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BMC Infectious Diseases
Published in: BMC Infectious Diseases 1/2022

Open Access 01-12-2022 | Coxsackievirus | Research

Prototypes virus of hand, foot and mouth disease infections and severe cases in Gansu, China: a spatial and temporal analysis

Authors: Haixia Liu, Yuzhou Zhang, Hong Zhang, Yunhe Zheng, Faxiang Gou, Xiaoting Yang, Yao Cheng, Hannah McClymont, Hui Li, Xinfeng Liu, Wenbiao Hu

Published in: BMC Infectious Diseases | Issue 1/2022

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Abstract

Background

Little research has been conducted on the spatio-temporal relationship between the severe cases and the enteroviruses infections of hand, foot and mouth disease (HFMD). This study aimed to investigate epidemic features and spatial clusters of HFMD incidence rates and assess the relationship between Enterovirus 71 (EV71) and Coxsackievirus A16 (CoxA16) and severe cases of HMFD in Gansu province, China.

Methods

Weekly county-specific data on HFMD between 1st January and 31st December 2018 were collected from the China Infectious Disease Information System (CIDIS), including enterovirus type (EV71 and CoxA16), severe and non-severe cases in Gansu province, China. Temporal risk [frequency index (α), duration index (β) and intensity index (γ)] and spatial cluster analysis were used to assess epidemic features and identify high-risk areas for HFMD. Time-series cross-correlation function and regression model were used to explore the relationship between the ratios of two types of viruses (i.e. EV71/Cox16) (EC) and severe cases index (i.e. severe cases/non-severe cases) (SI) of HFMD.

Results

Some counties in Dingxi City, Gansu were identified as a hot spot for the temporal risk indices. Time-series cross-correlation analysis showed that SI was significantly associated with EC (r = 0.417, P < 0.05) over a 4-week time lag. The regression analysis showed that SI was positively associated with EC (β = 0.04, 95% confidence interval (CI) 0.02–0.06).

Conclusion

The spatial patterns of HFMD incidence were associated with enteroviruses in Gansu. The research suggested that the EC could be considered a potential early warning sign for predicting severe cases of HFMD in Gansu province.
Literature
1.
Fang F. Study on long noncoding RNA in enterovirus 71-induced severe hand-foot-mouth disease. 2020.
2.
Mirand A, Le Sage FV, Pereira B, Cohen R, Levy C, Archimbaud C, Peigue-Lafeuille H, Bailly J-L, Henquell C. Ambulatory pediatric surveillance of hand, foot and mouth disease as signal of an outbreak of coxsackievirus A6 infections, France, 2014–2015. Emerg Infect Dis. 2016;22(11):1884.PubMedPubMedCentralCrossRef
3.
Buttery VW, Kenyon C, Grunewald S, Oberste MS, Nix WA. Atypical presentations of hand, foot, and mouth disease caused by coxsackievirus A6—Minnesota, 2014. MMWR Morb Mortal Wkly Rep. 2015;64(29):805.PubMedPubMedCentralCrossRef
4.
Solomon T, Lewthwaite P, Perera D, Cardosa MJ, McMinn P, Ooi MH. Virology, epidemiology, pathogenesis, and control of enterovirus 71. Lancet Infect Dis. 2010;10(11):778–90.PubMedCrossRef
5.
Xing W, Liao Q, Viboud C, Zhang J, Sun J, Wu JT, Chang Z, Liu F, Fang VJ, Zheng Y. Hand, foot, and mouth disease in China, 2008–12: an epidemiological study. Lancet Infect Dis. 2014;14(4):308–18.PubMedPubMedCentralCrossRef
6.
Zhang J. Trend of epidemics and variation of pathogens of hand, foot and mouth disease in China: a dynamic series analysis, 2008–2017. Chin J Epidemiol. 2019;40(2):147–54.
7.
Zhang Y, Zhu Z, Yang W, Ren J, Tan X, Wang Y, Mao N, Xu S, Zhu S, Cui A. An emerging recombinant human enterovirus 71 responsible for the 2008 outbreak of hand foot and mouth disease in Fuyang city of China. Virol J. 2010;7(1):94.PubMedPubMedCentralCrossRef
8.
Fu X, Wan Z, Li Y, Hu Y, Jin X, Zhang C. National epidemiology and evolutionary history of four hand, foot and mouth disease-related enteroviruses in China from 2008 to 2016. Virol Sin. 2020;35(1):21–33.PubMedCrossRef
9.
Wold W, Ison MG. Fields virology. 6th ed. Philadelphia: Lippincott Williams & Wilkins; 2013.
10.
Zheng YM, Yang J, Liao QH. Direct medical costs and influencing factors in severe hand, foot and mouth disease in children aged between six months and five years old. Zhonghua yu fang yi xue za zhi Chinese J Prev Med. 2017;51(1):87–92.
11.
Sui ML, Zhang C, Huang XY, Yi LI, Yang HY, Xing-Le LI, Yan-Hua DU, Wei HY, Shen XJ, Feng HF. Etiology, clinical characteristics,and laboratory results in patients with severe hand, foot, and mouth disease. J Pathog Biol. 2015.
12.
Jun SB, Jie CH, Ye C, Dong AX, Sen ZB. The risk factors of acquiring severe hand, foot, and mouth disease: a meta-analysis. Can J Infect Dis Med Microbiol. 2018;2018:1–12.
13.
Tongzeng LI, Liang L. Early warning and its evaluation methods of severe hand, foot, and mouth disease. Chin Gen Pract. 2019.
14.
Jiao L, Zhou BQ, Zhao YY. Meta analysis of early risk factors for severe hand foot mouth disease. Pract Prev Med. 2015;22:216–7.
15.
Bongyoung K, Shinje M, Geun-Ryang B, Hyungmin L, Hyunjoo P, Hee OS, Lau EHY. Factors associated with severe neurologic complications in patients with either hand-foot-mouth disease or herpangina: a nationwide observational study in South Korea, 2009–2014. PLoS ONE. 2018;13(8):e0201726.CrossRef
16.
Liu YX. The study on the pathogenesis and prevention of EV71 serious hand foot mouth disease. Chin J Exp Virol. 2013;27:401–2.
17.
China, NHCotpsRo. Guidelines for diagnosis and treatment of hand foot mouth disease (2018). Chin J Clin Infect Dis. 2018;11:161–6.
18.
van der Sanden S, Koopmans M, Uslu G, van der Avoort H. Epidemiology of enterovirus 71 in the Netherlands, 1963 to 2008. J Clin Microbiol. 2009;47(9):2826–33.PubMedPubMedCentralCrossRef
19.
Chen KT, Chang HL, Wang ST, Cheng YT, Yang JY. Epidemiologic features of hand-foot-mouth disease and herpangina caused by enterovirus 71 in Taiwan, 1998–2005. Pediatrics. 2007;120(2): e244.PubMedCrossRef
20.
Wang DY, Chen H, Yan DM, Zhang Y, Xu WB. Genetic characterization of coxsackievirus A16 isolated in Ningxia Hui Municipality in 2008. Chin J Epidemiol. 2010;31(8):904–8.
21.
Li L, He Y, Yang H, Zhu J, Xu X, Dong J, Zhu Y, Jin Q. Genetic characteristics of human enterovirus 71 and coxsackievirus A16 circulating from 1999 to 2004 in Shenzhen, People’s Republic of China. J Clin Microbiol. 2005;43(8):3835–9.PubMedPubMedCentralCrossRef
22.
Song YZHA, Liu DP, Yao JX, Yang C. Analysis of public health emergencies of hand, foot and mouth disease in Gansu Province from 2015 to 2019. Bull Dis Control Prev. 2020;35(04):51–2.
23.
24.
25.
Statistics NBo. China statistic yearbook. 2019.
26.
Wen T-H, Lin NH, Lin C-H, King C-C, Su M-D. Spatial mapping of temporal risk characteristics to improve environmental health risk identification: a case study of a dengue epidemic in Taiwan. Sci Total Environ. 2006;367(2–3):631–40.PubMedCrossRef
27.
Liu H, Zhang Y, Tian Y, Zheng Y, Hu W. Epidemic features of seasonal influenza transmission among eight different climate zones in Gansu, China. Environ Res. 2020;183: 109189.PubMedCrossRef
28.
Tiefelsdorf M. Modelling spatial processes: the identification and analysis of spatial relationships in regression residuals by means of Moran’s I, vol. 87. Berlin: Springer; 2006.
29.
Fang C, Liu H, Li G, Sun D, Miao Z. Estimating the impact of urbanization on air quality in China using spatial regression models. Sustainability. 2015;7(11):15570–92.CrossRef
30.
Waldhör T. The spatial autocorrelation coefficient Moran’s I under heteroscedasticity. Stat Med. 2010;15(7–9):887–92.
31.
Sang S, Gu S, Bi P, Yang W, Liu Q. Predicting unprecedented dengue outbreak using imported cases and climatic factors in Guangzhou, 2014. PLoS Negl Trop Dis. 2015;9:e0003808.PubMedPubMedCentralCrossRef
32.
Cohen J. Applied multiple regression/correlation analysis for the behavioral sciences, vol. 52. New York: L. Erlbaum Associates; 2003.
33.
Khazaei S, Soheilyzad M, Molaeipoor L, Khazaei Z, Rezaeian S, Khazaei S. Trend of smear-positive pulmonary tuberculosis in Iran during 1995–2012: a segmented regression model. Int J Prev Med. 2016;7:86.PubMedPubMedCentralCrossRef
34.
Li S, Lin H, Fen LZ, Yu HJ. Estimates of influenza-associated excess mortality by two regression models in Dalian city during 1991–2008. Int J Virol. 2015;22(3):172–9.
35.
Wang XL, Wei HX, Jia L, Huo D, Wang QY. Summary of research in economic burden of hand, foot, and mouth disease in China. Chin J Epidemiol. 2020;41(2):273–9.
36.
Zhang Z, Zheng YM, Jiang LL, Ji H, Chang ZR. Review on the etiology and complications of hand, foot and mouth disease, using data from the national sentinel surveillance program, in China, 2015–2016. Chin J Epidemiol. 2019;40(6):627–32.
37.
Chen JHZY, Wu HZ, Yu DS. Etiological surveillance and analysis of hand, foot and mouth disease in Gansu Province from 2013 to 2016. Chin J Virol. 2017;033(004):505–11.
38.
Li XNSX, Jia JX, Li XP, Lai XQ. Etiological momitoring and analysis of hand, foot and mouth disease in Dingxi City from 2018 to2019. Bull Dis Control Prev. 2020;35(02):39–41.
39.
Yi L, Lu J, Kung HF, He ML. The virology and developments toward control of human enterovirus 71. Crit Rev Microbiol. 2011;37(4):313.PubMedCrossRef
40.
Zhou X, Fan G, Xia W, He F, Chen H. Molecular epidemiology of human enterovirus 71 strains in the Nanchang Region of China in 2011. Jpn J Infect Dis. 2013;66(2):149–50.PubMedCrossRef
41.
Khong WX, Yan B, Yeo H, Tan EL, Lee JJ, Ng J, Chow VT, Alonso S. A non-mouse-adapted Enterovirus 71 (EV71) strain exhibits neurotropism, causing neurological manifestations in a novel mouse model of EV71 infection. J Virol. 2012;86(4):2121.PubMedPubMedCentralCrossRef
42.
Jiang M, Wei D, Ou WL, Li KX, Luo DZ, Li YQ, Chen E, Nong GM. Autopsy findings in children with hand, foot, and mouth disease. N Engl J Med. 2012;367(1):91–2.PubMedCrossRef
43.
Long L, Gao L-D, Hu S-X, Luo K-W, Chen Z-H, Ronsmans C, Zhou D-L, Lan Y-J. Risk factors for death in children with severe hand, foot, and mouth disease in Hunan, China. Infect Dis. 2016;48(10):744–8.CrossRef
44.
Qing LI, Shu-Hong XU, Tian MY. Analysis on clinical characteristics of severe hand-foot-and-mouth disease induced by enterovirus 71 infection in Guizhou. Matern Child Health Care China. 2014.
45.
Li J. Abstract P-204: clinical analysis and prognosis of 127 cases of hand-foot-mouth disease with EV71 infection. Pediatr Crit Care Med. 2018;19:110.CrossRef
46.
Xiang LH, Yuan GP, Ming-Zhu LI. Investigation on clinical manifestations and consulation of patients with hand-foot-mouth disease in Baoshan District of Shanghai City. Pract Prev Med. 2013.
47.
Huang E, Yao Z, Shi W. Epidemiological and etiological characteristics of severe cases of hand foot and mouth disease in Zhongshan, Guangdong, 2013–2017. 2019.
48.
Zhang T. The experience of early clinical diagnosis and treatment of severe hand foot mouth disease. China Health Standard Manage. 2017.
49.
Guo Y, Liang M, Guan X, Xing X, Li L, Jiang X. Epidemiological and clinical characteristics of severe and fatality cases with hand-foot-mouth disease in Hubei (2012). Strait J Prev Med. 2016.
50.
Zhu HS, Chen S, Wang MZ, Ou JM, Ye WJ. Analysis on association between incidence of hand foot and mouth disease and meteorological factors in Xiamen, 2013–2017. Chin J Epidemiol. 2019;40(5):531–6.
51.
Gou F, Liu X, Ren X, Liu D, Liu H, Wei K, Yang X, Cheng Y, Zheng Y, Jiang X. Socio-ecological factors and hand, foot and mouth disease in dry climate regions: a Bayesian spatial approach in Gansu, China. Int J Biometeorol. 2017;61:137–47.PubMedCrossRef
52.
Thammasonthijarern N, Kosoltanapiwat N, Nuprasert W, Sittikul P, Chatchen S. Molecular epidemiological study of hand, foot, and mouth disease in a kindergarten-based setting in Bangkok, Thailand. Pathogens. 2021;10(5):576.PubMedPubMedCentralCrossRef
53.
Li-Ren MA, Tang Y, Huang YL, Wei-Yi LI. Epidemic characteristics and influencing factors of hand-foot-mouth disease cluster cases in kindergartens of Huangpu District in Shanghai from 2012–2017. Occup Health. 2019.
54.
Li J, Yin X, Lin A, Nie X, Xu D. EV71 vaccination impact on the incidence of encephalitis in patients with hand, foot and mouth disease. Hum Vacc Immunother. 2021;17:2097–100.CrossRef
55.
Jiang L, Wang J, Zhang C, He W, Ning C. Effectiveness of enterovirus A71 vaccine in severe hand, foot, and mouth disease cases in Guangxi, China. Vaccine. 2019;38(7):1804–9.PubMedCrossRef
Metadata
Title
Prototypes virus of hand, foot and mouth disease infections and severe cases in Gansu, China: a spatial and temporal analysis
Authors
Haixia Liu
Yuzhou Zhang
Hong Zhang
Yunhe Zheng
Faxiang Gou
Xiaoting Yang
Yao Cheng
Hannah McClymont
Hui Li
Xinfeng Liu
Wenbiao Hu
Publication date
01-12-2022
Publisher
BioMed Central
Keyword
Coxsackievirus
Published in
BMC Infectious Diseases / Issue 1/2022
Electronic ISSN: 1471-2334
DOI
https://doi.org/10.1186/s12879-022-07393-4

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