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. 2017 Dec 7;12(12):e0188640.
doi: 10.1371/journal.pone.0188640. eCollection 2017.

Epidemiological and genetic characteristics of EV71 in hand, foot, and mouth disease in Guangxi, southern China, from 2010 to 2015

Minmei Chen  1 , Yu Ju  1 , Min Chen  1 , Zhenguo Xie  1 , Kaijiao Zhou  1 , Yi Tan  1 , Jianjun Mo  1
Affiliations

Epidemiological and genetic characteristics of EV71 in hand, foot, and mouth disease in Guangxi, southern China, from 2010 to 2015

Minmei Chen et al. PLoS One. .

Abstract

Hand, foot, and mouth disease (HFMD) is a significant public health challenge in China. Human enterovirus 71 (EV71) is regarded as the predominant causative pathogen of HFMD. Since 2015, two inactivated EV71 vaccines have been approved in mainland China, and because their use could change the HFMD pathogen spectrum, this should now be monitored. However, the epidemiological and genetic trends of EV71 with respect to HFMD in Guangxi, southern China, are still not clear. In this study, we describe the epidemiological and genetic characterization of this virus in clinically-diagnosed HFMD reported from 2010 to 2015 in Guangxi. Data showed that a two-year epidemic cycle, with a predominance of EV71 infections, contributed to HFMD outbreaks in Guangxi. Furthermore, this virus is a major causative agent of severe and fatal HFMD. Interestingly, in Guangxi, EV71-positive rates tended to decrease over time. In particular, EV71-positive rates were found in Fangchenggang city, which reported very few severe and fatal cases over the six-year period. Phylogenetic analysis of the VP1 gene revealed that the major circulating strains belonged exclusively to genotype C, subtype 4a (C4a), and most clustered with strains circulating in southern China. The most interesting finding was that a strain isolated in 2012 clustered with Vietnamese strains isolated from 2011-2012. The data highlight the importance of pathogen surveillance for HFMD in China, especially Guangxi, which is located on the border of China and the Association of Southeast Asian Nations.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Yearly distribution (2010–2015) of laboratory-reported hand, foot, and mouth disease (HFMD) cases, human enterovirus 71 (EV71)-positive cases, and EV71-positive rate, in Guangxi.
Fig 2
Fig 2. Monthly distribution of laboratory-reported hand, foot, and mouth disease (HFMD) cases in Guangxi from 2010 to 2015.
Fig 3
Fig 3. Distribution of human enterovirus 71 (EV71)-positive hand, foot, and mouth disease (HFMD) cases in Guangxi from 2010 to 2015 by month.
Fig 4
Fig 4. Distribution of human enterovirus 71 (EV71)-positive rate in Guangxi from 2010 to 2015 by month.
Fig 5
Fig 5. Heatmap of the yearly distribution of human enterovirus 71 (EV71)-positive hand, foot, and mouth disease (HFMD) cases by city in Guangxi, 2010–2015.
Fig 6
Fig 6. Annual human enterovirus 71 (EV71)-positive rates for hand, foot, and mouth disease (HFMD) at the provincial municipality level in Guangxi, 2010–2015.
BS: Baise; HC: Hechi; LZ: Liuzhou; GL: Guilin; CZ: Chongzuo; NN: Nanning; LB: Laibin; GG: Guigang; HZ: Hezhou; FCG: Fangchenggang; QZ: Qinzhou; BH: Beihai; YL: Yulin; WZ: Wuzhou.
Fig 7
Fig 7. Phylogenetic analyses of human enterovirus 71 (EV71) in Guangxi from 2010 to 2015.
See this image and copyright information in PMC

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