Abstract
BackgroundA rapid expansion of hand, foot, and mouth disease (HFMD) outbreaks has occurred and caused deaths in China in recent years, but little is known about the other etiologic agents except enterovirus 71 (EV71) and coxsackievirus A 16 (CA16). The objective of this study is to determine the genotype compositions of enterovirus causing HFMD in Shanghai and identify any associations between enterovirus types and clinical manifestations.MethodsStool specimens were collected from patients hospitalized for treatment of HFMD, from May 2010 to April 2011. Enterovirus was detected by reverse transcription PCR and directly genotyped by sequencing the PCR products. Phylogenetic analysis was based on the VP1 partial gene.ResultsOf 290 specimens, 277 (95.5%) tested positive for enterovirus. The major genotypes were EV71 (63.8%), CA10 (9.0%), CA6 (8.3%), CA16 (6.9%), CA12 (2.4%), and CA4 (1.4%). The EV71 strains belonged to the C4a subtype and CA16 belonged to the B subtype. CA6 was closely related to strains detected in Japan, Taiwan and China, and CA10, CA12 and CA4 were phylogenetically similar to other strains circulating in China. Mean hospital stays and the prevalence of complications in patients with EV71 infection were higher than those in patients in CA6, CA10 or CA16 infection (P < 0.05 for all comparisons). Children with CA12 infection were the youngest, and most likely have the highest risk of complications when compared to the other non-EV71 infection groups.ConclusionsThis study demonstrated a diversified pathogen compositions attributing to HFMD and clinical symptoms differing in enterovirus genotypes. It deserves our attention as early identification of enterovirus genotypes is important for diagnosis and treatment of HFMD patients.
Highlights
A rapid expansion of hand, foot, and mouth disease (HFMD) outbreaks has occurred and caused deaths in China in recent years, but little is known about the other etiologic agents except enterovirus 71 (EV71) and coxsackievirus A 16 (CA16)
The molecular epidemiology of the Shanghai EV71 strains was determined with a phylogenetic dendrogram, with the reference EV71 strains from Genbank representing all the known subgenotypes (A, B0-B5, C1-C5)
In this study, we identified a variety of enterovirus genotypes, including EV71, CA10, CA6, CA16, CA12, CA4, CA14, Echo6, and EV-C, from stool samples of patients hospitalized for HFMD in Shanghai, China
Summary
A rapid expansion of hand, foot, and mouth disease (HFMD) outbreaks has occurred and caused deaths in China in recent years, but little is known about the other etiologic agents except enterovirus 71 (EV71) and coxsackievirus A 16 (CA16). Foot, and mouth disease (HFMD), first reported in New Zealand in 1957, is a global and common infectious disease in young children, in those less than 5 years old. The disease usually resolves spontaneously, but severe complications, including death, can occur [1,2,3,4]. Large-scale outbreaks have occurred in China and caused 126 and 353 deaths in the year of 2008 and. Foot, and mouth disease is caused by human enterovirus, a genus of the Picornavirus family, and is characterized by a single 7.4kb of positive-strand genomic RNA. The VP1 is the most external and immunodominant picornavirus capsid protein and contains the major neutralization epitopes that has been used for virus serotype identification and evolutionary studies [8,9,10]
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