence of the genotype of EV71 circulating in Nanchang, China. Our study should facilitate the development of public health measures for the control and prevention of HFMD and EV71 infection in at-risk individuals in China.
Highlights
Hand, foot, and mouth disease (HFMD), a common illness in children aged,10 years, is generally a benign febrile exanthematous disease but may cause potential life-threatening neurological and systemic manifestations such as encephalitis [1]
We carried out laboratory procedures, including conventional reverse transcription-PCR (RT-PCR) and quantitative RT-PCR, to analyze the samples for the presence of the sequences of human enteroviruses, including enterovirus 71 (EV71) and coxsackievirus A16 (CA16), which are among the most common causes of HFMD
All the EV sequence (EVU)-positive samples (70 cases) were found to contain either the EV71 (63 cases or 90%) or CA16 sequence (19 cases or 27.1%) (Table S1). These results indicate that all HFMD cases in Nanchang were either infected with EV71 or CA16, and suggest that HFMD in Nanchang is more likely to be associated with EV71 infection than with CA16 infection
Summary
Foot, and mouth disease (HFMD), a common illness in children aged ,10 years, is generally a benign febrile exanthematous disease but may cause potential life-threatening neurological and systemic manifestations such as encephalitis [1]. Clinical features of HFMD caused by these viruses are indistinguishable. Uncomplicated HFMD usually resolves in 5–6 days; those caused by EV71 are more likely to be severe and carry a higher risk of developing neurological and cardiopulmonary complications and death [4,5]. As a complication of systemic EV71 infection, acute cardiopulmonary failure such as pulmonary oedema has a high mortality rate [3,6].
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