Abstract
After the first national-scale outbreak of Hand, foot, and mouth disease (HFMD) in China, a national surveillance network was established. Here we described the epidemiology and pathogenic profile of HFMD and the impact of EV-A71 vaccination on pathogen spectrum of enteroviruses in the southeastern Chinese city of Nanchang during 2010–2019. A total of 7,951 HFMD cases from sentinel hospitals were included, of which 4,800 EV-positive cases (60.4%) were identified by real-time RT-PCR. During 2010–2012, enterovirus 71 (EV-A71) was the main causative agent of HFMD, causing 63.1% of cases, followed by 19.3% cases associated with coxsackievirus A16 (CV-A16). Since 2013, the proportion of other enteroviruses has increased dramatically, with the sub genotype D3 strain of Coxsackievirus A6 (CV-A6) replacing the dominance of EV-A71. These genetically diverse native strains of CV-A6 have co-transmitted and co-evolved in Nanchang. Unlike EV-A71 and CV-A16, most CV-A6 infections were concentrated in autumn and winter. The incidence of EV-A71 infection negatively correlated with EV-A71 vaccination (r = −0.990, p = 0.01). And severe cases sharply declined as the promotion of EV-A71 vaccines. After 2-year implementation of EV-A71 vaccination, EV-A71 is no longer detected from the reported HFMD cases in Nanchang. In conclusion, EV-A71 vaccination changed the pattern of HFMD epidemic, and CV-A6 replaced the dominance of EV-A71 over time.
Highlights
Hand, foot, and mouth disease (HFMD) is a highly contagious disease in children caused by several human enteroviruses (EV), enterovirus A71 (EV-A71) and coxsackievirus A16 (CVA16) (Xing et al, 2014)
Since June 2009, clinical specimens must be collected from all severe HFMD cases, and the first 5 mild cases reported per month in each county or district are tested for enteroviruses by PCR by the local Centers for Disease Control and Prevention (CDC) (Xing et al, 2014; Li et al, 2018)
From January 2010 to December 2019, a total of 7,951 suspected HFMD cases were reported to the surveillance system by sentinel hospitals in Nanchang City
Summary
Foot, and mouth disease (HFMD) is a highly contagious disease in children caused by several human enteroviruses (EV), enterovirus A71 (EV-A71) and coxsackievirus A16 (CVA16) (Xing et al, 2014). Enteroviruses belong to the family Picornaviridae, genus Enterovirus Their positive single-strand RNA genome is about 7,500 nucleotides, and is composed of a large open reading frame (ORF) flanked by 5 and 3 untranslated regions (UTRs). The severity of incidence and mortality rate of HFMD in China is about 1.1 and 0.03%, respectively (Xing et al, 2014). To control enteroviral infections and reduce the mortality rate of HFMD, the Ministry of Health of China has classified HFMD as a category C notifiable infectious disease in 2008 (Xing et al, 2014). Outbreaks of HFMD associated with CV-A6 have occurred in China, the epidemiological and etiologic characteristics of most inland cities remain unclear
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