Seroepidemiology of human enterovirus71 and coxsackievirusA16 among children in Guangdong province, China

BMC Infectious Diseases

Changwen Ke¹  Jinyan Lin¹  Yonghui Zhang¹  Hui Li¹  Hong xiao¹  Wanly Zhang¹  Cong Ma¹  Dawei Guan¹  Hanri Zeng¹  Jing Lu²  Juan Su¹  Lina Yi²  Wei Li¹ 

[1] Key Laboratories of Depository and Application for Pathogenic Microbiology, Center for Disease Control and Prevention of Guangdong Province, Guangzhou, Guangdong, China;Guangdong Provincial Institution of Public Health, Guangzhou, Guangdong, China

关键词: Seroprevalence;    Coxsackievirus A 16;    Enterovirus 71;   

Others  :  1147054
DOI  :  10.1186/1471-2334-13-322

 received in 2013-03-17, accepted in 2013-07-10,  发布年份 2013

【 摘 要 】

Background

Hand, foot and mouth disease (HFMD) is a common pediatric illness. Mainly induced by the Enterovirus 71 and Coxsackievirus A 16 infections, the frequently occurred HFMD outbreaks have become a serious public health problem in Southeast Asia. Currently,only a few studies have investigated the human immunity to HFMD in China. In this study, we conducted a cohort study in Guangdong province, China.

Methods

Stored serum samples from children less than 10 years old were analyzed. The levels of EV71 and CA16 specific antibodies before, during and shortly after the 2008 large outbreak of HFMD were evaluated by the microneutralization test. The geometric mean titer (GMT) was calculated and compared. Statistical significance was taken as P < 0.05.

Results

The seroprevalence data showed a continuous circulation of EV71 and CA16 in Guangdong province China in 2007–2009. The low positive rate in 2009 correlated well with the unprecedented outbreak of HFMD in 2010. Age related increase of seroprevalence was identified in 1–3 years old children for EV71 and in 1–5 years old children for CA16 in Guangdong province. High GMT of EV71 and CA16 antibody titers were also found for these age groups.

Conclusions

All of the above findings indicated common infections for these age groups. And they should clearly be at the top of the priority in periodical seroprevalence survey and future vaccination campaign.

【 授权许可】

   
2013 Li et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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【 参考文献 】

• [1]Yi L, Lu J, Kung HF, He ML: The virology and developments toward control of human enterovirus 71. Crit Rev Microbiol 2011, 37(4):313-327.
• [2]Solomon T, Lewthwaite P, Perera D, Cardosa MJ, McMinn P, Ooi MH: Virology, epidemiology, pathogenesis, and control of enterovirus 71. Lancet Infect Dis 2010, 10(11):778-790.
• [3]Hsiung GD, Wang JR: Enterovirus infections with special reference to enterovirus 71. J Microbiol Immunol Infect 2000, 33(1):1-8.
• [4]Chen SC, Chang HL, Yan TR, Cheng YT, Chen KT: An eight-year study of epidemiologic features of enterovirus 71 infection in Taiwan. Am J Trop Med Hyg 2007, 77(1):188-191.
• [5]McMinn PC: An overview of the evolution of enterovirus 71 and its clinical and public health significance. FEMS Microbiol Rev 2002, 26(1):91-107.
• [6]Koroleva GA, Lukashev AN, Khudiakova LV, Mustafina AN, Lashkevich VA: Encephalomyelitis caused by enterovirus type 71 in children. Vopr Virusol 2011, 55(6):4-10.
• [7]Denizot M, Neal JW, Gasque P: Encephalitis due to emerging viruses: CNS innate immunity and potential therapeutic targets. J Infect 2012, 65(1):1-16.
• [8]McMinn P, Stratov I, Nagarajan L, Davis S: Neurological manifestations of enterovirus 71 infection in children during an outbreak of hand, foot, and mouth disease in Western Australia. Clin Infect Dis 2001, 32(2):236-242.
• [9]Shih SR, Stollar V, Li ML: Host factors in enterovirus 71 replication. J Virol 2011, 85(19):9658-9666.
• [10]Suzuki Y, Taya K, Nakashima K, Ohyama T, Kobayashi JM, Ohkusa Y, Okabe N: Risk factors for severe hand foot and mouth disease. Pediatr Int 2009, 52(2):203-207.
• [11]Lee MS, Chiang PS, Luo ST, Huang ML, Liou GY, Tsao KC, Lin TY: Incidence rates of enterovirus 71 infections in young children during a nationwide epidemic in Taiwan, 2008–09. PLoS Negl Trop Dis 2012, 6(2):e1476.
• [12]Tu PV, Thao NT, Perera D, Huu TK, Tien NT, Thuong TC, How OM, Cardosa MJ, McMinn PC: Epidemiologic and virologic investigation of hand, foot, and mouth disease, southern Vietnam, 2005. Emerg Infect Dis 2007, 13(11):1733-1741.
• [13]Wei SH, Huang YP, Liu MC, Tsou TP, Lin HC, Lin TL, Tsai CY, Chao YN, Chang LY, Hsu CM: An outbreak of coxsackievirus A6 hand, foot, and mouth disease associated with onychomadesis in Taiwan, 2010. BMC Infect Dis 2011, 11:346. BioMed Central Full Text
• [14]Mirand A, Henquell C, Archimbaud C, Ughetto S, Antona D, Bailly JL, Peigue-Lafeuille H: Outbreak of hand, foot and mouth disease/herpangina associated with coxsackievirus A6 and A10 infections in 2010, France: a large citywide, prospective observational study. Clin Microbiol Infect 2012, 18(5):E110-118.
• [15]Iwai M, Masaki A, Hasegawa S, Obara M, Horimoto E, Nakamura K, Tanaka Y, Endo K, Tanaka K, Ueda J, et al.: Genetic changes of coxsackievirus A16 and enterovirus 71 isolated from hand, foot, and mouth disease patients in Toyama, Japan between 1981 and 2007. Jpn J Infect Dis 2009, 62(4):254-259.
• [16]Wu Y, Yeo A, Phoon MC, Tan EL, Poh CL, Quak SH, Chow VT: The largest outbreak of hand; foot and mouth disease in Singapore in 2008: the role of enterovirus 71 and coxsackievirus A strains. Int J Infect Dis 2010, 14(12):e1076-1081.
• [17]Ang LW, Koh BK, Chan KP, Chua LT, James L, Goh KT: Epidemiology and control of hand, foot and mouth disease in Singapore, 2001–2007. Ann Acad Med Singapore 2009, 38(2):106-112.
• [18]Guan D, van der Sanden S, Zeng H, Li W, Zheng H, Ma C, Su J, Liu Z, Guo X, Zhang X, et al.: Population dynamics and genetic diversity of C4 strains of human enterovirus 71 in Mainland China, 1998–2010. PLoS One 2012, 7(9):e44386.
• [19]Sun LM, Zheng HY, Zheng HZ, Guo X, He JF, Guan DW, Kang M, Liu Z, Ke CW, Li JS, et al.: An enterovirus 71 epidemic in Guangdong Province of China, 2008: epidemiological, clinical, and virogenic manifestations. Jpn J Infect Dis 2011, 64(1):13-18.
• [20]Chan LG, Parashar UD, Lye MS, Ong FG, Zaki SR, Alexander JP, Ho KK, Han LL, Pallansch MA, Suleiman AB, et al.: Deaths of children during an outbreak of hand, foot, and mouth disease in sarawak, malaysia: clinical and pathological characteristics of the disease. For Outbreak Study Group Clin Infect Dis 2000, 31(3):678-683.
• [21]Lee MS, Lin TY, Chiang PS, Li WC, Luo ST, Tsao KC, Liou GY, Huang ML, Hsia SH, Huang YC, et al.: An investigation of epidemic enterovirus 71 infection in Taiwan, 2008: clinical, virologic, and serologic features. Pediatr Infect Dis J 2010, 29(11):1030-1034.
• [22]Centers for Disease Control and Prevention, Taiwan: Deaths among children during an outbreak of hand, foot, and mouth disease--Taiwan, Republic of China, April-July 1998. MMWR Morb Mortal Wkly Rep 1998, 47(30):629-632.
• [23]Zhang J, Sun J, Chang Z, Zhang W, Wang Z, Feng Z: Characterization of hand, foot, and mouth disease in China between 2008 and 2009. Biomed Environ Sci 2011, 24(3):214-221.
• [24]Tan X, Huang X, Zhu S, Chen H, Yu Q, Wang H, Huo X, Zhou J, Wu Y, Yan D, et al.: The persistent circulation of enterovirus 71 in People's Republic of China: causing emerging nationwide epidemics since 2008. PLoS One 2011, 6(9):e25662.
• [25]Liu MY, Liu W, Luo J, Liu Y, Zhu Y, Berman H, Wu J: Characterization of an outbreak of hand, foot, and mouth disease in Nanchang, China in 2010. PLoS One 2011, 6(9):e25287.
• [26]Yan XF, Gao S, Xia JF, Ye R, Yu H, Long JE: Epidemic characteristics of hand, foot, and mouth disease in Shanghai from 2009 to 2010: Enterovirus 71 subgenotype C4 as the primary causative agent and a high incidence of mixed infections with coxsackievirus A16. Scand J Infect Dis 2011, 44(4):297-305.
• [27]Ji H, Li L, Liu Y, Ge H, Wang X, Hu J, Wu B, Fu J, Zhang Z, Chen X, et al.: Seroepidemiology of human enterovirus71 and coxsackievirusA16 in Jiangsu province. China Virol J 2012, 9(1):248. BioMed Central Full Text
• [28]Zeng M, El Khatib NF, Tu S, Ren P, Xu S, Zhu Q, Mo X, Pu D, Wang X, Altmeyer R: Seroepidemiology of Enterovirus 71 infection prior to the 2011 season in children in Shanghai. J Clin Virol 2012, 53(4):285-289.
• [29]Mao Q, Dong C, Li X, Gao Q, Guo Z, Yao X, Wang Y, Gao F, Li F, Xu M, et al.: Comparative analysis of the immunogenicity and protective effects of inactivated EV71 vaccines in mice. PLoS One 2012, 7(9):e46043.
• [30]Lee MS, Tseng FC, Wang JR, Chi CY, Chong P, Su IJ: Challenges to licensure of enterovirus 71 vaccines. PLoS Negl Trop Dis 2012, 6(8):e1737.
• [31]Liang Z, Mao Q, Gao Q, Li X, Dong C, Yu X, Yao X, Li F, Yin W, Li Q, et al.: Establishing China's national standards of antigen content and neutralizing antibody responses for evaluation of enterovirus 71 (EV71) vaccines. Vaccine 2011, 29(52):9668-9674.
• [32]Meng FY, Li JX, Li XL, Chu K, Zhang YT, Ji H, Li L, Liang ZL, Zhu FC: Tolerability and immunogenicity of an inactivated enterovirus 71 vaccine in Chinese healthy adults and children: an open label, phase 1 clinical trial. Hum Vaccin Immunother 2012, 8(5):668-674.
• [33]Li YP, Liang ZL, Gao Q, Huang LR, Mao QY, Wen SQ, Liu Y, Yin WD, Li RC, Wang JZ: Safety and immunogenicity of a novel human Enterovirus 71 (EV71) vaccine: a randomized, placebo-controlled, double-blind, Phase I clinical trial. Vaccine 2012, 30(22):3295-3303.
• [34]Rabenau HF, Richter M, Doerr HW: Hand, foot and mouth disease: seroprevalence of Coxsackie A16 and Enterovirus 71 in Germany. Med Microbiol Immunol 2009, 199(1):45-51.
• [35]Tarr AW, Urbanowicz RA, Ball JK: The role of humoral innate immunity in hepatitis C virus infection. Viruses 2012, 4(1):1-27.
• [36]Minor PD: The polio-eradication programme and issues of the end game. J Gen Virol 2011, 93(Pt 3):457-474.
• [37]Abraham RS: Relevance of antibody testing in patients with recurrent infections. J Allergy Clin Immunol 2012, 130(2):558-559. e556
• [38]Liang Y, Zhou X, Yang E, Pu J, Che Y, Wang J, Ma N, Liu L, Ding D, Tang D, et al.: Analysis of the Th1/Th2 reaction in the immune response induced by EV71 inactivated vaccine in neonatal rhesus monkeys. J Clin Immunol 2012, 32(5):1048-1058.
• [39]Mao Q, Li N, Yu X, Yao X, Li F, Lu F, Zhuang H, Liang Z, Wang J: Antigenicity, animal protective effect and genetic characteristics of candidate vaccine strains of enterovirus 71. Arch Virol 2011, 157(1):37-41.
• [40]Buxbaum S, Berger A, Preiser W, Rabenau HF, Doerr HW: Enterovirus infections in Germany: comparative evaluation of different laboratory diagnostic methods. Infection 2001, 29(3):138-142.
• [41]Liu Y, Wang X, Sun D, Ding S, Zhang B, Du Z, Xue F: Detecting Spatial-Temporal Clusters of HFMD from 2007 to 2011 in Shandong Province. China PLoS One 2013, 8(5):e63447.
• [42]Zhu Z, Zhu S, Guo X, Wang J, Wang D, Yan D, Tan X, Tang L, Zhu H, Yang Z, et al.: Retrospective seroepidemiology indicated that human enterovirus 71 and coxsackievirus A16 circulated wildly in central and southern China before large-scale outbreaks from 2008. Virol J 2010, 7:300. BioMed Central Full Text
• [43]Yu H, Wang M, Chang H, Lu J, Lu B, Li J, Chen W, Tang R, Gan L, Zhao J, et al.: Prevalence of antibodies against enterovirus 71 in children from Lu'an City in Central China. Jpn J Infect Dis 2011, 64(6):528-532.
• [44]Zhu Q, Hao Y, Ma J, Yu S, Wang Y: Surveillance of hand, foot, and mouth disease in mainland China (2008–2009). Biomed Environ Sci 2011, 24(4):349-356.
• [45]Yu SC, Hao YT, Zhang J, Xiao GX, Liu Z, Zhu Q, Ma JQ, Wang Y: Using interrupted time series design to analyze changes in hand, foot, and mouth disease incidence during the declining incidence periods of 2008–2010 in China. Biomed Environ Sci 2012, 25(6):645-652.
• [46]Li Y, Zhu R, Qian Y, Deng J, Sun Y, Liu L, Wang F, Zhao L: Comparing Enterovirus 71 with Coxsackievirus A16 by analyzing nucleotide sequences and antigenicity of recombinant proteins of VP1s and VP4s. BMC Microbiol 2011, 11:246. BioMed Central Full Text
• [47]Huang WC, Huang LM, Kao CL, Lu CY, Shao PL, Cheng AL, Fan TY, Chi H, Chang LY: Seroprevalence of enterovirus 71 and no evidence of crossprotection of enterovirus 71 antibody against the other enteroviruses in kindergarten children in Taipei city. J Microbiol Immunol Infect 2011, 45(2):96-101.
• [48]Deng T, Huang Y, Yu S, Gu J, Huang C, Xiao G, Hao Y: Spatial-temporal clusters and risk factors of hand, foot, and mouth disease at the district level in Guangdong Province. China PLoS One 2013, 8(2):e56943.
• [49]Ang LW, Phoon MC, Wu Y, Cutter J, James L, Chow VT: The changing seroepidemiology of enterovirus 71 infection among children and adolescents in Singapore. BMC Infect Dis 2011, 11:270. BioMed Central Full Text