title: Seroepidemiology of human enterovirus71 and coxsackievirusA16 in Jiangsu province, China.
abstract: BACKGROUND
  The major etiology of hand, foot and mouth disease (HFMD) is infection with human enterovirus A (HEV-A). Among subtypes of HEV-A, coxsackievirusA16 (CoxA16) and enterovirus 71 (EV71) are major causes for recurrent HFMD among infants and children in Jiangsu Province, mainland China. Here, we analyzed maternal antibodies between prenatal women and their neonates, to determine age-specific seroprevalence of human EV71 and CoxA16 infections in infants and children aged 0 to 15 years. The results may facilitate the development of immunization against HFMD.
  
  
  METHODS
  This study used cross-section of 40 pairs of pregnant women and neonates and 800 subjects aged 1 month to 15 years old. Micro-dose cytopathogenic effects measured neutralizing antibodies against EV71 and CoxA16. Chi-square test compared seroprevalence rates between age groups and McNemar test, paired-Samples t-test and independent-samples t-test analyzed differences of geometric mean titers.
  
  
  RESULTS
  A strong correlation between titers of neutralizing antibody against EV71 and CoxA16 in prenatal women and neonates was observed (rEV71 = 0.67, rCoxA16 = 0.56, respectively, p < 0.05). Seroprevalence rates of anti-EV71 antibody gradually decreased with age between 0 to 6 months old, remained low between 7 to 11 months (5.0-10.0%), and increased between 1 and 4 years (22.5-87.5%). Age-specific seroprevalence rates of anti-EV71 antibody stabilized in >80% of children between 5 to 15 years of age. However, seroprevalence rates of anti-CoxA16 antibody were very low (0.0-13.0%) between 0 to 6 months of age, gradually increased between 7 months to 4 years (15.0-70.0%), and stabilized at 54.0% (108/200) between 5 to 15 years. Seroprevalence rates against EV71 and CoxA16 were low under 1 year (0.0-10.0%), and showed an age dependent increase with high seroprevalence (52.5-62.5%) between 4 and 10 years of age.
  
  
  CONCLUSIONS
  Concomitant infection of EV71 and CoxA16 was common in Jiangsu Province. Therefore, development of bivalent vaccine against both EV71 and CoxA16 is critical. The optimal schedule for vaccination may be 4 to11 months of age.
authors.affiliation: Jiangsu Provincial Center for Disease Control and Prevention, No,172, Jiangsu Road, Gulou District, Nanjing, 210009 Jiangsu Province, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Ji
authors.forename: Liang
authors.initials: L
authors.lastname: Li
authors.forename: YanMing
authors.initials: Y
authors.lastname: Liu
authors.forename: HengMing
authors.initials: H
authors.lastname: Ge
authors.forename: XuShan
authors.initials: X
authors.lastname: Wang
authors.forename: Jianli
authors.initials: J
authors.lastname: Hu
authors.forename: Bin
authors.initials: B
authors.lastname: Wu
authors.forename: JianGuang
authors.initials: J
authors.lastname: Fu
authors.forename: ZhenYu
authors.initials: Z
authors.lastname: Zhang
authors.forename: XiaoQin
authors.initials: X
authors.lastname: Chen
authors.forename: MingLei
authors.initials: M
authors.lastname: Zhang
authors.forename: Qiang
authors.initials: Q
authors.lastname: Ding
authors.forename: WenBo
authors.initials: W
authors.lastname: Xu
authors.forename: FenYang
authors.initials: F
authors.lastname: Tang
authors.forename: MingHao
authors.initials: M
authors.lastname: Zhou
authors.forename: Hua
authors.initials: H
authors.lastname: Wang
authors.forename: FengCai
authors.initials: F
authors.lastname: Zhu
mesh_terms: D000293:Adolescent; D000367:Age Factors; D057134:Antibodies, Neutralizing / Q000097:blood / Q000276:immunology; D000914:Antibodies, Viral / Q000097:blood / Q000276:immunology; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D029821:Enterovirus A, Human / Q000276:immunology*; D005260:Female; D006232:Hand, Foot and Mouth Disease / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D016036:Seroepidemiologic Studies
chemical_list: D057134:Antibodies, Neutralizing; D000914:Antibodies, Viral