The first Boston disease vaccine

The latest research conducted by Feng-Cai Zhu et al. from Regional Centre for Disease Prevention and Control in Nanjing have contributed to the development of the first vaccine for human enterovirus 71 (EV-71). The virus is considered to be the main cause of hand, foot and mouth disease. In China over a million of people suffer from it and several hundred die because of it every year.

Boston disease, which is also called HFMD- hand, foot and mouth disease or enteroviral vesicular stomatitis with eczema, is highly inflammatory disease caused by Picornaviridae viruses – most often by enterovirus EV-71, less often by type A of Coxackie virus. The disease is an airborne one and may also be transferred by the direct contact with the patient’s secretion. The virus is also located in pustular fluid.

The disease’s prodromal period lasts 4-6 days. Usually, it has benign course with minor symptoms lasting for 7 days. Apart from the constitutional symptoms it is characterized by blains and ulcers, which are painful in advanced stage of the disease. In most cases the efflorescences heal over without use of any medications. Rarely, the disease’s course is severe and is accompanied by neurological complications namely, non-purulent meningitis which, especially in young patients, may cause death. Another complications may be diabetes mellitus type 1, pulmonary oedema, bleeding into lungs and myocarditis.

The Boston disease appear all over the world but most commonly it is found in Eastern Asia. It affects mainly children. In China about 1,8 million of cases were reported in 2010. 905 of afflicted people died. Regarding the lack of vaccine for the virus which causes HFMD, only symptomatic treatment was used until now.

10 245 volunteers took part in controlled research on the efficiency of the vaccine. 5120 of them were a research group and 5125 control group. The participants of the research were healthy children from 6 to 35 month of life which within 4 weeks were administered 2 intramuscular injections. The control group was given a placebo. The efficiency of the vaccine was 90%. It prevents from the disease caused by this specific virus. However, it is EV-71 which is responsible for the majority of HFMD cases with dangerous complications. In about 70% of children vaccination has caused complications namely, benign topical reactions to the injection.

Regarding the fact that the vaccine prevents only from disease caused by EV-71, the scientists have not decided yet whether it should be introduced. Currently, other vaccines e.g. for streptococcus pneumonia, rotaviruses or human papillomavirus are considered.

Written by: Anna Szajerska, Karolina Gasińska

Source:
1. Feng-Cai Zhu, Fan-Yue Meng, Jing-Xin Li, et al. Efficacy, safety, and immunology of an inactivated alum-adjuvant enterovirus 71 vaccine in children in China: a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial. The Lancet. 2013, 9882 (381): 2024 – 2032. doi:10.1016/S0140-6736(13)61049-1
2. Mu Z, Wang B, Zhang X, et al. Crystal Structure of 2A Proteinase from Hand, Foot and Mouth Disease Virus, J Mol Biol. 2013. doi: 10.1016/j.jmb.2013.08.016.
3. Ho M, Chen ER, Hsu KH, et al. An epidemic of enterovirus 71 infection in Taiwan. Taiwan Enterovirus Epidemic Working Group. N. Engl. J. Med. 1999. 341 (13): 929–35. doi:10.1056/NEJM199909233411301. PMID 10498487.
4. Źródło internetowe: http://www.gis.gov.pl/dep/?lang=pl&dep=13&id=82 [Data odsłony 13.09.2013 r.]
5. Źródło internetowe: http://www.aerzteblatt.de/nachrichten/54595/Erster-Impfstoff-gegen-die-Hand-Fuss-Mund-Krankheit [Data odsłony 13.09.2013 r.]
6. Źródło internetowe: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2813%2961049-1/abstract [Data odsłony 13.09.2013 r.]


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