Abstract
An increase in the incidence of hand, foot and mouth disease (HFMD) cases has been observed in the Hunan province of mainland China since 2009 with a particularly higher level of severe cases in 2010–2012. Intestinal viruses of the picornaviridae family are responsible for the human syndrome associated with HFMD with enterovirus 71 (EV71) and Coxsackievirus A16 (Cox A16) being the most common causative strains. HFMD cases associated with EV71 are generally more severe with an increased association of morbidity and mortality. In this study, the etiology surveillance data of HFMD cases in Hunan province from March 2010 to October 2012 were analyzed to determine if there is a statistically relevant linear correlation exists between the detection rate of EV71 in mild cases and the proportion of severe cases among all HFMD patients. As the cases progressed from mild to severe to fatal, the likelihood of EV71 detection increased (25.78%, 52.20% and 84.18%, respectively). For all cases in the timeframe evaluated in this study, the presence of virus was detected in 63.21% of cases; among cases showing positivity for virus, EV71 infection accounted for 50.14%. These results provide evidence to support the observed higher morbidity and mortality associated with this outbreak and emphasizes the importance of early detection in order to implement necessary prevention measures to mitigate disease progression.
Highlights
Comparisons of the rates for viral positivity were performed by the chi-squared (x2) test and the trends in the Statistical correlation of Enterovirus 71 (EV71) detection and case severity The viral detection rate of EV71 was subjected to stratification analysis according to case severity in order to determine if identification of EV71 is dependent up on case
The positive detection rate of EV71 was found to increase in conjunction with an increase in disease severity of HFMD cases (25.78% in mild cases, 52.20% in severe cases, and 84.18% in fatal cases)
[12] In the current study, we found that the detection rate of EV71 positivity was remarkably higher than that of other intestinal viruses among the severe cases
Summary
Foot and mouth disease (HFMD) is a moderately contagious viral illness that commonly affects infants and children; its initial symptomology is characterized by fever, reduced appetite and sore throat and mouth, which is followed by a skin rash with flat red spots that develops on the palms of the hands and soles of the feet. [1] Outbreaks of HFMD are the result of many factors, including multiple infection sources, complex and various transmission styles, susceptible populations, and a lack of an effective vaccine. [2] Currently, most reports regarding HFMD outbreaks have concentrated on the characteristics associated with a particular epidemic and potential individual risk factors for increased severity of disease. [3,4,5] The number of studies that has focused on mitigation of early disease to prevent the development of severe and/or fatal cases is limited.Enterovirus 71 (EV71) and Coxsackievirus A16 (Cox A16) are considered to be the predominant pathogens responsible for the reported epidemics of HFMD. [6,7] EV71 belongs to the genus Enterovirus in the Picornaviridae family and was first successfully isolated in 1969; since this virus has been found to be associated with higher virulence and potential for neurological disease. [8] [9] Previous studies have directly linked EV71 to the development of severe cases of HFMD, which often result in death. [8] [9] In this study, the etiological surveillance data of HFMD, gathered in the Hunan province from March 2010 through October 2012, were analyzed to determine if a correlation exists between the detection rate of EV71 in mild cases and the proportion of severe cases among all HFMD patients. [1] Outbreaks of HFMD are the result of many factors, including multiple infection sources, complex and various transmission styles, susceptible populations, and a lack of an effective vaccine. [2] Currently, most reports regarding HFMD outbreaks have concentrated on the characteristics associated with a particular epidemic and potential individual risk factors for increased severity of disease. [3,4,5] The number of studies that has focused on mitigation of early disease to prevent the development of severe and/or fatal cases is limited. Enterovirus 71 (EV71) and Coxsackievirus A16 (Cox A16) are considered to be the predominant pathogens responsible for the reported epidemics of HFMD. [8] [9] Previous studies have directly linked EV71 to the development of severe cases of HFMD, which often result in death.
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