title: Clinical and epidemiological characteristics of adult hand, foot, and mouth disease in northern Zhejiang, China, May 2008-November 2013.
abstract: BACKGROUND
  Hand, foot, and mouth disease (HFMD) is an infectious disease typically caused by enterovirus 71 (EV71) and Coxsackievirus A16. The incidence of HFMD appears to be increasing across the Asia Pacific region, with deaths occurring predominantly among children. Therefore, most HFMD reports focus on children and few have studied HFMD in adults. However, more adult HFMD cases may be seen in the foreseeable future as a result of global warming, continued viral evolution, and an increase in traveling. Thus, this study investigated the clinical and epidemiological characteristics of adult HFMD.
  
  
  METHODS
  Case data of 49 adult HFMD patients who attended The First Affiliated Hospital of Jiaxing College, China from May 2008 to November 2013 were obtained. Socio-demographic data were collected through follow-up phone calls. Throat swab specimens were tested for enterovirus by quantitative reverse transcription-polymerase chain reaction and further confirmed by virus isolation assay. For 10 patients infected with EV71, the gene encoding the EV71 VP1 protein was sequenced and analyzed. Data from 8,354 child HFMD patients and 49 adult patients in the fever clinic of The First Affiliated Hospital of Jiaxing College during the same period were collected for comparison.
  
  
  RESULTS
  This study revealed that close contact with HFMD patients and poor personal hygiene consciousness were risk factors for adult HFMD. This study also found that EV71 subgenotype C4a was the most common pathogen associated with adult HFMD in this area. Furthermore, this study demonstrated several unique epidemiological characteristics of adult HFMD compared to child HFMD, such as the geographic and gender distribution of adult HFMD patients and HFMD seasonality.
  
  
  CONCLUSIONS
  The findings in this study showed the potential threat of adult HFMD.
authors.forename: Xin-guang
authors.initials: XG
authors.lastname: Yin
authors.forename: Hui-xing
authors.initials: HX
authors.lastname: Yi
authors.forename: Jin
authors.initials: J
authors.lastname: Shu
authors.forename: Xing-ju
authors.initials: XJ
authors.lastname: Wang
authors.forename: Xiao-jun
authors.initials: XJ
authors.lastname: Wu
authors.affiliation: Department of Infectious Diseases, Centre for Gastroenterology and Hepatology, The First Affiliated Hospital of Jiaxing College, 1882 Central-South Road, Jiaxing 314001, Zhejiang Province, People's Republic China. yu.lh70s@gmail.com.
authors.forename: Ling-hua
authors.initials: LH
authors.lastname: Yu
mesh_terms: D000328:Adult; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D003141:Communicable Diseases / Q000453:epidemiology; D029821:Enterovirus A, Human / Q000235:genetics*; D005260:Female; D006232:Hand, Foot and Mouth Disease / Q000453:epidemiology*; D006801:Humans; D015994:Incidence; D008297:Male; D010802:Phylogeny; D012307:Risk Factors; D012621:Seasons