title: [Etiology study on severe cases caused by hand-foot-mouth disease in children from Henan province, 2014].
abstract: OBJECTIVE
  To investigate the etiology of severe hand-foot-mouth disease (HFMD) in children in Henan province.
  
  
  METHODS
  A total of 244 HFMD cases admitted to a hospital in Zhengzhou from April to June of 2014 were recruited for research sampling, Real-time RT-PCR, virus isolation, VP1 sequencing and alignment methods were used to test the enterovirus-related etiology. SPSS 17.0 was used in performing statistical analysis.
  
  
  RESULTS
  There were 109 severe and 135 mild cases among all the 244 HFMD cases. The number of enterovirus positive stool samples was 229, with positive rate as 93.85%. EV71, Cox A16 and Cox A10 made up 83.84%, 5.68% and 8.30% of the enterovirus etiologicy, strains, respectively. EV71 infection caused 8 HFMD cases with heart-lung failure and 2 death, Cox A10 infection led to 1 HFMD case with heart-lung failure and death. There were statistically differences seen regarding the enterovirus infection rates between severe and the mild HFMD cases (χ(2)=5.312,P=0.021). Statistically significant difference was seen in the constituent ratio of EV71, Cox A16 and the others by Fisher' s exact test (P=0.048). There was statistically significant difference seen between the cardiorespiratory failure rate and the fatality rate by EV71 and Cox A10 infection (χ(2)=0.051,P=0.821; χ(2)=2.198,P=0.138). Cox A10 strains idenfied in Henan in 2014 belonged to genotype 6. The rates on homology of nucleotide and amino acid among the Cox A10 strains in Henan in 2014 were 94.3%-99.7% and 96.3%-100.0% respectively.
  
  
  CONCLUSIONS
  EV71 still remained the most common pathogen that causing severe HFMD in children, with the increasing Cox A10 percentage in the pathogens spectrum of HFMD infection. Cox A10 strains in Henan in 2014 belonged to genotype 6. Genotype 6 Cox A10 had appeared and widely distributed in Henan for long time, but not yet variated or reconstructed. Cox A10 infection could lead to cardio-respiratory failure thus called for the monitoring program on non-EV71 and non-Cox A16 enterovirus, especially Cox A10 to be strenthened.
authors.affiliation: Institute of Infectious Disease Prevention and Control, Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China.
authors.forename: Xingle
authors.initials: X
authors.lastname: Li
authors.affiliation: Institute of Infectious Disease Prevention and Control, Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China.
authors.forename: Yi
authors.initials: Y
authors.lastname: Li
authors.affiliation: Institute of Infectious Disease Prevention and Control, Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China.
authors.forename: Baifan
authors.initials: B
authors.lastname: Zhang
authors.affiliation: College of Public Health, Zhengzhou University, Zhengzhou 450052, China.
authors.forename: Meili
authors.initials: M
authors.lastname: Sui
authors.affiliation: Institute of Infectious Disease Prevention and Control, Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China.
authors.forename: Jingjing
authors.initials: J
authors.lastname: Pan
authors.affiliation: College of Public Health, Zhengzhou University, Zhengzhou 450052, China.
authors.forename: Zhijuan
authors.initials: Z
authors.lastname: Chen
authors.affiliation: College of Public Health, Zhengzhou University, Zhengzhou 450052, China.
authors.forename: Ningning
authors.initials: N
authors.lastname: Cheng
authors.affiliation: Institute of Infectious Disease Prevention and Control, Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China.
authors.forename: Yanhua
authors.initials: Y
authors.lastname: Du
authors.affiliation: Institute of Infectious Disease Prevention and Control, Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China.
authors.forename: Haiyan
authors.initials: H
authors.lastname: Wei
authors.affiliation: Institute of Infectious Disease Prevention and Control, Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China.
authors.forename: Bianli
authors.initials: B
authors.lastname: Xu
authors.affiliation: Institute of Infectious Disease Prevention and Control, Henan Provincial Center for Disease Control and Prevention, Zhengzhou 450016, China.
authors.forename: Xueyong
authors.initials: X
authors.lastname: Huang
mesh_terms: D000596:Amino Acids / Q000235:genetics; D001699:Biometry; D002648:Child; D029821:Enterovirus A, Human / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D004769:Enterovirus Infections / Q000453:epidemiology* / Q000821:virology; D019143:Evolution, Molecular; D005838:Genotype; D006232:Hand, Foot and Mouth Disease / Q000453:epidemiology / Q000517:prevention & control* / Q000821:virology*; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D060888:Real-Time Polymerase Chain Reaction
chemical_list: D000596:Amino Acids