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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
ARTICLE HIGHLIGHTS
Research background
Before 2016, the main causative serotypes of hand, foot, and mouth disease (HFMD) were coxsackievirus A16 (CV-A16) and enterovirus A71 (EV-A71). Some regions in China have shown that CV-A6 has recently supplanted EV-A71 and CV-A16 due to the introduction of EV-A71 vaccines. Finding out Central China's epidemiological characteristics is equally important.
Research motivation
By investigating the clinical symptoms and pathogen spectrum of HFMD in Shiyan City, central China, after 2016, it will provide critical proof for future knowledge of the etiology of HFMD.
Research objectives
To investigate the epidemiological and etiological features of HFMD in Shiyan City, which may provide information on the disease's recent prevalence in central China.
Research methods
The Shiyan Center for Disease Control and Prevention HFMD data from 2016 to 2020 were examined. Between 2018 and 2020, throat swab specimens were collected from hospitalized HFMD patients in Shiyan. To detect and genotype enteroviruses, real-time reverse transcription-polymerase chain reaction and sequencing of the 5'-untranslated region were used. The effect of predominant enterovirus serotypes and the correlation between CV-A6 infection and various clinical characteristics in Shiyan HFMD patients were studied using a logistic regression model and the least absolute shrinkage and selection operator model.
Research results
The frequency of HFMD dramatically dropped in 2017 as the number of immunized persons in Shiyan grew year after year. But the prevalence of HFMD rose once more in 2018 and 2019. Between 2018 and 2020, CV-A6 superseded EV-A71 and CV-A16 as the main cause of HFMD in Shiyan. CV-A6 was associated with an increased risk of fever and myocardial damage. The limitation is that the dominant CV-A6 genotypes in Shiyan and other regions were not identified. More research is needed to determine the relationship between different CV-A6 genotypes and clinical features.
Research conclusions
The most common enterovirus serotype in Shiyan City was CV-A6, which replaced EV-A71 and CV-A16 as the HFMD pathogen.
Research perspectives
The prevention of HFMD in central China will be aided by the creation of vaccines against CV-A6 or multiple infections as well as increased CV-A6 surveillance.
