Abstract
Hand, foot, and mouth disease (HFMD) is an infectious disease caused by human enterovirus 71 (EV71), coxsackievirus A16 (CVA16) and other enteroviruses. It is of interest that other enteroviruses associated with HFMD in Jinan have been rarely reported. The aim of the present study is to detect and characterize the circulating serotypes of non-EV71 and non-CVA16 enteroviruses associated with HFMD in Jinan city, Shandong province, China. A total of 400 specimens were collected from clinically diagnosed HFMD cases in Jinan from January 2009 to June 2013. All specimens were infected with non-EV71 and non-CVA16 enteroviruses previously confirmed by RT-PCR or real-time PCR according to the protocols at that time. The GeXP-based multiplex RT-PCR assay (GeXP assay) was performed to investigate the pathogen spectrum of 15 enteroviruses (coxsackieviruses A4, A5, A6, A9, A10, A16; coxsackieviruses B1, B3, B5; Echoviruses 6, 7, 11, 13, 19 and EV71) infections associated with HMFD. For GeXP assay negative samples, reverse transcription nested PCR (nested RT-PCR) based on the 5’ -untranslated region (5’- UTR) sequence and phylogenetic analysis were conducted to further explore the etiology of multiple enteroviruses. The results showed that a total of twenty serotypes of enteroviruses (including EV71 and CVA16) were identified by GeXP assay and nested RT-PCR. The most circulating twelve serotypes of enteroviruses with HFMD in Jinan from 2009 to June 2013 were EV71, CVA16, CVA10, CVA6, CVA12, CVA2, Echo3, CVA4, CVA9, CVB1, CVB3 and Echo6. CVA10 and CVA6 were the most prevalent pathogens other than EV71 and CVA16 in Jinan and their most prevalent seasons were spring and summer, and a slight increase was observed in autumn and early winter. It should be noted that mixed-infections were identified by GeXP assay and the phylogenetic tree clearly discriminated the multiple pathogens associated with HFMD. Our results thus demonstrate that there was a clear lack of a reliable testing method for EV71 and CVA16 and multiple non-EV71 and non-CVA16 enteroviruses associated with HFMD were present in Jinan. The GeXP assay combined with nested RT-PCR based on 5’-UTR region could meet the need for the national surveillance of multiple enteroviruses or the investigation of epidemic outbreaks triggered by enteroviruses in the future.
Highlights
Hand, foot and mouth disease (HFMD) is a prevalent, typically self-limited viral syndrome in children and adults
A total of 293 (73.25%) cases were identified by GeXP assay and the true positives (GeXPpositive) for enterovirus 71 (EV71), coxsackievirus A16 (CVA16), coxsackievirus A6 (CVA6), CVA10 and CVA4 were confirmed by nested RT-PCR with pan-enterovirus specific primers targeting the 5’-UTR region [18]
The predominant pathogens causing HFMD have been EV71 and CVA16 from 2009 to 2013 in Jinan city, since HFMD was included into National Notifiable Disease surveillance system in 2008 [8,9]
Summary
Foot and mouth disease (HFMD) is a prevalent, typically self-limited viral syndrome in children and adults. It has emerged as a major public health concern in China since the first case of HFMD was reported in Shanghai in 1982 [1]. HFMD has been found to be associated with various enteroviruses including human enterovirus 71 (EV71), coxsackievirus A(1–10, 12, 16, 22) and coxsackievirus B(1–5) and echoviruses [3,4,5,6,7]. For GeXP assay negative samples, nested RT-PCR [18] and phylogenetic analysis based on 5’-UTR region were further performed to fully explore the pathogen spectrum and epidemiology of enteroviruses associated with HFMD in Jinan over the period from January 2009 to June 2013
Sign-in/Register to view highlights & summary 
Published Version (
Free)
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
