Figures & data
a Severe cases. b Mild cases. c Age distribution of HFMD mild and severe cases from 2012 to 2016 in Shanghai. As CV-A6 and CV-A10 was not detected for further EV-serotype identification until 2013, the untyped EV for 2012–2016 shown here may include CV-A6 and CV-A10 infections
Pathogen distribution of HFMD cases in Shanghai, China, 2012–2016
a Continuous lines represent the number of EV-positive HFMD cases; the histogram shows the percentages of EV71, CV-A16 and untyped enterovirus isolated from EV-positive samples. b Monthly distribution of enterovirus serotypes from HFMD cases in Shanghai from 2012 to 2016. *In a, all the untyped EV refers to pan EV-positive but EV71- and CV-A16-negative samples. In b, the untyped EV samples in 2012 correspond to pan EV-positive but EV71- and CV-A16-negative samples, and untyped EV samples from 2013 to 2016 correspond to pan EV-positive but EV71, CV-A16, CV-A6 and CV-A10-negative samples
Fig. 3 Phylogenetic analysis of EV71, CVA16, CV-A6 and CV-A10 circulating in Shanghai in 2012-2016. a Total VP1 gene sequences from 31 EV71 strains (891 bps) in this study and 41 reference sequences downloaded from GenBank were used for phylogenetic analyses. EV71 strains circulating in Shanghai in 2012–2016 belonged to the C4a cluster. b Total VP1 gene sequences from 39 CV-A16 strains (891 bps) in this study and 22 reference sequences downloaded from GenBank were used for phylogenetic analyses. CV-A16 strains circulating in Shanghai in 2012–2016 belonged to B1a and B1b clusters. c Partial VP1 gene sequences from 38 CV-A6 strains (354 bps) in this study and 42 reference sequences downloaded from GenBank were used for phylogenetic analyses. CV-A6 strains circulating in Shanghai in 2012–2016 belonged to D-cluster 1. d Partial VP1 gene sequences from 12 CV-A10 strains (572 bps) in this study and 31 reference sequences downloaded from GenBank were used for phylogenetic analyses. CV-A10 strains circulating in Shanghai in 2012–2016 belonged to B cluster.
Demographic profile of the subjects in three years studied
Overall seroprevalence of HEV 71 and/or CVA 16 antibody
Fig. 4 Seropositive rate of neutralizing antibody against EV71 and CV-A16 in healthy individuals. a Overall neutralising antibody seropositive rate in healthy individuals in Shanghai during 2014–2016. b–c EV71 and CV-A16 neutralising antibody levels from healthy individuals in Shanghai during 2014–2016 before and after the HFMD epidemics.
Fig. 5 Age-dependent seroprevalence and GMT values of EV71 and CV-A16 neutralising antibodies in healthy individuals in Shanghai, 2014–2016. a Age-dependent seropositive rate of neutralizing antibody against EV71. b Age-dependent seropositive rate of neutralizing antibody against CV-A16. c Age-dependent GMT values of neutralizing antibody against EV71. d Age-dependent GMT values of neutralizing antibody against CV-A16.
