Clinical and epidemiological characteristics of adult hand, foot, and mouth disease in northern Zhejiang, China, May 2008 – November 2013

BMC Infectious Diseases

Ling-hua Yu³  Xiao-jun Wu²  Xing-ju Wang²  Jin Shu¹  Hui-xing Yi⁴  Xin-guang Yin² 

[1] Intensive Care Unit, The First Affiliated Hospital of Jiaxing College, Jiaxing 314001, Zhejiang Province, People’s Republic China;Centre for Gastroenterology and Hepatology, The First Affiliated Hospital of Jiaxing College, Jiaxing 314001, Zhejiang Province, People’s Republic of China;Department of Infectious Diseases, Centre for Gastroenterology and Hepatology, The First Affiliated Hospital of Jiaxing College, 1882 Central-South Road, Jiaxing 314001, Zhejiang Province, People’s Republic China;Intensive Care Unit, The Second Affiliated Hospital of Zhejiang University, Hangzhou 31009, Zhejiang Province, People’s Republic of China

关键词: Genotype;    CA16;    EV71;    Enterovirus;    Adult;    HFMD;   

Others  :  1127824
DOI  :  10.1186/1471-2334-14-251

 received in 2014-02-05, accepted in 2014-05-06,  发布年份 2014

【 摘 要 】

Background

Hand, foot, and mouth disease (HFMD) is an infectious disease typically caused by enterovirus 71 (EV71) and Coxsackievirus A16. The incidence of HFMD appears to be increasing across the Asia Pacific region, with deaths occurring predominantly among children. Therefore, most HFMD reports focus on children and few have studied HFMD in adults. However, more adult HFMD cases may be seen in the foreseeable future as a result of global warming, continued viral evolution, and an increase in traveling. Thus, this study investigated the clinical and epidemiological characteristics of adult HFMD.

Methods

Case data of 49 adult HFMD patients who attended The First Affiliated Hospital of Jiaxing College, China from May 2008 to November 2013 were obtained. Socio-demographic data were collected through follow-up phone calls. Throat swab specimens were tested for enterovirus by quantitative reverse transcription-polymerase chain reaction and further confirmed by virus isolation assay. For 10 patients infected with EV71, the gene encoding the EV71 VP1 protein was sequenced and analyzed. Data from 8,354 child HFMD patients and 49 adult patients in the fever clinic of The First Affiliated Hospital of Jiaxing College during the same period were collected for comparison.

Results

This study revealed that close contact with HFMD patients and poor personal hygiene consciousness were risk factors for adult HFMD. This study also found that EV71 subgenotype C4a was the most common pathogen associated with adult HFMD in this area. Furthermore, this study demonstrated several unique epidemiological characteristics of adult HFMD compared to child HFMD, such as the geographic and gender distribution of adult HFMD patients and HFMD seasonality.

Conclusions

The findings in this study showed the potential threat of adult HFMD.

【 授权许可】

   
2014 Yin et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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【 参考文献 】

• [1]Wong SS, Yip CC, Lau SK, Yuen KY: Human enterovirus 71 and hand, foot and mouth disease. Epidemiol Infect 2010, 138(8):1071-1089.
• [2]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.
• [3]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.
• [4]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.
• [5]Wang CY, Li Lu F, Wu MH, Lee CY, Huang LM: Fatal coxsackievirus A16 infection. Pediatr Infect Dis J 2004, 23(3):275-276.
• [6]Legay F: Fatal coxsackievirus A-16 pneumonitis in adult. Emerg Infect Dis 2007, 13(7):1084-1086.
• [7]Ministry of Health of the People’s Republic of China: Hand Foot and Mouth Disease Control and Prevention Guide. 2008. in Chinese
• [8]Reid SM, Ferris NP, Hutchings GH, Zhang Z, Belsham GJ, Alexandersen S: Detection of all seven serotypes of foot-and-mouth disease virus by real-time, fluorogenic reverse transcription polymerase chain reaction assay. J Virol Methods 2002, 105(1):67-80.
• [9]Chang LY, Tsao KC, Hsia SH, Shih SR, Huang CG, Chan WK, Hsu KH, Fang TY, Huang YC, Lin TY: Transmission and clinical features of enterovirus 71 infections in household contacts in Taiwan. JAMA 2004, 291(2):222-227.
• [10]Wang Y, Feng Z, Yang Y, Self S, Gao Y, Longini IM, Wakefield J, Zhang J, Wang L, Chen X, Yao L, Stanaway JD, Wang Z, Yang W: Hand, foot, and mouth disease in China: patterns of spread and transmissibility. Epidemiology 2011, 22(6):781-792.
• [11]Ho M, Chen ER, Hsu KH, Twu SJ, Chen KT, Tsai SF, Wang JR, Shih SR: An epidemic of enterovirus 71 infection in Taiwan. N Engl J Med 1999, 341:929-935.
• [12]Mao LX, Wu B, Bao WX, Han FA, Xu L, Ge QJ, Yang J, Yuan ZH, Miao CH, Huang XX, Zhang C, Xu H: Epidemiology of hand, foot, and mouth disease and genotype characterization of Enterovirus 71 in Jiangsu, China. J Clin Virol 2010, 49:100-104.
• [13]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.
• [14]Ryu WS, Kang B, Hong J, Hwang S, Kim A, Kim J, Cheon DS: Enterovirus 71 infection with central nervous system involvement, South Korea. Emerg Infect Dis 2010, 16(11):1764-1766.
• [15]Chang LY, King CC, Hsu KH, Ning HC, Tsao KC, Li CC, Huang YC, Shih SR, Chiou ST, Chen PY, Chang HJ, Lin TY: Risk factors of enterovirus 71 infection and associated hand, foot, and mouth disease/herpangina in children during an epidemic in Taiwan. Pediatrics 2002, 109:e88.
• [16]Brady RR, Verran J, Damani NN, Gibb AP: Review of mobile communication devices as potential reservoirs of nosocomial pathogens. J Hosp Infect 2009, 71:295-300.
• [17]Huang Y, Deng T, Yu S, Gu J, Huang C, Xiao G, Hao Y: Effect of meteorological variables on the incidence of hand, foot, and mouth disease in children: a time-series analysis in Guangzhou, China. BMC Infect Dis 2013, 13:134. BioMed Central Full Text
• [18]Yun C, Lufang J, Yan S, Qianli W: Survey on the enterovirus 71 survival ability on different surfaces under different climate. Chin J Infect Dis 2012, 30(7):398-400.
• [19]Chen KT, Chang HL, Wang ST, Cheng YT, Yang JY: Epidemiologic features of hand-foot-mouth disease and Herpangina caused by enterovirus 71 in Taiwan, 1998–2005. Pediatrics 2007, 120(2):e244-e252.
• [20]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.