Abstract
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.
Highlights
In 2012 a large outbreak of hand, foot, and mouth disease (HFMD) widely spread over China, causing more than 2 million cases and 567 deaths
Three severe cases with laboratoryconfirmed enterovirus 71 (EV71) infections were fatal with 2 female infants succumbing to cardiopulmonary failure and 1 female child (5.7 years) succumbing to central respiratory failure
Discussion multiple genotypes and subgenotype of EV71 are circulating simultaneously or alternatively in other countries and regions, [20, 21] our study revealed that EV71 remained the predominant enterovirus causing the 2012 large outbreaks of HFMD and severe central nerves system (CNS) disease in Shanghai
Summary
In 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; to analyze the dynamic patterns of neutralizing antibody (NAb) against EV71 and evaluate the diagnostic value of several methods for clinical detection of EV71. Foot, and mouth disease (HFMD) has been an emerging highly contagious disease in children in countries of the Western Pacific Region since the late nineties, posing a serious public health threat. Monitoring the genetic variations of circulating EV71 strains and the emergence of new types or recombinants of EV71 in the epidemic regions is important for vaccine development and drug discovery
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