| Objectives To find the epidemiological characteristics and pathogenic composition of severe and fatal cases of other enterovirus hand-foot-mouth disease in Hebei province during 2013 to 2017 by analyzing the epidemiology and pathogen distribution characteristics.To provide theoretical basis for the prevention and control of other enterovirus hand-foot-mouth disease.To master the characteristics of pathogen gene evolution by analyzing genetic characteristics of severe and fatal cases caused by other enterovirus pathogens in hebei province.Methods 1 Epidemiological characteristics of severe and fatal cases of other enteroviruses hand-foot-mouth disease in Hebei Province from 2013 to 2017:Collect and collate the epidemic data of hand-foot-mouth disease surveillance in Hebei Province from2013 to 2017 in China’s disease prevention and control information system.Descriptive epidemiological method was used to analyze the distribution characteristics of the spatial,emporal and population.2 Epidemiological and evolutionary characteristics of other enteroviruses causing hand-foot-mouth disease:Other enterovirus specimens of severe and dead cases of HFMD were collected from the HFMD laboratories in Hebei Province from2013 to 2017,and the positive specimens were selected by virus isolation.The nucleic acid was extracted and amplify the VP1 region,and the amplified products were sequenced.The genotype of the virus was determined by Blast comparison and the distribution characteristics of the pathogen were described.The nucleotide and amino acid homology of the pathogenic gene sequence was analyzed,and the phylogenetic tree was constructed with the corresponding representative strain sequence.Results 1 From 2013 to 2017,a total of 300323 cases of hand-foot-mouth disease were reported in Hebei Province,with an average annual incidence of 81.14/100000.Among which,7698 cases were hand-foot-mouth disease caused by other enteroviruses.It accounted for 2.56%of the total reported cases of HFMD,with an average annual incidence of 2.08/100000.Over the past five years,86 cases(84 severe cases and 2 deaths)of severe and fatal cases of other enterovirus hand-foot-mouth disease were reported,accounting for 1.12%of the reported cases of other enterovirus hand-foot-mouth disease,with an average annual incidence of 2.32/10000000.There were significant differences in the proportion of severe cases and deaths in each year(χ~2=18.97,P=0.001).There was no significant difference in the incidence of severe cases and deaths of other enterovirus hand-foot-mouth disease in each year(χ~2=4.85,P=0.303).The distribution is seasonal.The number of cases began to rise in April,peaked in May-July,and then declined gradually.The time distribution was consistent with that of hand-foot-mouth disease in the same period.The cases were mainly concentrated in the south of Hebei Province.The top four areas include Hengshui,Shijiazhuang,Xingtai and Qinhuangdao,accounting for 80.23%of the total reported cases of severe cases and deaths in the past five years.Children in the 1-age group were the predominant cases,accounting for 65.12%in five years.There were 50males and 36 females,and the sex ratio was 1.39:1.There was no significant difference in gender distribution among different years(χ~2=3.09,P=0.543).Among the occupational distribution,scattered children,nursery children and students were the main ones,and the number of scattered children accounted for 93.02%of the total number of cases.2 From2013 to 2017,Hand-Foot-Mouth Disease Laboratory collected 86 samples of severe and fatal cases of other enterovirus Hand-Foot-Mouth Disease in Hebei,39 positive strains were obtained by virus isolation,the positive rate was 45.35%.The VP1 region of the virus was amplified and sequenced.The genotypes of the virus were identified by Blast comparison,including CV-A2,CV-A4,CV-A6,CV-A9,CV-A10,Echo3 and Echo11.In time distribution,the pathogen composition showed a dynamic change.In the past five years,other enterovirus pathogens have been detected.In addition to CV-A10 in 2013,other four years are composed of a variety of pathogens,and the types of pathogens are different.Distribution of pathogens was found in Handan,Hengshui,Shijiazhuang,Xingtai and Qinhuangdao.Among them,Xingtai has the most pathogenic types,including CV-A2,CV-A6,CV-A9,CV-A10 and Echo3.3 The nucleotide and amino acid sequence homologies of CV-A6 isolates were 82.3%-97.8%and 88.5%-98.1%respectively.The nucleotide and amino acid sequence homologies of CV-A10 isolates were 71.0%-97.5%and 74.0%-98.2%respectively.The homology of nucleotide and amino acid sequences between CV-A4 isolates was 81.3%and 92.0%respectively.The phylogenetic tree showed that CV-A6 isolates were in the same branch as the representative strains of D3a and D3b subtypes,CV-A10 isolates were in the same branch as the representative strains of D2 and D3 subtypes,and CV-A4 isolates were in the D3 branch.Conclusions 1 Severe and fatal cases of other enterovirus hand-foot-mouth disease in Hebei showed seasonal and periodic occurrence.It mainly concentrated in April-October,and reached the peak in May-June,which was consistent with the epidemic trend of hand-foot-mouth disease.2 Distribution is sporadic,mainly happened in the southern in Hebei.Children were mainly concentrated in 1-age group.Boys are more susceptible to severe illness than girls.3 There were many other enterovirus pathogens in severe and fatal cases of HFMD in Hebei,including CV-A2,CV-A4,CV-A6,CV-A9,CV-A10,Echo3 and Echo11.The dominant pathogens are CV-A6 and CV-A10,and there are no new evolutionary branches.Figure12;Table10;Reference 143... |
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