House of Journal of Clinical Pediatric Surgery, Hunan Children's Hospital, University of South China, Changsha, 410007, China.
Department of Pediatric Intensive Care Unit (PICU), Hunan Children's Hospital, University of South China, Changsha, 410007, China.
Sci Rep. 2019 Aug 12;9(1):11662. doi: 10.1038/s41598-019-48259-1.
Hand, foot, and mouth disease (HFMD) is endemic in the Pacific region, especially in mainland China. The case-fatality ratio of HFMD is increasing steadily. Knowledge of the changing epidemiology of HFMD in different regions is necessary for implementing appropriate intervention strategies. In this study, we describe the clinical and epidemiological characteristics of HFMD in Hunan Children's Hospital between 2013 and 2017. A total of 7203 patients with HFMD were admitted, with complication and mortality rates of 35.62% and 0.78%, respectively. The total number of children with HFMD, proportion of severely ill children, and HFMD mortality rate were the highest in 2014. The number of cases caused by EV-A71 and CV-A16 decreased continuously, while the number of cases caused by 'other enteroviruses' increased yearly since 2014, suggesting that other enteric viruses will gradually replace EV-A71 and CV-A16 as the main pathogenic HFMD agents. Furthermore, EV-A71 and mixed infections accounted for the high case fatality rates in children with severe HFMD, among whom EV-A71 infection resulted in the highest complication and mortality rates; the mild form of the disease was dominated by 'other enteroviruses'. In conclusion, the changing etiological pattern highlights the need to improve pathogen surveillance and vaccine strategies for HFMD control.
手足口病（HFMD）在太平洋地区流行，特别是在中国内地。HFMD 的病死率呈稳步上升趋势。了解不同地区 HFMD 的流行病学变化，对于实施适当的干预策略是必要的。本研究描述了 2013 年至 2017 年期间湖南省儿童医院 HFMD 的临床和流行病学特征。共收治 7203 例 HFMD 患儿，并发症和死亡率分别为 35.62%和 0.78%。2014 年 HFMD 患儿总数、重症患儿比例和 HFMD 死亡率最高。自 2014 年以来，EV-A71 和 CV-A16 引起的病例数持续减少，而“其他肠道病毒”引起的病例数逐年增加，表明其他肠道病毒将逐渐取代 EV-A71 和 CV-A16 成为主要的致手足口病病原体。此外，EV-A71 和混合感染导致重症 HFMD 患儿的高病死率，其中 EV-A71 感染导致的并发症和死亡率最高；轻症病例以“其他肠道病毒”为主。总之，病原体谱的变化提示需要改进 HFMD 的病原体监测和疫苗策略。
