An outbreak of hand, foot, and mouth disease associated with subgenotype C4 of human enterovirus 71 in Shandong, China
Abstract
Background An outbreak of hand, foot, and mouth disease (HFMD) included 1149 people in Linyi City, Shandong Province, China, in 2007: three children died.Objectives To characterize the pathogens responsible for this outbreak and to analyze their genetic features.Study design A total of 233 clinical specimens were collected from 105 hospitalized patients, including 11 patients with severe HFMD. Virological investigations (direct RT-PCR, viral isolation and molecular identification) and phylogenetic analysis were performed.Results Human enterovirus 71 (HEV71) was the main pathogen that caused this outbreak, based on clinical manifestations, epidemiological data, and laboratory results. Phylogenetic analysis indicated that the Shandong HEV71 isolates belonged to 3 lineages in subgenotype C4. Subgenotype C4 could be further divided into two clusters (C4a and C4b), which corresponded to two time periods. Cluster C4a HEV71 has been the predominant virus circulating in mainland China in the past 5 years.Conclusions The 2007 HFMD outbreak was mainly caused by HEV71 subgenotype C4 with 3 transmission chains. This virus has been continuously circulating in China since 1998. The Shandong strains co-evolved with isolates from other provinces in mainland China and neighboring countries.
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EV71 and CVA16 are the two major causative agents of HFMD in different areas of mainland China, and other species A coxsackieviruses have also been demonstrated to be involved.
“EV71 and CVA16 are the two major causative agents in different areas, and other coxsackieviruses of species A, such as CVA10, CVA6, CVA4, CVA12, etc, have also been demonstrated to be involved [24]–[26].”
From Molecular Epidemiology of Human Enterovirus Associated with Aseptic Meningitis in Shandong Province, China, 2006–2012 (2014) · cites this paper as [25]
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- Authors
- Zhang, Y., Tan, X.-J., Wang, H.-Y., Yan, D.-M., Zhu, S.-L., Wang, D.-Y., Ji, F., Wang, X.-J., Gao, Y.-J., Chen, L., An, H.-Q., Li, D.-X., Wang, S.-W., Xu, A.-Q., Wang, Z.-J., & Xu, W.-B.
- Affiliations
- Chinese Center For Disease Control and Prevention (CN)
- Shandong Center for Disease Control and Prevention (CN)
- Venue
- Journal of Clinical Virology
- Publisher
- Elsevier BV
- Published
- 2009-04
- Volume
- 44
- Issue
- 4
- Pages
- 262-267
- ISSN
- 1386-6532 (ISSN-L)
- OpenAlex
- W2013518376
- Cited by
- 402
- References
- 21
- Citations by year
- 2026: 3 · 2025: 4 · 2024: 21 · 2023: 10 · 2022: 12 · 2021: 21 · 2020: 23 · 2019: 15 · 2018: 24 · 2017: 19 · 2016: 28 · 2015: 33 · 2014: 42 · 2013: 46 · 2012: 32
- FWCI
- 21.79
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Journal of Clinical Virology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Infectious Diseases › Viral Infections and Immunology Research
- Health Sciences › Medicine › Infectious Diseases › Viral Infections and Outbreaks Research
- Health Sciences › Medicine › Infectious Diseases › Infectious Encephalopathies and Encephalitis
- Keywords
- hand, foot and mouth disease, enterovirus 70, viral outbreak, phylogenetic analysis, transmission chains, severe HFMD, viral evolution
- MeSH terms
- Child, Child, Preschool, China, Disease Outbreaks, Hand, Foot and Mouth Disease, Humans, Infant, Molecular Sequence Data, Phylogeny, RNA, Viral, Cluster Analysis, Sequence Homology, Sequence Analysis, DNA, Reverse Transcriptase Polymerase Chain Reaction, Enterovirus A, Human
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