title: Epidemiological and etiological characteristics of hand, foot, and mouth disease in Henan, China, 2008-2013.
abstract: Hand, foot, and mouth disease (HFMD) is a common childhood illness caused by enteroviruses. HFMD outbreaks and reported cases have sharply increased in China since 2008. Epidemiological and clinical data of HFMD cases reported in Henan Province were collected from 2008 to 2013. Clinical specimens were obtained from a subset of these cases. Descriptive epidemiological methods were used to analyze the time, region and population distribution. The VP1 gene from EV71 and CA16 isolates was amplified, and the sequences were analyzed. 400,264 cases of HFMD were reported in this study, including 22,309 severe and 141 fatal cases. Incidence peaked between April and May. Laboratory confirmation was obtained for 27,692 (6.9%) cases; EV71, CA16, and other enteroviruses accounted for 59.5%, 14.1%, 26.4%, respectively. Phylogenetic analysis revealed that EV71 belonged to the C4a evolution branch of C4 sub-genotype and CA16 belonged to subtype B1a or B1b. The occurrence of HFMD in Henan was closely related to season, age and region distribution. Children under five were the most affected population. The major pathogens causing HFMD and their genotypes have not notably changed in Henan. The data strongly support the importance of EV71 vaccination in a high population density area such as Henan, China.
authors.affiliation: 1] Henan Center for Disease Control and Prevention, Zhengzhou, People's Republic of China [2] Henan Key Laboratory of pathogenic microorganisms, Zhengzhou, People's Republic of China.
authors.forename: Xueyong
authors.initials: X
authors.lastname: Huang
authors.affiliation: Henan Center for Disease Control and Prevention, Zhengzhou, People's Republic of China.
authors.forename: Haiyan
authors.initials: H
authors.lastname: Wei
authors.affiliation: 1] International Emerging Infections Program, US Centers for Disease Control and Prevention, Beijing, People's Republic of China [2] Global Disease Detection Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, USA.
authors.forename: Shuyu
authors.initials: S
authors.lastname: Wu
authors.affiliation: 1] Henan Center for Disease Control and Prevention, Zhengzhou, People's Republic of China [2] Henan Key Laboratory of pathogenic microorganisms, Zhengzhou, People's Republic of China.
authors.forename: Yanhua
authors.initials: Y
authors.lastname: Du
authors.affiliation: 1] State Key Laboratory of Pathogens and Biosecurity, Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, Beijing, People's Republic of China [2] Key Laboratory of Genome Sciences and Information, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing, People's Republic of China.
authors.forename: Licheng
authors.initials: L
authors.lastname: Liu
authors.affiliation: Henan Center for Disease Control and Prevention, Zhengzhou, People's Republic of China.
authors.forename: Jia
authors.initials: J
authors.lastname: Su
authors.affiliation: Henan Center for Disease Control and Prevention, Zhengzhou, People's Republic of China.
authors.forename: Yuling
authors.initials: Y
authors.lastname: Xu
authors.affiliation: Henan Center for Disease Control and Prevention, Zhengzhou, People's Republic of China.
authors.forename: Haifeng
authors.initials: H
authors.lastname: Wang
authors.affiliation: 1] Henan Center for Disease Control and Prevention, Zhengzhou, People's Republic of China [2] Henan Key Laboratory of pathogenic microorganisms, Zhengzhou, People's Republic of China.
authors.forename: Xingle
authors.initials: X
authors.lastname: Li
authors.affiliation: Henan Center for Disease Control and Prevention, Zhengzhou, People's Republic of China.
authors.forename: Yanxia
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Henan Center for Disease Control and Prevention, Zhengzhou, People's Republic of China.
authors.forename: Guohua
authors.initials: G
authors.lastname: Liu
authors.affiliation: 1] State Key Laboratory of Pathogens and Biosecurity, Institute of Microbiology and Epidemiology, Academy of Military Medical Sciences, Beijing, People's Republic of China [2] Key Laboratory of Genome Sciences and Information, Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing, People's Republic of China.
authors.forename: Weijun
authors.initials: W
authors.lastname: Chen
authors.affiliation: 1] International Emerging Infections Program, US Centers for Disease Control and Prevention, Beijing, People's Republic of China [2] Global Disease Detection Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, USA.
authors.forename: John David
authors.initials: JD
authors.lastname: Klena
authors.affiliation: Henan Center for Disease Control and Prevention, Zhengzhou, People's Republic of China.
authors.forename: Bianli
authors.initials: B
authors.lastname: Xu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D036022:Capsid Proteins / Q000235:genetics*; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D004196:Disease Outbreaks; D005260:Female; D005838:Genotype; D006232:Hand, Foot and Mouth Disease / Q000453:epidemiology* / Q000209:etiology / Q000235:genetics / Q000473:pathology / Q000821:virology*; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010802:Phylogeny
chemical_list: D036022:Capsid Proteins; C442501:VP1 protein, Foot-and-mouth disease virus