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      Severe enterovirus A71 associated hand, foot and mouth disease, Vietnam, 2018: preliminary report of an impending outbreak

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          Abstract

          Since January 2018, over 53,000 hospitalisations and six deaths due to hand, foot and mouth disease (HFMD) have occurred across Vietnam with most cases from September onward. In a large tertiary referral hospital, Ho Chi Minh City, enterovirus A71 subgenogroup C4 was predominant, while B5 was only sporadically detected. The re-emergence of C4 after causing a severe HFMD outbreak with > 200 deaths in 2011–12 among susceptible young children raises concern of another impending severe outbreak.

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          Molecular epidemiology and evolution of enterovirus 71 strains isolated from 1970 to 1998.

          B. A. Brown, M. Oberste, J. Alexander … (1999)
          Enterovirus 71 (EV71) (genus Enterovirus, family Picornaviridae), a common cause of hand, foot, and mouth disease (HFMD), may also cause severe neurological diseases, such as encephalitis and poliomyelitis-like paralysis. To examine the genetic diversity and rate of evolution of EV71, we have determined and analyzed complete VP1 sequences (891 nucleotides) for 113 EV71 strains isolated in the United States and five other countries from 1970 to 1998. Nucleotide sequence comparisons demonstrated three distinct EV71 genotypes, designated A, B, and C. The genetic variation within genotypes (12% or fewer nucleotide differences) was less than the variation between genotypes (16.5 to 19.7%). Strains of all three genotypes were at least 94% identical to one another in deduced amino acid sequence. The EV71 prototype strain, BrCr-CA-70, isolated in California in 1970, is the sole member of genotype A. Strains isolated in the United States and Australia during the period from 1972 to 1988, a 1994 Colombian isolate, and isolates from a large HFMD outbreak in Malaysia in 1997 are all members of genotype B. Although strains of genotype B continue to circulate in other parts of the world, none have been isolated in the United States since 1988. Genotype C contains strains isolated in 1985 or later in the United States, Canada, Australia, and the Republic of China. The annual rate of evolution within both the B and C genotypes was estimated to be approximately 1.35 x 10(-2) substitutions per nucleotide and is similar to the rate observed for poliovirus. The results indicate that EV71 is a genetically diverse, rapidly evolving virus. Its worldwide circulation and potential to cause severe disease underscore the need for additional surveillance and improved methods to identify EV71 in human disease.
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            EV71 vaccine, a new tool to control outbreaks of hand, foot and mouth disease (HFMD).

            Qun-Ying Mao, Yiping Wang, Lianlian Bian … (2016)
            On December 3rd 2015, the China Food and Drug Administration (CFDA) approved the first inactivated Enterovirus 71 (EV71) whole virus vaccine for preventing severe hand, foot and mouth disease (HFMD). As one of the few preventive vaccines for children's infectious diseases generated by the developing countries in recent years, EV71 vaccine is a blessing to children's health in China and worldwide. However, there are still a few challenges facing the worldwide use of EV71 vaccine, including the applicability against various EV71 pandemic strains in other countries, international requirements on vaccine production and quality control, standardization and harmonization on different pathogen monitoring and detecting methods, etc. In addition, the affordability of EV71 vaccine in other countries is a factor to be considered in HFMD prevention. Therefore, with EV71 vaccine commercially available, there is still a long way to go before reaching effective protection against severe HFMD after EV71 vaccines enter the market. In this paper, the bottlenecks and prospects for the wide use of EV71 vaccine after its approval are evaluated.
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              Enterovirus 71–associated Hand, Foot, and Mouth Disease, Southern Vietnam, 2011

              Truong Khanh, Saraswathy Sabanathan, Tran Thanh … (2012)
              We prospectively studied 3,791 children hospitalized during 2011 during a large outbreak of enterovirus 71–associated hand, foot, and mouth disease in Vietnam. Formal assessment of public health interventions, use of intravenous immunoglobulin and other therapies, and factors predisposing for progression of disease is needed to improve clinical management.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Euro Surveill
                Journal ID (iso-abbrev): Euro Surveill
                Journal ID (publisher-id): eurosurveillance
                Title: Eurosurveillance
                Publisher: European Centre for Disease Prevention and Control (ECDC)
                ISSN (Print): 1025-496X
                ISSN (Electronic): 1560-7917
                Publication date (Print): 15 November 2018
                Volume: 23
                Issue: 46
                Electronic Location Identifier: 1800590
                Affiliations
                [1 ]Children’s Hospital 1, Ho Chi Minh City, Vietnam
                [2 ]Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
                [3 ]Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom
                [4 ]Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
                Author notes

                Correspondence: Le Van Tan ( tanlv@ 123456oucru.org )

                Article
                Publisher ID: 1800590 Publisher ID: 1800590 Other ID: 1800590
                DOI: 10.2807/1560-7917.ES.2018.23.46.1800590
                PMC ID: 6247458
                PubMed ID: 30458911
                SO-VID: 190531f5-a0ae-44bd-a2c0-4d522316c5b0
                Copyright © This article is copyright of The Authors, 2018.
                License:

                This is an open-access article distributed under the terms of the Creative Commons Attribution (CC BY 4.0) Licence. You may share and adapt the material, but must give appropriate credit to the source, provide a link to the licence, and indicate if changes were made.

                History
                Date received : 25 October 2018
                Date accepted : 15 November 2018
                Categories
                Subject: Rapid Communication
                Custom metadata
                sequence 3

                Keywords: enteroviruses,enterovirus a71,hand,foot and mouth disease,vietnam
                Data availability:
                Keywords: enteroviruses, enterovirus a71, hand, foot and mouth disease, vietnam

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