Clinical Characteristics And Genetic Characteristics Of VP1 Region In Children With Hand-foot-mouth Disease In Hebei Province

Objectives To understand the hand,foot and mouth disease(HFMD)of Hebei Province by collecting clinical data,collecting and detecting clinical samples and testing the VP1 region of main pathogen during hospitalization in Hebei Province in 2019.The current status of clinical characteristics of children,grasp the specific clinical characteristics of children with pathogenic HFMD in Hebei Province,explore the homology and subtype of different pathogens in Hebei Province,and provide the basis for the prevention and control of HFMD.The accumulated data of diagnosis and treatment of HFMD related to different pathogens in the province and even China.Methods 1 A case survey of children with hand,foot and mouth disease during hospitalization in a top three hospital in Hebei Province was conducted based on a standardized questionnaire to obtain clinical data and clinical specimens.2 Design specific primers for the VP1 region of main pathogen.After RT-PCR amplification and agarose gel electrophoresis,the RT-PCR products with the desired bands were sent to the biological company for sequencing.3 DNASTAR software was used to analyze the homology of the VP1 region of main pathogen epidemic strain in Hebei Province in 2019 and construct a phylogenetic tree.Results 1 There were 158 general cases of 217 children with HFMD in Hebei Province,59 cases involving the nervous system,including 57 cases with mild involvement of the nervous system and 2 cases with severe involvement of the nervous system.There were 88 positive samples,mainly CV-A16(37.50%)and CV-A6(37.50%).2 Children with HFMD in Hebei Province had a clear history of contact at 7.37%,the course of disease was 8.00(7.00,10.00)days,the interval between visits was 2.00(1.00,4.00)days,and the hospitalization time was 6.00(5.00,7.00)Days,were discharged or recovered.3 The clinical manifestations of children with hand,foot and mouth disease in Hebei Province are different in age:children with HFMD in the 0-year-old group were more common in children with limbs than those in the 2-year-old group,less likely to startle than those in the 1-year-old group common(?~2=5.82,P<0.0167;?~2=5.91,P<0.0167);Ig A reduction in children with HFMD in the 0-year-old group was more common than in the 1-year-old group,and more common in the 2-year-old group(?~2=5.82,P<0.0167;?~2=5.91,P<0.0167);The Ig G,Ig A and,Ig M was highest in the 2-year-old group,followed by the 1-year-old group,and then in the 0-year-old group(?~2=14.57,P<0.01;?~2=27.77,P<0.01;?~2=8.01,P=0.02).4 The areas of CV-A16 related HFMD of rash extremities(42.42%),and trunk(24.24%)are also more common.The number of rash distribution sites is 4 or more(54.55%).The highest incidence of herpes or ulcers in the mouth is Pharyngeal isthmus(75.76%).5 The clinical manifestations of children with CV-A6 related and CV-A16 related HFMD are different: compared with children with CV-A16 related HFMD,children with CV-A6 related HFMD are treated more promptly(Z =-3.00,P<0.01),higher fever peaks(Z=-2.33,P =0.02),herpes or ulcers in the pharyngeal area are more common(?~2=11.98,P<0.01),cases with digestive symptoms more(?~2=5.08,P=0.02),white blood cell content is higher(Z=-2.66,P=0.01),white blood cell elevation rate is also higher(?~2=4.05,P=0.04),and Ig G content is more Low(Z=-2.91,P<0.01)and lower Ig A content(?~2=-2.19,P=0.03).6 The nucleotide sequence homology of the VP1 region of the CV-A16 virus epidemic strain in Hebei Province in 2019 is 87.5% to 100%.One branch of the virus epidemic strain has 90.9%~96.1% homology with the B1 b subtype,but 88.3%~92.3% homology with the B1 a subtype;the other branch has 89.6%~96.3% homology with the B1 a subtype,but 88.6%~91.0% the homology with B1 b subtype.Phylogenetic tree analysis showed that one branch of the CV-A16 virus epidemic strain in Hebei Province in 2019 was subtype B1 b,and the other branch was subtype B1 a.7 The nucleotide homology of the two 2019 strains of CV-A6 virus in Hebei Province is 95.7%,both of which have the highest homology to the D3 subtype,and the results of the phylogenetic tree show that they all belong to the D3 subtype.Conclusions 1 Children with CV-A6 related HFMD in Hebei Province have high-grade fever in the early stage,and the rash has atypical and widely distributed characteristics.It is more common in herpes or ulcers of the throat and digestive system symptoms,It should be fully paid attention to in clinical diagnosis and contributes to the early recognition of HFMD.2 The B1 a and B1 b subtypes of CV-A16 and the D3 subtype of CV-A6 exist in Hebei Province in 2019,and co-evolve with domestic popular strains.3 Advocate the full application of molecular biology techniques for viral nucleic acid typing,so that the clinical diagnosis of HFMD can obtain etiological support,to achieve early diagnosis and early treatment,and control the epidemic of diseases.Figure4;Table30;Reference 99...