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. 2017 Jul;145(9):1865-1874.
doi: 10.1017/S0950268817000309. Epub 2017 Apr 3.

Epidemics and aetiology of hand, foot and mouth disease in Xiamen, China, from 2008 to 2015

S Z He  1 , M Y Chen  2 , X R Xu  1 , Q Yan  2 , J J Niu  1 , W H Wu  2 , X S Su  2 , S X Ge  2 , S Y Zhang  2 , N S Xia  2
Affiliations

Epidemics and aetiology of hand, foot and mouth disease in Xiamen, China, from 2008 to 2015

S Z He et al. Epidemiol Infect. 2017 Jul.

Abstract

Over the past 8 years, human enteroviruses (HEVs) have caused 27 227 cases of hand, foot and mouth disease (HFMD) in Xiamen, including 99 severe cases and six deaths. We aimed to explore the molecular epidemiology of HFMD in Xiamen to inform the development of diagnostic assays, vaccines and other interventions. From January 2009 to September 2015, 5866 samples from sentinel hospitals were tested using nested reverse transcription PCR that targeted the HEV 5' untranslated region and viral protein 1 region. Of these samples, 4290 were tested positive for HEV and the amplicons were sequenced and genotyped. Twenty-two genotypes were identified. Enterovirus 71 (EV71) and coxsackieviruses A16, A6 and A10 (CA16, CA6 and CA10) were the most common genotypes, and there were no changes in the predominant lineages of these genotypes. EV71 became the most predominant genotype every 2 years. From 2013, CA6 replaced CA16 as one of the two most common genotypes. The results demonstrate the vast diversity of HFMD pathogens, and that minor genotypes are able to replace major genotypes. We recommend carrying-out long-term monitoring of the full spectrum of HFMD pathogens, which could facilitate epidemic prediction and the development of diagnostic assays and vaccines.

Keywords: Enterovirus; epidemiology; infectious disease epidemiology; surveillance.

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Conflict of interest statement

None.

Figures

Fig. 1.
Fig. 1.
Location of Xiamen in China.
Fig. 2.
Fig. 2.
Temporal distribution of overall and severe HFMD cases in Xiamen from January 2008 to September 2015. (a) Overall and (b) severe HFMD cases by month.
Fig. 3.
Fig. 3.
Annual incidence rates of overall HFMD cases in Xiamen, and Siming, Haicang, Huli, Jimei, Tong'an and Xiang'an districts from 2008 to 2014.
Fig. 4.
Fig. 4.
Full spectrum of HFMD pathogens in Xiamen from January 2009 to September 2015. (a) Overall HFMD cases by quarter and (b) severe HFMD cases by year.
See this image and copyright information in PMC

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