Retrospective study of the incidence of HFMD and seroepidemiology of antibodies against EV71 and CoxA16 in prenatal women and their infants

Feng-Cai Zhu, Zheng-Lun Liang, Fan-Yue Meng, Ying Zeng, Qun-Ying Mao, Kai Chu, Xue-Fang Song, Xin Yao, Jing-Xin Li, Hong Ji, Yi-Ju Zhang, Liang Li, Hong-Xing Pan, Ke Xu, Wei-Ming Dai, Wei-Wei Zhang, Fei Deng, Hua Wang, Jun-Zhi Wang, Feng-Cai Zhu, Zheng-Lun Liang, Fan-Yue Meng, Ying Zeng, Qun-Ying Mao, Kai Chu, Xue-Fang Song, Xin Yao, Jing-Xin Li, Hong Ji, Yi-Ju Zhang, Liang Li, Hong-Xing Pan, Ke Xu, Wei-Ming Dai, Wei-Wei Zhang, Fei Deng, Hua Wang, Jun-Zhi Wang

Abstract

Background: Hand, foot, and mouth disease (HFMD) has been emerging as an important public problem over the past few decades, especially in Asian and Pacific regions. A national program on EV71 vaccine development against HFMD was initiated in China, in 2008, which called for a need for seroepidemiological study for the target population.

Methodology/principal findings: This was a retrospective study conducted in Jiangsu Province, in October, 2010. We measured the neutralizing antibodies against EV71 and CoxA16 in a cohort of infants aged of 2, 7, 12, and 27-38 months and their mothers just before delivery. Series sera samples from 975 infants and 555 mothers were collected and analyzed. Questionnaires on the history of HFMD were completed in the survey. A total of 143 HFMD cases were collected, but only 11.2% were reported to the National Infectious Disease Information Management System. The level of maternal antibody titers decreased dramatically during the first 7 month and remained at a relatively low level thereafter. But it increased significantly from month 12 to months 27-38. The accumulate incidence density of HFMD demonstrated a significant increase after 14 months of age, resulting in a accumulate incidence density of 50.8/1000 person-years in survey period. Seropositivity of EV71 antibody in infants at the age of 2 months seems to demonstrate a protective effect against HFMD.

Conclusions and significance: High seropositive rate of EV71 and CoxA16 antibody was found in prenatal women in mainland China, and there is a need to enhance the HFMD case management and the current surveillance system. We suggest that infants aged between 6 to 14 months should have the first priority to receive EV71 vaccine.

Trial registration: ClinicalTrials.gov NCT01183611.

Conflict of interest statement

Competing Interests: The authors have the following competing interest: Ying Zeng and Xue-Fang Song are affiliated to Shenzhen Kangtai Biological Products Co., Ltd. There are no patents, products in development or marketed products to declare. This does not alter the authors’ adherence to all the PLoS ONE policies on sharing data and materials, as detailed online in the guide for authors.

Figures

Figure 1. Infection Spectrum of EV71 or…
Figure 1. Infection Spectrum of EV71 or CoxA16.
1 Reported cases of HFMD infections from National Infectious Disease Information Management System. 2 Underreported cases of HFMD infections, went to hospital. 3 Underreported cases of HFMD infections, did not go to hospital. 4 Non-HFMD infections of EV71 or CoxA16. 5 Uninfected.
Figure 2. Reverse cumulative distribution curves of…
Figure 2. Reverse cumulative distribution curves of neutralizing antibody titers in infants at month 2, 7, 12, and 27–38.
Figure 3. Accumulate Incidence density of HFMD…
Figure 3. Accumulate Incidence density of HFMD during the observation period in the infant cohort (from the first baby through October 2010).

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