Phylogenetic analysis based on the 915-nucleotide VP1 gene of CA24v.

<p>All Jiangsu CA24v isolates identified in this study, marked with black triangles, were compared with strains available in GenBank. Strains for which the complete sequences of both the 3Cpro and VP1 regions were available are indicated **. The MEGA 4.0 software was used for the phylogenetic analysis. The stability of the nodes was assessed using neighbor-joining cluster analysis with 1000 bootstrap replications, and only bootstrap values >70% are shown at the nodes.</p

AHC cases reported to NDSIMS in Jiangsu from 2007 to 2010.

<p>AHC cases reported to NDSIMS in Jiangsu from 2007 to 2010.</p

Amino acid mutations in the 3Cpro region in different genotypes of CA24v.

*<p>Amino acid mutation only present in all GIV-C5 strains.</p

Distribution of the reported AHC cases in Jiangsu Province during the outbreak of September 2010.

<p>Distribution of the reported AHC cases in Jiangsu Province during the outbreak of September 2010.</p

Homology of the complete 3Cpro regions of the strains in different clusters within CA24v genotype GIV investigated in this study.

<p>Homology of the complete 3Cpro regions of the strains in different clusters within CA24v genotype GIV investigated in this study.</p

Amino acid mutations in the VP1 region in different genotypes of CA24v.

*<p>Amino acid mutation only present in all GIV-C5 strains.</p

Phylogenetic analysis based on the 549-nucleotide 3Cpro gene of CA24v.

<p>All Jiangsu CA24v isolates identified in this study, marked with black triangles, were compared with strains available in GenBank. Strains for which the complete sequences of both the 3Cpro and VP1 regions were available are indicated with **. The MEGA 4.0 software was used for the phylogenetic analysis. The stability of the nodes was assessed using neighbor-joining cluster analysis with 1000 bootstrap replications, and only bootstrap values >70% are shown at the nodes.</p

Spatiotemporal Dynamics of Hand-Foot-Mouth Disease and Its Relationship with Meteorological Factors in Jiangsu Province, China

<div><p>Hand, foot and mouth disease (HFMD) is an important public health issue in mainland China, including Jiangsu Province. The main purpose of this study was to depict the epidemiological characteristics of HFMD and evaluate the effects of meteorological variables on its dynamics via spatiotemporal analytic methods, which is essential for formulating scientific and effective prevention and control strategies and measures. In total, 497,910 cases of HFMD occurred in the 2009-2013 period, with an average annual incidence of 126.3 per 100,000 in Jiangsu. Out of these, 87.7% were under 5 years old with a male-to-female incidence ratio of 1.4. The dominant pathogens of the laboratory-confirmed cases were EV71 and CoxA16, accounting for 44.8% and 30.6% of all cases, respectively. Two incidence peaks were observed in each year, the higher occurring between April and June, the lower between November and December. The incidence ranged between 16.8 and 233.5 per 100,000 at the county level. The incidence in the South of the province was generally higher than that in the northern regions. The most likely spatiotemporal cluster detected by space–time scan analysis occurred in May-June of 2012 in the southern region. Average temperature and rainfall were positively correlated with HFMD incidence, while the number of days with rainfall ≥ 0.1mm, low temperature, high temperature and hours of sunshine were negatively related. Particularly, relative humidity had no relationship. In conclusion, the prevalence of HFMD in Jiangsu Province has an obvious feature of seasonality. The etiological composition changed dynamically and might be a latent driving force for the temporal variation of the incidence of HFMD. A moderately warm environment promotes the transmission of the HFMD viruses, while particularly cold and hot climate conditions restrain their transmission.</p></div

Spatial distribution of proportion of EV71, CA16 and the other EVs HFMD during 2009–2013 in Jiangsu province, Eastern China.

<p>A. Spatial distribution of proportion of CA16 of HFMD cases. B. Spatial distribution of proportion of EV71 of HFMD cases. C. Spatial distribution of proportion of the other EVs of HFMD cases.</p

Spatial distribution of HFMD during 2009–2013 in Jiangsu province, Eastern China.

<p>A. Spatial distribution of age-standardized incidence of HFMD. B. Spatial distribution of proportion of severe HFMD cases.</p