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. 2021 Jan 2;18(1):292.
doi: 10.3390/ijerph18010292.

Leading Enterovirus Genotypes Causing Hand, Foot, and Mouth Disease in Guangzhou, China: Relationship with Climate and Vaccination against EV71

Zhicheng Du  1 , Yong Huang  2 , Wayne R Lawrence  3 , Jianxiong Xu  2 , Zhicong Yang  4 , Jianyun Lu  4 , Zhoubin Zhang  4 , Yuantao Hao  1
Affiliations

Leading Enterovirus Genotypes Causing Hand, Foot, and Mouth Disease in Guangzhou, China: Relationship with Climate and Vaccination against EV71

Zhicheng Du et al. Int J Environ Res Public Health. .

Abstract

(1) Background: Assignment of pathogens to the correct genus, species, and type is vital for controlling infectious epidemics. However, the role of different enteroviruses during hand, foot, and mouth disease (HFMD) epidemics and the major contributing factors remain unknown. (2) Methods: HFMD cases from 2016 to 2018 in Guangzhou, China were collected. The relationship between HFMD cases and genotype frequency, as well as the association between genotype frequency and climate factors, were studied using general linear models. We transformed the genotype frequency to the isometric log-ratio (ILR) components included in the model. Additionally, vaccination rates were adjusted in the climate-driven models. (3) Results: We observed seasonal trends in HFMD cases, genotype frequency, and climate factors. The model regressing case numbers on genotype frequency revealed negative associations with both the ILRs of CAV16 (RR = 0.725, p < 0.001) and EV71 (RR = 0.421, p < 0.001). The model regressing genotype frequency on driven factors showed that the trends for EV71 proportions were inversely related to vaccination rate (%, β = -0.152, p = 0.098) and temperature (°C, β = -0.065, p = 0.004). Additionally, the trends for CVA16 proportions were inversely related to vaccination rate (%, β = -0.461, p = 0.004) and temperature (°C, β = -0.068, p = 0.031). The overall trends for genotype frequency showed that EV71 decreased significantly, while the trends for CVA16 increased annually. (4) Conclusions: Our findings suggest a potential pathway for climate factors, genotype frequency, and HFMD cases. Our study is practical and useful for targeted prevention and control, and provides environmental-based evidence.

Keywords: climate; genotype frequency; hand, foot, and mouth disease.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript, or in the decision to publish the results.

Figures

Figure 1
Figure 1
Geographic location of study area in Guangzhou, China.
Figure 2
Figure 2
Observed trends in case numbers and genotype frequency of HFMD from 2016 to 2018 in Guangzhou, China. (A) Case number of HFMD; (B) genotype frequency of HFMD.
Figure 3
Figure 3
Observed trends in vaccination rates and climate factors from 2016 to 2018 in Guangzhou, China.
Figure 4
Figure 4
Fitted trends in genotype frequency of HFMD from 2016 to 2018 in Guangzhou, China.
Figure 5
Figure 5
Predicted and observed trends in genotype frequency of HFMD in Guangzhou, China. (A) and (B) indicate the observed and forecasted genotype frequency, respectively.
See this image and copyright information in PMC

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