Epidemiological and etiological characteristics of hand, foot, and mouth disease in Ningbo, China, 2008-2011.
BACKGROUND
Outbreaks of hand, foot, and mouth disease (HFMD) in central China have caused public health concerns since 2007. It is of particular public health significance to update epidemiology of HFMD in port cities.


OBJECTIVE
To investigate epidemical, etiological and clinical characteristics of HFMD in Ningbo, China, from 2008 to 2011.


METHODS
From May 2008 to December 2011, a total of 37,404 HFMD cases including 196 severe and 12 fatal cases were investigated. Human enteroviruses from 2360 cases were determined by real-time RT-PCR. The VP1 gene of EV71 from 78 cases and CA16 from 21 cases, the VP4 gene from 28 cases, and full-length genomes of 10 isolates were analyzed. Neutralizing antibodies were evaluated in 258 healthy subjects. Parameters associated with severe HFMD were evaluated.


RESULTS
Annual incidence of HFMD was 3066.8/100,000 in the population of ≤5 years. EV71 C4a, CA16 B1, and other enteroviruses accounted for 63.7%, 24.0% and 12.3%, respectively. The genomes of EV71 from fatal and non-fatal cases were nearly identical. The positive rates of neutralizing antibody to EV71 increased from 13.5% to 67.6% in 1- to 5-year healthy groups. The neutralizing antibody to CA16 B1 isolate was negative. EV71, exposure history and certain early manifestations including fever, vomiting, limb exanthema and peripheral neutrophil ratio were significantly associated with HFMD severity.


CONCLUSIONS
HFMD mainly caused by EV71 C4a and CA16 B1 is seriously epidemic in Ningbo. Future emphasis should be paid on EV71 immuno-prophylaxis and early identification of severe cases upon the etiological and clinical characteristics.
Department of Viral Research, Ningbo Center of Disease Control and Prevention, Ningbo 315010, China.
Hongxia
H
Ni
Bo
B
Yi
Jianhua
J
Yin
Ting
T
Fang
Tianfeng
T
He
Yan
Y
Du
Jin
J
Wang
Hongwei
H
Zhang
Lei
L
Xie
Yibo
Y
Ding
Wenzhen
W
Gu
Shu
S
Zhang
Yifang
Y
Han
Hongjun
H
Dong
Tong
T
Su
Guozhang
G
Xu
Guangwen
G
Cao
D057134:Antibodies, Neutralizing / Q000097:blood; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D004196:Disease Outbreaks; D004770:Enterovirus / Q000145:classification / Q000235:genetics* / Q000276:immunology / Q000302:isolation & purification; D029821:Enterovirus A, Human / Q000235:genetics* / Q000276:immunology / Q000302:isolation & purification; D004769:Enterovirus Infections / Q000453:epidemiology / Q000821:virology; D058872:Epidemics; D005260:Female; D006232:Hand, Foot and Mouth Disease / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D017720:Molecular Epidemiology; D010802:Phylogeny; D020133:Reverse Transcriptase Polymerase Chain Reaction; D017422:Sequence Analysis, DNA
D057134:Antibodies, Neutralizing