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. 2017 Apr 19:7:45630.
doi: 10.1038/srep45630.

Epidemiology of 45,616 suspect cases of Hand, Foot and Mouth Disease in Chongqing, China, 2011-2015

Jian Tao  1   2 , Xiao-Yan He  1 , Yu Shi  3 , Guohun Zhu  4 , Shan Liu  1 , Zhenzhen Zhang  5 , Shi Tang  1 , Rong Zhang  1 , Bin Peng  6 , Zhidai Liu  1 , Junjie Tan  1 , Qian Chen  1 , Xingbin Wang  1 , Liming Bao  1   7 , Lin Zou  1 , Penghui Zhang  3
Affiliations

Epidemiology of 45,616 suspect cases of Hand, Foot and Mouth Disease in Chongqing, China, 2011-2015

Jian Tao et al. Sci Rep. .

Abstract

Epidemiology and etiology of hand, foot, and mouth disease (HFMD) based on large sample size or evaluation of detection for more enterovirus serotypes are not well investigated in Chongqing of China. 45,616 suspect HFMD patients were prospectively enrolled among whom 21,615 were laboratory confirmed HFMD cases over a 5-year period (January 2011 to December 2015). Their epidemiological, clinical, and laboratory data were extracted and stratified by month, age, sex, disease severity, and enterovirus serotype. Subsequently 292 non-EV-A71/CV-A16 HFMD confirmed cases were randomly selected in three consecutive outbreaks to detect CV-A6 and CV-A10, using RT-PCR. Results showed that the HFMD epidemic peaked in early summer and autumn. The median age of onset was 2.45 years with a male-to-female ratio of 1.54:1, and with children under 5 years of age accounting for 92.54% of all confirmed cases. EV-A71 and CV-A16 infection accounted for only 36.05% (7793/21615) of total confirmed cases while EV-A71 accounted for 59.64% (232/389) of severe cases. Importantly, the proportion of EV-A71 infection generally increased with age which showed rapid growth in severe cases. CV-A6 and CV-A10 were tested positive in Chongqing, but CV-A6 had greater positive rates of 62.33% while CV-A10 had 4.79% in non-EV-A71/CV-A16 HFMD confirmed cases.

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Conflict of interest statement

The authors declare no competing financial interests.

Figures

Figure 1
Figure 1. Flow diagram of HFMD patients in whom epidemiology and etiology were investigated.
EV-A71 = enterovirus A71. CV-A16 = coxsackievirus A16. Other EVs = other enterovirus universal. *Cliassification according to the criteria issued by National Health and Family Planning Commission of the People’s Republic of China.
Figure 2
Figure 2. Monthly distribution and constituent ratio of enterovirus serotype associated with HFMD confirmed cases in Chongqing of China, 2011–2015.
Figure 3
Figure 3. Age distribution in HFMD confirmed cases in Chongqing of China, 2011–2015.
Figure 4
Figure 4. Proportions of enterovirus serotype in HFMD confirmed cases in Chongqing of China, 2011–2015.
(A) Based on total cases. (B) Based on mild cases. (C) Based on severe cases. EV-A71 = enterovirus A71. CV-A16 = coxsackievirus A16. Other EVs = other enterovirus universal.
Figure 5
Figure 5. Enterovirus serotype distribution by age group in HFMD confirmed cases in Chongqing of China, 2011–2015.
(A) Based on number of cases. (B) Based on proportion of serotypes.
Figure 6
Figure 6. Enterovirus serotype distribution by age group in HFMD severe cases in Chongqing of China, 2011–2015.
(A) Based on number of cases. (B) Based on proportion of serotypes.
Figure 7
Figure 7. CV-A6 and CV-A10 detection in non-EV-A71 non-CV-A16 confirmed cases in three different outbreaks of November 2015, June 2016 and October 2016 in Chongqing of China.
See this image and copyright information in PMC

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