Children's Hospital 1, Ho Chi Minh City, Vietnam.
Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam.
PLoS Negl Trop Dis. 2020 Aug 17;14(8):e0008544. doi: 10.1371/journal.pntd.0008544. eCollection 2020 Aug.
Hand, foot and mouth disease (HFMD) continues to challenge Asia with pandemic potential. In Vietnam, there have been two major outbreaks occurring during 2011-2012 (>200,000 hospitalizations and >200 deaths) and more recently in 2018 (>130,000 hospitalizations and 17 deaths). Given the high burden and the complex epidemic dynamics of HFMD, synthesizing its clinical and epidemiological data remains essential to inform the development of appropriate interventions and design public health measures. We report the results of a hospital-based study conducted during 2015-2018, covering the severe HFMD outbreak recently documented in Vietnam in 2018. The study was conducted at three major hospitals responsible for receiving HFMD patients from southern Vietnam with a population of over 40 million. A total of 19 enterovirus serotypes were detected in 1196 HFMD patients enrolled in the clinical study during 2015-2018, with enterovirus A71 (EV-A71), coxsackievirus A6 (CV-A6), CV-A10 and CV-A16 being the major causes. Despite the emergence of coxsackieviruses, EV-A71 remains the leading cause of severe HFMD in Vietnam. EV-A71 was consistently detected at a higher frequency during the second half of the years. The emergence of EV-A71 subgenogroup C4 in late 2018 was preceded by its low activity during 2017-early 2018. Compared with EV-A71 subgenogroup B5, C4 was more likely to be associated with severe HFMD, representing the first report demonstrating the difference in clinical severity between subgenogroup C4 and B5, the two predominant EV-A71 subgenogroups causing HFMD worldwide. Our data have provided significant insights into important aspects of HFMD over four years (2015-2018) in Vietnam, and emphasize active surveillance for pathogen circulation remains essential to inform the local public health authorities in the development of appropriate intervention strategies to reduce the burden of this emerging infections. Multivalent vaccines are urgently needed to control HFMD.
手足口病（HFMD）持续对亚洲构成大流行威胁。在越南，2011-2012 年曾发生两次重大疫情（超过 20 万例住院和超过 200 例死亡），最近一次是在 2018 年（超过 13 万例住院和 17 例死亡）。鉴于手足口病的高负担和复杂的流行动态，综合其临床和流行病学数据对于制定适当的干预措施和设计公共卫生措施仍然至关重要。我们报告了 2015-2018 年期间进行的一项基于医院的研究结果，该研究涵盖了最近在越南发生的 2018 年严重手足口病疫情。该研究在三家主要医院进行，这些医院负责接收来自人口超过 4000 万的越南南部的手足口病患者。在 2015-2018 年期间纳入临床研究的 1196 例手足口病患者中，共检测到 19 种肠道病毒血清型，其中肠道病毒 A71（EV-A71）、柯萨奇病毒 A6（CV-A6）、CV-A10 和 CV-A16 是主要病原体。尽管出现了柯萨奇病毒，但 EV-A71 仍然是越南严重手足口病的主要病原体。EV-A71 在下半年的检测频率一直较高。2018 年底 EV-A71 亚组 C4 的出现之前，其在 2017 年至 2018 年初的活动水平较低。与 EV-A71 亚组 B5 相比，C4 更有可能与严重手足口病相关，这是首次报告表明亚组 C4 和 B5 之间临床严重程度的差异，这两个亚组是导致全球手足口病的主要 EV-A71 亚组。我们的数据提供了 2015-2018 年四年间（2015-2018 年）越南手足口病的重要信息，并强调主动监测病原体传播仍然是为当地公共卫生当局制定适当干预策略以减轻这种新出现感染负担提供信息的关键。迫切需要多价疫苗来控制手足口病。
