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While there were a few outliers, the CA16 strains clustered in three distinct genetic lineages (A, B, and C) supported by the indicated bootstrap values (Fig. Lancet 2005; 365:2031-40; http://dx.doi.org/10.1016/S0140-6736(05)66697-4[CrossRef], [PubMed], [Web of Science ®] leading to large information gaps and limited evidence for national health policy decisions. Inactivated EV71 vaccines based on different C4 isolates were independently developed and evaluated by 3 different Chinese companies (Table 1) [27]. Currently there are three companies that completed the phase III clinical trials of whole virus inactivated vaccines. We estimated that the aggregated incidence rate of EV71-HFMD in the EV71 vaccine phase III trials and the corresponding rate in national surveillance were 18.3 (95% CI 16.3–20.6) and 13.4 (95% CI 12.4–14.5) per 1,000 person-years, respectively. We considered only children aged 6 mo to 5 y (60 mo) because (i) 90%, 94%, and 96% of mild, severe, and fatal HFMD cases, respectively, occur in this age group [6] and (ii) vaccine efficacy has been demonstrated only in those aged 6–71 mo [12–14]. However, it should be emphasized that EV71 leads to more severe conditions and deaths than other relevant viruses.

Clin. The annual morbidity among male was approximately 1.5 times as high as that among female. The median hospital stay was 2.96 days. Although mainland China is neighboring to Taiwan, subgenotype C4 was the unique type detected in China since 1998, during which there was no transition or co-circulation of any other genotypes (Fig. In both P1 and mature proteins VP1-VP4 encoding regions, sequence identities with CVA16 prototype were 76.5%-78.0%, 75.1%-77.1%, 75.1%-78.8%, 76.7%-79.2% and 79.2%-83.5%, respectively (Table 3), these values are consistent with the 75% rule of enterovirus typing [21]. Moreover, Liu et al. The sequenced DNA fragments were evaluated and assembled into a complete genome.


In this study, phylogenetic analysis of CVA6 strains from 2008 to 2013 in Guangdong was performed and compared with reference strains from other regions in GenBank database. Korean J Pediatr 2011; 54:11 – 6; http://dx.doi.org/10.3345/kjp.2011.54.1.11; PMID: 21359055 [CrossRef], [PubMed] The population aged 5 y or more often had preexisting NT antibody, rarely developed clinical manifestations after EV71 infection.21 Le VT, Phan TQ, Do QH, Nguyen BH, Lam QB, Bach VC, et al. The complete VP1 nucleotide sequences (852 nucleotides) of the CVB4 strains that were determined in this study have been deposited in GenBank under the accession numbers KF781519 to KF781523. The association between polymorphisms of candidate genes and severity of EV71 infection was analyzed with ordinal logistic regression analysis separately. We included all cases with illness onset from January 1, 2008 through December 31, 2012 in the analysis. DXY.CN: According to the papers published by your team, the incidence of HFMD in southern Jiangsu is higher than that in northern part. It is concluded that the existing HB vaccines can be used for interrupting the transmission of “a” determinant’s 126- and 145-point mutants from mother to child, indicating unnecessary to develop a new type of vaccine against “a” determinant’s 126- and 145-point mutants.

For clinical classification, we followed Guidelines for Diagnosis and Management of Hand, Foot and Mouth Disease (2010) (http://www.moh.gov.cn/publicfiles/business/htmlfiles/mohyzs/s3586/201004/46884.htm), released by China Ministry of Health. The mechanisms underlying the cardiopulmonary failure are thought to be neurogenic in origin, with disproportionate sympathetic stimulation and catecholamine secretion directly affecting the cardiac muscle and raising pulmonary pressures. The seroprevalence data in Guangdong Province, China showed that EV71 was responsible for 44.6%, 46.4% and 31.8% of reported cases, while CA16 accounted for 70.3%, 51.6% and 47.3% in 2007, 2008 and 2009, respectively. VP1 is the receptor binding and immunodominant protein of EV71. In recent years, HFMD was prevalent in areas of Southeast Asia, such as Thailand, Taiwan, and Singapore [2,4,5,6] and represented a serious health hazard. The Enterovirus genus in the family Picornaviridae consists of 4 species with strains isolated from humans: Human enterovirus A (HEV-A), HEV-B, HEV-C, HEV-D [1]. The VP1 sequence contains serotype-specific information that can be used for virus identification.

Copyright: © 2012 Lu et al. These authors attest that this manuscript is free of bias related to their industry affiliations. We found a relatively strong association between weekly HFMD incidence and weekly average temperature. The genome of CVA22 strain 438913 is 7,404 bp in length, after excluding the polyadenylated tract, and the G+C content is 43.75%, which is similar to that of the other sequenced CVA22 strains. Picornavirus and enterovirus diversity with associated human diseases. Li, K. The HFMD incidence spatial heterogeneity distributed among provinces, and the scale measurement of overdispersion was 548.077.

The good news is that work to develop a vaccine for HFMD is underway. Enterovirus 71 (EV-A71) and coxsackievirus A16 (CV-A16) were the dominant serotypes during 2008–2012, and they were replaced by CV-A6 as the major causative agent in 2013. The patient demographic data, clinical symptoms, diagnostic test results and medical imaging findings were collected by the clinical team.