Abstract
To understand control interventions, the molecular epidemiology of acute hemorrhagic conjunctivitis (AHC) was investigated from 2004 to 2014.A total of 613,485 AHC cases (annualized cases 55,771) with two deaths were included. Our findings showed that AHC was reported in all provinces, predominantly in Southern and Eastern China. The incidence rates were highest in 2007 (5.65/100,000) and 2010 (21.78/100,000) respectively. A clear seasonal pattern was identified with a peak from August to October. AHC cases occurred in all age groups; however, five to 14 years was the predominant group [23.06%, 133, 510/578,909]. The median age was 24 years (one month~97 years). The median duration from onset to diagnosis was 1.5 days, and there was no difference between the <15, 15~60 and >60-year-old patients [p = 0.0653]. The phylogenetic analysis of 100 nonstructural proteins (3C) and 84 structural proteins (VP1) revealed that AHC outbreaks were caused by Coxsackievirus A24 variant. Genotypes G4-c5a, G4-c5b, and G4-c3 co-circulated with both temporal and geographical overlaps. In conclusion, despite the overall steady decline in the number of AHC cases since the peak in 2010, it still remains a serious public health problem in Southern and Eastern China that targets on the school aged children under 15 years old.
Highlights
Acute hemorrhagic conjunctivitis (AHC) outbreaks have become a severe public health issue in China, in school-aged children[1]
The Western and Northeastern provinces reported the lowest number of cases, which only accounted for 1.14% of total cases (6,984/613,485) (Figs 3A–D and 4)
China was identified as one of the most affected countries, and epidemics of AHC caused by Coxsackievirus A24 variant (CA24v) reappeared in China beginning in 200713
Summary
AHC outbreaks have become a severe public health issue in China, in school-aged children[1]. To manage the epidemiological status of AHC, in 2003, China’s government launched the National Disease Supervision Information Management System (NDSIMS) for notification of infectious diseases. AHC belongs to the Class C notifiable infectious disease category in China. AHC cases diagnosed by physicians should be registered through the public health surveillance program within 24 hours of a diagnosis[13,19]. The notifiable surveillance data from 2004 to 2014 in China was used to analyze the molecular epidemiological features in the largest sample size with the aims to identify the specificities of the high-risk areas, populations and seasons and the clinical severity as well as to identify the etiological agent that caused the outbreaks. This research will assist in planning and developing resources that can decrease the transmission of this highly contagious disease and will increase government and public awareness regarding the potential risk of AHC and the means to control and prevent AHC outbreaks in the future
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