Open Access Highly Accessed Open Badges Research

Seroepidemiology of human enterovirus71 and coxsackievirusA16 in Jiangsu province, China

Hong Ji1, Liang Li1, YanMing Liu2, HengMing Ge3, XuShan Wang4, JianLi Hu1, Bin Wu1, JianGuang Fu1, ZhenYu Zhang3, XiaoQin Chen3, MingLei Zhang3, Qiang Ding4, WenBo Xu2, FenYang Tang1, MingHao Zhou1, Hua Wang1 and FengCai Zhu1*

Author Affiliations

1 Jiangsu Provincial Center for Disease Control and Prevention, No.172, Jiangsu Road, Gulou District, Nanjing, 210009 Jiangsu Province, China

2 Chinese Center for Disease Control and Prevention, No.155, Changbai Road, Changping District, Beijing 102206, China

3 Donghai County Center for Disease Control and Prevention, Jingdu Road, Niushan Town, Donghai County, Lianyungang City, Jiangsu Province, China

4 Ganyu County Center for Disease Control and Prevention, Huanghai Road, Qingkou Town, Ganyu County, Lianyungang City, Jiangsu Province, China

For all author emails, please log on.

Virology Journal 2012, 9:248  doi:10.1186/1743-422X-9-248

Published: 29 October 2012



The major etiology of hand, foot and mouth disease (HFMD) is infection with human enterovirus A (HEV-A). Among subtypes of HEV-A, coxsackievirusA16 (CoxA16) and enterovirus 71 (EV71) are major causes for recurrent HFMD among infants and children in Jiangsu Province, mainland China. Here, we analyzed maternal antibodies between prenatal women and their neonates, to determine age-specific seroprevalence of human EV71 and CoxA16 infections in infants and children aged 0 to 15 years. The results may facilitate the development of immunization against HFMD.


This study used cross-section of 40 pairs of pregnant women and neonates and 800 subjects aged 1 month to 15 years old. Micro-dose cytopathogenic effects measured neutralizing antibodies against EV71 and CoxA16. Chi-square test compared seroprevalence rates between age groups and McNemar test, paired-Samples t-test and independent-samples t-test analyzed differences of geometric mean titers.


A strong correlation between titers of neutralizing antibody against EV71 and CoxA16 in prenatal women and neonates was observed (rEV71 = 0.67, rCoxA16 = 0.56, respectively, p < 0.05). Seroprevalence rates of anti-EV71 antibody gradually decreased with age between 0 to 6 months old, remained low between 7 to 11 months (5.0–10.0%), and increased between 1 and 4 years (22.5–87.5%). Age-specific seroprevalence rates of anti-EV71 antibody stabilized in >80% of children between 5 to 15 years of age. However, seroprevalence rates of anti-CoxA16 antibody were very low (0.0–13.0%) between 0 to 6 months of age, gradually increased between 7 months to 4 years (15.0–70.0%), and stabilized at 54.0% (108/200) between 5 to 15 years. Seroprevalence rates against EV71 and CoxA16 were low under 1 year (0.0–10.0%), and showed an age dependent increase with high seroprevalence (52.5–62.5%) between 4 and10 years of age.


Concomitant infection of EV71 and CoxA16 was common in Jiangsu Province. Therefore, development of bivalent vaccine against both EV71 and CoxA16 is critical. The optimal schedule for vaccination may be 4 to11 months of age.

Human enterovirus71; CoxsackievirusA16; Maternally-acquired immunity; Neutralizing antibody; Hand, foot and mouth disease; Seroepidemiology