Circulation of Coxsackievirus A6 in hand-foot-mouth disease in Guangzhou, 2010-2012

Abstract

BackgroundHand, foot and mouth disease (HFMD) is usually caused by Enterovirus 71(EV71), and Coxsackievirus A16 (CV-A16) in Guangzhou, the biggest city of South China. However, Coxsackievirus A6 (CV-A6) were observed increased dramatically from 2010–2012.MethodsIn order to understand and to describe the epidemiologic and genetic characteristics of CV-A6, specimens of 5482 suspected HFMD cases were collected and examined by real-time fluorescence PCR. All samples positive for enteroviruses were analyzed by descriptive statistics. Phylogenetic analysis of CV-A6 based on the VP1 sequences was performed to investigate molecular and evolutionary characteristics.ResultsCoxsackievirus A6 increased dramatically from 9.04% in 2010 to 23.21% in 2012 and became one of the main causative agents of HFMD in Guangzhou. CV-A6 attack rates were highest in one to two year olds (33.14%). Typical clinic symptoms of CV-A6 HFMD include fever (589/720, 81.81%), maculopopular rash and vesicular exanthema around the perioral area (408/720, 56.66%), intraoral (545/720, 75.69%), the buttock (395/720, 54.86%), the trunk (244/720, 33.89%), the knee (188/720, 26.11%), and the dorsal aspects of hands (437/720, 60.69%). Phylogenetic analysis showed the CV-A6 isolates in this study belonged to Cluster A1 and were similar to those found in Shanghai in 2011 and 2012 (JX495148, KC414735), Shenzhen in 2011 (JX473394), Japan in 2011 (AB649243, AB649246), France in 2010(HE572928), Thailand in 2012(JX556564) and Israel in 2012 and 2013(.KF991010, KF991012).Electronic supplementary materialThe online version of this article (doi:10.1186/1743-422X-11-157) contains supplementary material, which is available to authorized users.

Fourteen types of co-circulating recombinant enterovirus were associated with hand, foot, and mouth disease in children from Wenzhou, China

“…Indeed, and in agreement with previous studies [12], nearly half of the severe HFMD cases observed in Wenzhou were due to EV-A71, while infections by other enteroviruses often had a mild manifestation. We also confirmed the atypical clinical presentation (more widespread rash, larger blisters and subsequent skin peeling and/or nail shedding) associated with CV-A6 infection [30][31][32][33][34][38][39][40][41][42][43][44][45], and which also affected younger children than EV-A71.…”

“…Our data indicates that most of HFMD cases in Wenzhou were caused by CV-A6. Given the presence of CV-A6 in other parts of China [18,20,38] and abroad [30][31][32][33][34][39][40][41][42][43][44][45], it is clear that more widespread surveillance is needed to determine its potential to ignite a global pandemic.…”

An atypical course of coxsackievirus A6 associated hand, foot and mouth disease in extremely low birth weight preterm twins

“…The most prominent symptoms include fever and a variety of skin lesions, such as maculopapular or vesicular eruptions in the oral cavity and on the distal extremities, buttocks and genital [1]. HFMD can be caused by multiple different serotypes of human enteroviruses of which enterovirus 71 and coxsackievirus (CV) A16 are most often associated with major outbreaks of HFMD worldwide [2].…”

Coxsackievirus A6 (CV-A6) Encephalomyelitis in an Immunocompromised Child: a Case Report and Brief Review of the Literature

“…In addition, atypical skin manifestations like widespread mucocutaneous bullous reactions mimicking drug adverse reactions, vesiculobullous erosive eruptions, severe vasculitislike rash, rash similar to eczema herpeticum or chickenpox, or rash resembling primary immunobullous disease have been frequently described (6,7). Severe and rare manifestations such as aseptic meningitis, encephalitis, and epididymitis have been reported among children (8,9). From India, Gopal Krishna et al, during the year 2012 published a small cohort of HFMD cases collected from the southern and eastern parts of the country and more than 90% of the infections were attributed to CV-A16 and CV-A6.…”