Hunan Provincial Center for Disease Control and Prevention, Changsha, China.
Institut Pasteur of Shanghai, Chinese Academy of Sciences, Beijing, China.
Clin Infect Dis. 2018 Nov 13;67(11):1729-1735. doi: 10.1093/cid/ciy341.
Hand, foot, and mouth disease (HFMD) represents a substantial disease burden in the Western Pacific region. We investigated the spectrum of causative enteroviruses of HFMD, and evaluated different clinical samples' diagnostic yield for enteroviruses.
We enrolled pediatric patients hospitalized for HFMD among 6 hospitals in Anhua County, Hunan Province, China between October 2013 and September 2016. Throat swabs and stool samples (or rectal swabs) were collected to detect the enterovirus serotypes by real-time reverse-transcription polymerase chain reaction (PCR) or nested PCR.
Among the 2836 patients, only 1 developed severe illness. Seventeen serotypes were identified in 2401 patients (85%), with the most frequently detected being CV-A16 (29% [814]), CV-A6 (28% [784]), EV-A71 (17% [491]), CV-A10 (4% [114]), and CV-A4 (2% [53]). Children were younger in CV-A6, CV-A10, and CV-A4 infections (median, 12 months; interquartile range [IQR], 12-24 months) than EV-A71 and CV-A16 infections (median, 24 months; IQR, 12-36 months; P < .05). The predominant enterovirus serotype shifted between CV-A16 and CV-A6 during the 3 years. Stool had a higher diagnostic yield (89%) than rectal (77%) and throat swabs (74%). Detection rates reached 93% when testing stools followed by throat swabs if stools were negative, and 89% when testing rectal swabs followed by throat swabs if rectal swabs were negative.
Our results provide a virological benchmark for future surveillance and diagnostics. Continuous comprehensive virological surveillance is essential, especially after implementation of the EV-A71 vaccine in China, to monitor serotype replacement and the vaccine's impact.
手足口病（HFMD）在西太平洋地区造成了相当大的疾病负担。我们调查了手足口病的致病肠道病毒谱，并评估了不同临床样本对肠道病毒的诊断效果。
我们在 2013 年 10 月至 2016 年 9 月期间在湖南省安化县的 6 家医院招募了因 HFMD 住院的儿科患者。采集咽拭子和粪便样本（或直肠拭子），通过实时逆转录聚合酶链反应（PCR）或巢式 PCR 检测肠道病毒血清型。
在 2836 例患者中，仅有 1 例发展为重症病例。在 2401 例患者（85%）中检测到 17 种血清型，最常见的是 CV-A16（29%[814 例]）、CV-A6（28%[784 例]）、EV-A71（17%[491 例]）、CV-A10（4%[114 例]）和 CV-A4（2%[53 例]）。CV-A6、CV-A10 和 CV-A4 感染的患儿年龄较小（中位数 12 个月；四分位距 [IQR]，12-24 个月），而 EV-A71 和 CV-A16 感染的患儿年龄较大（中位数 24 个月；IQR，12-36 个月；P<0.05）。3 年间，主要肠道病毒血清型由 CV-A16 转变为 CV-A6。粪便的检测率（89%）高于直肠拭子（77%）和咽拭子（74%）。如果粪便检测为阴性，先检测粪便后检测咽拭子的检测率为 93%，如果直肠拭子检测为阴性，先检测直肠拭子后检测咽拭子的检测率为 89%。
我们的研究结果为今后的监测和诊断提供了病毒学基准。连续全面的病毒学监测至关重要，尤其是在中国实施 EV-A71 疫苗后，需要监测血清型更替和疫苗的影响。
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