The HFMD surveillance system was established with the national HFMD surveillance system in May 2008. The specimens were collected from the first five mild, probable HFMD patients who visited the hospitals every month in each of the 137 counties or districts and from all the severe and fatal cases in Shandong province. Depending on the symptoms and clinical status of each patient, the following clinical specimens were collected: throat swab, rectal swab, feces, vesicular fluid or cerebrospinal fluid.
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