Coxsackievirus A6 was the most common enterovirus serotype causing hand, foot, and mouth disease in Shiyan City, central China

doi:10.12998/wjcc.v10.i31.11358

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Nov 6, 2022 (publication date) through Nov 27, 2024

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World Journal of Clinical Cases

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Clin Cases. Nov 6, 2022; 10(31): 11358-11370
Published online Nov 6, 2022. doi: 10.12998/wjcc.v10.i31.11358

Table 1 Incidence, severe illness, mortality, and etiological results of hand, foot, and mouth disease cases in 2016-2020 of Shiyan, central China, n (%)

Characteristics	Year
Characteristics	2016	2017	2018	2019	2020
Total cases	10473	5405	8513	9997	1452
Incidence rates (/100000)	308.63	158.05	247.78	292.48	42.73
Laboratory-detected cases	660	530	700	530	146
Laboratory-confirmed cases	367	363	518	370	72
Severe cases	1	0	2	1	0
Fatal cases	2	0	0	0	0
Etiological results
EV-A71	167 (45.5)	9 (2.5)	0 (0.0)	1 (0.3)	0 (0.0)
CV-A16	125 (34.1)	43 (11.8)	316 (61.0)	56 (15.1)	2 (2.8)
Other enteroviruses	75 (20.4)	311 (85.7)	202 (39.0)	313 (84.6)	70 (97.2)

HFMD: Hand, foot, and mouth disease; EV-A71: Enterovirus A71; CV-A16: Coxsackievirus A16.

Table 2 Logistic regression analysis on the effect of predominant enterovirus serotypes in 168 laboratory-confirmed hand, foot, and mouth disease cases in Shiyan, central China, n (%)

	HFMD pathogens				Univariate analysis	Multivariate analysis
	CV-A6 (n = 121)	CV-A16 (n = 8)	CV-A10 (n = 5)	Other enteroviruses (n = 34)	P value	Coefficient (SD)	P value
Gender					1	-0.224 (0.451)	0.619
Male (n = 105)	76 (62.8)	5 (62.5)	4 (80.0)	20 (58.8)
Female (n = 63)	45 (37.2)	3 (37.5)	1 (20.0)	14 (41.2)
Age (yr)					0.794
≤ 1 (n = 91)	65 (53.7)	4 (50.0)	3 (60.0)	19 (55.9)
≤ 2 (n = 49)	37 (30.6)	2 (25.0)	2 (40.0)	8 (23.5)		0.131 (0.497)	0.792
≤ 3 (n = 18)	13 (10.7)	0 (0.0)	0 (0.0)	5 (14.7)		0.236 (0.717)	0.742
≤ 6 (n = 10)	6 (5.0)	2 (25.0)	0 (0.0)	2 (5.9)		-0.371 (0.785)	0.637
Fever					0.013^a	2.124 (0.747)	0.004^b
Yes	116 (95.9)	5 (62.5)	5 (100.0)	29 (85.3)
No	5 (4.1)	3 (37.5)	0 (0.0)	5 (14.7)
Clinical manifestations
Skin or oral mucosal rashes	121 (100.0)	8 (100.0)	5 (100.0)	34 (100.0)
Respiratory system syndromes¹	24 (19.8)	3 (37.5)	1 (20.0)	3 (8.8)	0.603	0.811 (0.589)	0.168
Myocardial damage	31 (25.6)	1 (12.5)	1 (20.0)	2 (5.9)	0.025^a	1.040 (0.678)	0.125
Vomit	0 (0.0)	0 (0.0)	1 (20.0)	0 (0.0)	0.623	-15.923 (882.744)	0.986
Laboratory findings, n (%, mean ± SD)
WBC increased	69 (56.6, 14.07 ± 3.42)	4 (50.0, 19.82 ± 10.74)	5 (100.0, 20.68 ± 7.67)	15 (44.1, 13.88 ± 4.38)	0.042^a	-0.058 (0.050)	0.247
CRP increased	79 (64.8, 24.64 ± 26.90)	5 (62.5, 25.28 ± 26.64)	5 (100.0, 47.68 ± 29.52)	15 (44.1, 25.97 ± 43.35)	0.431	-0.007 (0.006)	0.271
CK-MB increased	56 (45.9, 33.77 ± 13.78)	2 (25.0, 30.00 ± 4.24)	4 (80.0, 28.00 ± 6.48)	17 (50.0, 30.94 ± 7.04)	0.262	0.045 (0.027)	0.097
LDH increased	98 (80.3, 313.08 ± 59.37)	6 (75.0, 298.17 ± 38.97)	5 (100.0, 275.00 ± 24.81)	27 (79.4, 334.52 ± 59.64)	0.487	-0.009 (0.004)	0.043^a
ALT increased	20 (16.4)	1 (12.5)	1 (20.0)	3 (8.8)	0.333	-0.575 (1.328)	0.665
AST increased	29 (23.8)	1 (12.5)	1 (20.0)	3 (8.8)	0.086	1.778 (1.196)	0.137
Radiographic evaluation
Abnormal chest X-ray²	48 (39.3)	4 (50.0)	1 (20.0)	8 (23.5)	0.267	0.275 (0.449)	0.540
Abnormal electrocardiogram³	24 (19.7)	1 (12.5)	1 (20.0)	5 (14.7)	0.389	0.236 (0.566)	0.677

¹Respiratory system syndromes were defined as the presence of at least one of the followings: Bronchopneumonia, bronchitis, or other upper respiratory tract diseases.

²Abnormal chest X-ray: unilateral or bilateral enhanced lung texture.

³abnormal electrocardiogram: sinus arrhythmia, or sinus tachycardia.

^aP < 0.05.

^bP < 0.01. HFMD: Hand, foot, and mouth disease; CV-A6: Coxsackievirus A6; CV-A16: Coxsackievirus A16; CV-A10: Coxsackievirus A10; SD: Standard deviation; WBC: White blood cell; CRP: C-reactive protein; CK-MB: Creatine kinase MB isoenzyme; LDH: Lactate dehydrogenase; ALT: Alanine transaminase; AST: Aspartate aminotransferase.

Table 3 The least absolute shrinkage and selection operator regression analysis of the correlation between coxsackievirus A6 infection and various characteristics in hand, foot, and mouth disease patients in Shiyan, China

Characteristic	CV-A6 infection
Characteristic	Coefficient (SE)	P value
Temperature	-8.880e-01 (3.899e-01)	0.023^a
Myocardial damage	1.224e+00 (5.894e-01)	0.037^a
CK-MB increased	7.187e-02 (2.978e-02)	0.015^a
LDH increased	-1.355e-02 (4.137e-03)	0.001^b

^aP < 0.05.

^bP < 0.01. CV-A6: Coxsackievirus A6; SE: Standard error; CK-MB: Creatine kinase MB isoenzyme; LDH: Lactate dehydrogenase.

Citation: Li JF, Zhang CJ, Li YW, Li C, Zhang SC, Wang SS, Jiang Y, Luo XB, Liao XJ, Wu SX, Lin L. Coxsackievirus A6 was the most common enterovirus serotype causing hand, foot, and mouth disease in Shiyan City, central China. World J Clin Cases 2022; 10(31): 11358-11370
URL: https://www.wjgnet.com/2307-8960/full/v10/i31/11358.htm
DOI: https://dx.doi.org/10.12998/wjcc.v10.i31.11358