手,口蹄疫(HFMD)是一种高度传染性的病毒性疾病,主要影响全球儿童。中国大陆出现了重大的流行病学转变,由非肠道病毒A71(EV-A71)和非柯萨奇病毒A16(CVA16)肠道病毒(EV)引起的手足口病病例大幅增加。我们的研究对从广东收集的36,461例EV阳性标本进行了回顾性检查,中国,从2013年到2021年。流行病学趋势表明,2013年之后,柯萨奇病毒A6(CVA6)和柯萨奇病毒A10(CVA10)已成为手足口病的主要病原.与之形成鲜明对比的是,EV-A71的发病率急剧下降,2018年后濒临灭绝值得注意的是,CVA10感染病例相当年轻,平均年龄为1.8岁,与EV-A71感染患者的2.3年相比,可能表明在幼儿中积累的EV-A71特异性群体免疫力。通过广泛的基因组测序和分析,我们鉴定了2A蛋白中的N136D突变,自2017年以来,在广东流通的CVA10基因组C内形成了一个主要的亚簇。此外,在CVA10的基因组F中观察到高频率的重组事件,这表明该谱系的患病率可能被低估.EV基因型的动态景观,以及它们可能导致疫情爆发的可能性,强调有必要扩大监测工作,以包括更多样化的EV基因型。此外,考虑到电动汽车基因型的优势转移,重新评估和优化现有的疫苗接种策略可能是谨慎的,目前主要针对EV-A71。
Hand, Foot and Mouth Disease (HFMD) is a highly contagious viral illness primarily affecting children globally. A significant epidemiological transition has been noted in mainland China, characterized by a substantial increase in HFMD cases caused by non-Enterovirus A71 (EV-A71) and non-Coxsackievirus A16 (CVA16) enteroviruses (EVs). Our study conducts a retrospective examination of 36,461 EV-positive specimens collected from Guangdong, China, from 2013 to 2021. Epidemiological trends suggest that, following 2013, Coxsackievirus A6 (CVA6) and Coxsackievirus A10 (CVA10) have emerged as the primary etiological agents for HFMD. In stark contrast, the incidence of EV-A71 has sharply declined, nearing extinction after 2018. Notably, cases of CVA10 infection were considerably younger, with a median age of 1.8 years, compared to 2.3 years for those with EV-A71 infections, possibly indicating accumulated EV-A71-specific herd immunity among young children. Through extensive genomic sequencing and analysis, we identified the N136D mutation in the 2 A protein, contributing to a predominant subcluster within genogroup C of CVA10 circulating in Guangdong since 2017. Additionally, a high frequency of recombination events was observed in genogroup F of CVA10, suggesting that the prevalence of this lineage might be underrecognized. The dynamic landscape of EV genotypes, along with their potential to cause outbreaks, underscores the need to broaden surveillance efforts to include a more diverse spectrum of EV genotypes. Moreover, given the shifting dominance of EV genotypes, it may be prudent to re-evaluate and optimize existing vaccination strategies, which are currently focused primarily target EV-A71.