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©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
Coxsackievirus A6 was the most common enterovirus serotype causing hand, foot, and mouth disease in Shiyan City, central China
Jing-Feng Li, Chuan-Jie Zhang, Ya-Wei Li, Chao Li, Shi-Chao Zhang, Sha-Sha Wang, Yong Jiang, Xin-Bing Luo, Xing-Juan Liao, Shou-Xin Wu, Ling Lin
Jing-Feng Li, Chao Li, Shi-Chao Zhang, Sha-Sha Wang, Yong Jiang, Xin-Bing Luo, Xing-Juan Liao, Department of Pediatrics, Taihe Hospital, Affiliated Hospital of Hubei University of Medicine, Shiyan 442000, Hubei Province, China
Chuan-Jie Zhang, Department of Children Health Care, Wuhan Children's Hospital (Wuhan Maternal and Child Healthcare Hospital), Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430061, Hubei Province, China
Ya-Wei Li, Department of Health Services, Taihe Hospital, Affiliated Hospital of Hubei University of Medicine, Shiyan 442000, Hubei Province, China
Shou-Xin Wu, Ling Lin, Department of Pharmaceuticals, Shanghai Biotecan Pharmaceuticals Co. Ltd., Shanghai 200000, China
Shou-Xin Wu, Ling Lin, Zhangjiang Center for Translational Medicine, Shanghai Zhangjiang Institute of Medical Innovation, Shanghai 442000, China
Author contributions: Li JF, Zhang CJ, and Li YW contributed equally to this study; Li JF, Zhang CJ, and Li YW designed and performed the research and co-wrote the paper; Li C, Wang SS, Zhang SC, Jiang Y, Luo XB, and Liao XJ collected the clinical specimens and the corresponding characteristics; Wu SX, and Lin L performed the serotypes identification of clinical samples; all authors have read and approved the final manuscript.
Supported by the Hubei Province Health and Family Planning A Scientific Research Project, No. WJ2017M220; the Wuhan Health Bureau Scientific Research Fund, No. WX19C11; the Joint Precision Medical Research Fund From Taihe Hospital, No. 2016JZ10; the Shiyan COVID-19 Pilot Emergency Scientific Research Project, No. 20Y19; and the Wuhan Children's Hospital Research Project, No. 2017FE007.
Institutional review board statement: This study was reviewed and approved by the Institutional Review Board of the Taihe Hospital, Affiliated Hospital of Hubei University of Medicine (2017KS035). The study was carried out following the Code of Ethics of the World Medical Association (Declaration of Helsinki) for experiments involving humans.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: All authors hereby declare that no conflict of interest exists.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Jing-Feng Li, MD, Chief Physician, Department of Pediatrics, Taihe Hospital, Affiliated Hospital of Hubei University of Medicine, No. 32 Renmin South Road, Shiyan 442000, Hubei Province, China. zihe1206@126.com
Received: July 19, 2022
Peer-review started: July 19, 2022
First decision: August 22, 2022
Revised: September 4, 2022
Accepted: September 20, 2022
Article in press: September 20, 2022
Published online: November 6, 2022
Processing time: 99 Days and 20.5 Hours
BACKGROUND
Hand, foot, and mouth disease (HFMD) has become one of the most common infectious diseases in China. Before 2016, the primary causal serotypes were enterovirus A71 (EV-A71) and coxsackievirus A16 (CV-A16). Following the introduction of EV-A71 vaccines in China since 2016, the situation could change. CV-A6 has recently replaced EV-A71 and CV-A16 in some areas of China. However, the epidemiological characteristics of central China remain unknown.
AIM
To investigate the clinical symptoms and pathogen spectrum of HFMD in Shiyan City, central China, in recent years.
METHODS
The epidemiological, clinical, and laboratory data from HFMD cases reported to the Shiyan Center for Disease Control and Prevention between January 2016 and December 2020 were analyzed. 196 throat swab specimens were collected from hospitalized HFMD patients between January 2018 and December 2020. To detect and genotype enteroviruses, real-time reverse transcription-polymerase chain reaction and sequencing of the 5'-untranslated region were used. In Shiyan, 168 laboratory-confirmed HFMD cases were studied using a logistic regression model to determine the effect of predominant enterovirus serotypes. Based on the logistic regression model, the least absolute shrinkage and selection operator model was used to analyze the correlation between CV-A6 infection and various clinical characteristics in HFMD patients in Shiyan.
RESULTS
From 2016 to 2020, 35840 HFMD cases were reported in Shiyan. The number of cases decreased by 48.4% from 2016 to 2017. Approximately 1.58-fold increases were found in 2018 and 2019 when compared to the previous year, respectively. In 2020, a decrease of about 85.5% was reported when compared to 2019. The most common serotypes shifted from EV-A71 and CV-A16 (about 60%-80% in 2016 and 2018) to others (more than 80.0% in 2017, 2019, and 2020). EV-A71 lost its dominance in 2017 in Shiyan. Among 196 confirmed HFMD cases, 85.7% tested positive for enterovirus, with CV-A6 being the most common serotype (121/168, 72.0%). The positive rates for CV-A16 and CV-A10 were 4.8% and 3.0%, respectively. There was no EV-A71 discovered. Infection with CV-A6 was linked to fever, myocardial damage, increased creatine kinase MB isoenzyme, and lactate dehydrogenase levels.
CONCLUSION
CV-A6 was the most common enterovirus serotype in Shiyan City, replacing EV-A71 and CV-A16 as the HFMD pathogen. Developing vaccines against CV-A6 or multiple pathogens, as well as rising CV-A6 surveillance, will help prevent HFMD in central China.
Core Tip: Hand, foot, and mouth disease (HFMD) has become China's most common infectious disease since 2008. Enterovirus A71 (EV-A71) and coxsackievirus A16 (CV-A16) were the primary causal serotypes. However, the dominant serotypes shifted recently to other enteroviruses. Nevertheless, there has been no report on the prevalence of the pathogen spectrum in Hubei, central China, since 2017. Our findings revealed that CV-A6 was the most common HFMD pathogen in Shiyan City, displacing EV-A71 and CV-A16. Fever and myocardial damage were more common in HFMD caused by CV-A6.
