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Table 3 Studies related to the causes of HFMD

From: A literature review and case report of hand, foot and mouth disease in an immunocompetent adult

Study

Results

Conclusions

Zhu et al. Beijing, China 2009 [27]

51 cases with HFMD

 25 CVA16 positive cases

 4 C4aEV71 positive cases

 7 Cases neither positive for EV71 nor CVA16

In 2007 in China there was a higher incidence of HFMD caused by CVA16

Osterback et al. Turku, Finland 2009 [31]

35 cases with HFMD

 34 CVA6 positive cases

CVA6 is emerging as the primary cause of the disease

Zhang et al. Pekín, Beijing 2009 [5]

70 cases with HFMD

 30 Positive for enterovirus initiation: 66.7 % positive for EV71

 At 4 days: 66.7 % positive for EV71

 At 5 days: 12.9 % positive for EV71

Samples must be collected within 4 days after the onset of the disease, because there is more likelihood of positive viral detection

Blomgvist et al. Helsinki, Finland 2010 [3]

317 cases with HFMD

212 positive cases of CVA6 and/or CVA10

Outbreak due to new genetic variants of the Coxsackie virus, CVA10 and CVA6

Rabenau et al. Frankfurt, Germany 2010 [52]

696 cases with HFMD

 88–73 % of children under 4 years are susceptible to infection

 30.6 % seropositive for both viruses

 43.5 % neutralizing antibodies (Ntab)

 25.9 % did not have antibodies

The seroprevalence study shows a common dissemination of CVA16 and EV71 in Germany, and a comparatively higher sensitivity in the younger population

Liu et al. Nanchang, China 2011 [14]

109 cases with HFMD

 90 % children under 8 years

 High prevalence of subgenotype C4

C4aEV71 genotype is now the more common infectious agent in China

Yang et al. Beijing, China 2011 [32]

301 cases with HFMD

 Enterovirus (HEV) (88.4 %), EV71 (50.4 %), CVA16 (38.3 %), CVA4 (1.1 %), CVA6 (1.1 %), CVA10 (1.1 %), CVA12 (2.6 %), CVB (5.3 %)

HFMD epidemics can persist for a long time in China, due to the different genetic variations in the composition of the virus, enteroviral characteristics of recombination and co-infection, increased travel, migration and the lack of an effective vaccine

Yan et al. Shanghai, China 2011 [30]

3208 HFMD cases

EV71—86.5 %, CVA16—6.9 %, CVA16 + EV71—17.6 %

Children 1–4 years 76.9 %

M:F—65.3 %: 34.7 %

Subgenotype C4 of EV71 circulating

The subgenotype C4 of EV71 was the main causative agent of the epidemic in Shanghai. The group most affected were children under 4 years. There was a higher prevalence in boys than in girls. High incidence of mixed infections of EV71 and CVA16

Rabenau et al. Frankfurt, Germany 2010 [52]

696 cases with HFMD

 88–73 % of children under 4 years are susceptible to infection

 30.6 % seropositive for both viruses

 43.5 % neutralizing antibodies (Ntab)

 25.9 % did not have antibodies

The seroprevalence study shows a common dissemination of CVA16 and EV71 in Germany, and a comparatively higher sensitivity in the younger population

  1. HFMD hand, foot and mouth disease