Spectrum of Enterovirus Serotypes Causing Uncomplicated Hand, Foot, and Mouth Disease and Enteroviral Diagnostic Yield of Different Clinical Samples
Spectrum of Enterovirus Serotypes Causing Uncomplicated Hand, Foot, and Mouth Disease and Enteroviral Diagnostic Yield of Different Clinical Samples
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引起单纯性手足口病的肠道病毒血清型谱及不同临床样本的肠道病毒诊断率
DOI：
10.1093/cid/ciy341
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发表时间：
2018-12-01
影响因子：
11.8
通讯作者：
Yu, Hongjie
中科院分区：
文献类型：
--
作者：
Gao, Lidong;Zou, Gang;Yu, Hongjie
背景
手足口病（HFMD）是西太平洋地区的重大疾病负担。本文调查了手足口病肠道病毒的病原谱，并对不同临床标本的肠道病毒诊断率进行了评价。
方法
我们招募了2013年10月至2016年9月期间在中国湖南省安化县6家医院因手足口病住院的儿科患者。采集咽拭子和粪便（或直肠拭子）标本，采用实时荧光定量PCR或巢式PCR检测肠道病毒血清型。
结果
在2836名患者中，只有1人出现严重疾病。在2401例患者（85%）中确定了17种血清型，最常检测到的是CV-A16（29% [814]）、CV-A6（28% [784]）、EV-A71（17% [491]）、CV-A10（4% [114]）和CV-A4（2% [53]）。CV-A6、CV-A10和CV-A4感染的儿童（中位数，12个月;四分位距[IQR]，12-24个月）比EV-A71和CV-A16感染的儿童（中位数，24个月; IQR，12-36个月; P < .05）更年轻。3年中肠道病毒主要血清型在CV-A16和CV-A6之间转换。粪便的诊断率（89%）高于直肠拭子（77%）和咽拭子（74%）。检测率达到93%时，测试粪便，然后咽拭子，如果粪便是阴性的，和89%时，测试直肠拭子，然后咽拭子，如果直肠拭子是阴性的。
结论
我们的研究结果为未来的监测和诊断提供了病毒学基准。持续全面的病毒学监测至关重要，特别是在中国实施EV-A71疫苗后，以监测血清型替代和疫苗的影响。
Background
Hand, foot, and mouth disease (HFMD) represents a substantial disease burden in the Western Pacific region. We investigated the spectrum of causative enteroviruses of HFMD, and evaluated different clinical samples' diagnostic yield for enteroviruses.
Methods
We enrolled pediatric patients hospitalized for HFMD among 6 hospitals in Anhua County, Hunan Province, China between October 2013 and September 2016. Throat swabs and stool samples (or rectal swabs) were collected to detect the enterovirus serotypes by real-time reverse-transcription polymerase chain reaction (PCR) or nested PCR.
Results
Among the 2836 patients, only 1 developed severe illness. Seventeen serotypes were identified in 2401 patients (85%), with the most frequently detected being CV-A16 (29% [814]), CV-A6 (28% [784]), EV-A71 (17% [491]), CV-A10 (4% [114]), and CV-A4 (2% [53]). Children were younger in CV-A6, CV-A10, and CV-A4 infections (median, 12 months; interquartile range [IQR], 12-24 months) than EV-A71 and CV-A16 infections (median, 24 months; IQR, 12-36 months; P < .05). The predominant enterovirus serotype shifted between CV-A16 and CV-A6 during the 3 years. Stool had a higher diagnostic yield (89%) than rectal (77%) and throat swabs (74%). Detection rates reached 93% when testing stools followed by throat swabs if stools were negative, and 89% when testing rectal swabs followed by throat swabs if rectal swabs were negative.
Conclusions
Our results provide a virological benchmark for future surveillance and diagnostics. Continuous comprehensive virological surveillance is essential, especially after implementation of the EV-A71 vaccine in China, to monitor serotype replacement and the vaccine's impact.