Molecular epidemiology and clinical characteristics of enteroviruses associated HFMD in Chengdu, China, 2013-2022

Abstract

Objectives: This study aims to investigate molecular epidemiology and clinical characteristics of enterovirus associated hand-foot-mouth disease (HFMD) in Chengdu, China, 2013-2022. Monitoring the molecular epidemiology and clinical features of HFMD for up to 10 years may provide some ideas for future protection and control measures.

Methods: We conducted a retrospective analysis of the medical records of all patients with laboratory-confirmed HFMD-related enterovirus infection at the West China Second University Hospital from January 2013 to December 2022. We described the characteristics in serotype, age, sex distribution and hospitalization of enterovirus infection cases using data analysis and graphic description.

Results: A total of 29,861 laboratory-confirmed cases of HFMD-related enterovirus infection were reported from 2013 to 2022. There was a significant reduction in the number and proportion of EV-A71 cases after 2016, from 1713 cases (13.60%) in 2013-2015 to 150 cases (1.83%) in 2017-2019. During the COVID-19 pandemic, EV-A71 cases even disappeared. The proportion of CV-A16 cases decreased from 13.96% in 2013-2015 to 10.84% in 2017-2019 and then to 4.54% in 2020-2022. Other (non-EV-A71 and non-CV-A16) serotypes accounted for 95.45% during 2020-2022, with CV-A6 accounting for 50.39% and CV-A10 accounting for 10.81%. Thus, CV-A6 and CV-A10 became the main prevalent serotypes. Furthermore, There was no significant difference in the enterovirus prevalence rate between males and females. The hospitalization rate of EV-A71 patients was higher that of other serotypes. In general, the proportion of HFMD hospitalizations caused by other pathogens except for EV-A71, CV-A16, CV-A10 and CV-A16 was second only to that caused by EV-A71. The proportion of children over 4 years old infected with enterovirus increased.

Conclusion: The incidence of HFMD associated with enterovirus infection has decreased significantly and CV-A6 has been the main pathogen of HFMD in Chengdu area in recent years. The potential for additional hospitalizations for other untested enterovirus serotypes suggested that attention should also be paid to the harms of infections with unknown enterovirus serotypes. Children with HFMD were older. The development of new diagnostic reagents and vaccines may play an important role in the prevention and control of enterovirus infection.

Keywords: Change; Clinical characteristics; Enterovirus; Epidemiology; HFMD.

Fig. 1

Flowchart about the study. A Flowchart illustrating the enrolled HFMD cases during the study period from 2013 to 2022. B Flowchart illustrating the several directions of research

Fig. 2

Overall distribution of enteroviruses in 2013–2022. A The yearly distribution of laboratory-confirmed HFMD cases in 2013–2022. B The monthly distribution of laboratory-confirmed HFMD cases in 2013–2022. C The yearly proportion of several common serotypes in laboratory-confirmed HFMD cases in 2013–2022. EVs: All enteroviruses caused HFMD; EV-A71: Enterovirus 71; CV-A16: Coxsackievirus A16; CV-A6: Coxsackievirus A6; CV-A10: Coxsackievirus A10; Other EVs 1: Not including EV-A71 and CV-A16; Other EVs 2: Not including EV-A71, CV-A16, CV-A6 and CV-A10; Enterovirus positive rate: The number of laboratory-confirmed EV-positive cases compared to the number of possible HFMD cases

Fig. 3

Clinical characteristics of HFMD cases with several common serotypes in 2013–2022. A The sex distribution in cases of EVs, EV-A71, CV-A16, CV-A6, and CV-A10, respectively. B The age distribution in cases of EVs, EV-A71, CV-A16, CV-A6, and CV-A10, respectively. C The main diagnosis in cases of EVs, EV-A71, CV-A16, CV-A6, and CV-A10, respectively. D The hospitalization rate in cases of EVs, EV-A71, CV-A16, CV-A6, and CV-A10 each year from 2013 to 2022, respectively. E Overall hospitalization rates for EVs, EV-A71, CV-A16, CV-A6, and CV-A10 in 2013–2022. F Male to female ratio of HFMD inpatients and outpatients respectively, 2013–2022. G The age distribution of HFMD inpatients and outpatients respectively, 2013–2022