In this article of EBioMedicine, Chunlan Song and colleagues studied 1109 children with hand, foot and mouth disease (HFMD) [1]. They demonstrated that the ones having throat swabs testing positive for a specific enterovirus serotype via RT-PCR had higher viral genomic loads, which correlated with four markers of clinical severity, namely admission to the ICU, CNS complications, LOS over five days and need for IVIG or steroids. This association was significant for patients infected with EV-A71 and less consistent for higher viral genomic loads of CV-A6. The authors observed a decline in viral load over time after illness onset of all HFMD associated enteroviruses. The association was statistically significant for CV-A6, CV-A10 and CV-A4, but not significant for CV-A2, CV-A16, or EV-A71. In the sensitivity analysis, however, the patients whose throat swabs tested negative for enteroviruses but whose stools tested positive for EV-A71 or CV-A16 were included, which allowed detection of a statistically significant difference, which is consistent with the results of previous studies [2]. This is one of the few and the largest investigations to study the association of enterovirus genomic loads among HFMD patients and their clinical severities. It is notable that less than 5% of the children in this study had an underlying medical condition, and none of the patients were immunocompromised.
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