Comparison of Nonpolio Enteroviruses in Children With Herpangina and Hand, Foot and Mouth Disease in Taiwan

Abstract

Herpangina Outbreak Reports On 4 April 2018 we searched in PubMed using ((enterovir* OR coxack*) AND ((hand AND foot AND mouth) OR (herpangina))) for published studies on viral characteristics of herpangina in East or Southeast Asia, but there have only been reports for individual outbreaks over a short duration of time (typically under one year), and only reported in small areas in Thailand 2015 1-3 , China 4-7 ; Korea 2009 8,9 , and Taiwan 10. Additionally there are reports written in Japanese, published in Japanese Journal of Infectious Disease. We did not find any report investigating viral characteristics of herpangina at a larger or longer scale.

Global landscape of coxsackieviruses in human health

“…Herpangina, like HFMD, is primarily caused by EVs, particularly CVs. Although the majority of herpangina cases have been mostly associated with CVA2, CVA4, CVA6, and CVA10 ( Table 1 ) other CVs types are also responsible for outbreaks/sporadic cases, including CVA1, CVA3, CVA5, CVA7, CVA8, CVA9, CVA12, CVA16, CVA20, CVA22, CVA24, CVB1, CVB2, CVB3, CVB4, CVB5, CVB6 ( Table 1 ) ( Yao et al, 2017 ; Yang et al, 2019 ; Ai et al, 2021 ; Kim et al, 2023 ; Zhao et al, 2020 ; Wenner, 1972 ; Cherry and Krogstad, 2009 ). Additionally, EV coinfection, especially CVs C-species, can favor the emergence of uncommon symptoms ( Zhu et al, 2023 ; Yao et al, 2017 ).…”

“… Associated-diseases Coxsackievirus identified Number of coxsackieviruses types identified Ref. Species A Species B Species C Total HFMD CVA2, CVA4, CVA5, CVA6, CVA7, CVA8, CVA10, CVA12, CVA14, CVA16 CVA9, CVB1-B5 CVA1, CVA11, CVA13, CVA19, CVA20, CVA21, CVA22, CVA24 10 6 8 24 ( Tapparel et al, 2013 ; Sousa et al, 2018 ; Mirand et al, 2012 ; Guan et al, 2015 ; Puenpa et al, 2014 ; Zhu et al, 2023 ; Yao et al, 2017 ; C. Wang et al, 2018 ; Yi et al, 2022 ; Liu et al, 2023 ; Duong et al, 2016 ) Herpangina and other skin manifestations ( CVA2, CVA3, CVA4, CVA5, CVA6, CVA7, CVA8, CVA10, CVA12, CVA16 CVA9, CVB1-B6 CVA1, CVA20, CVA22, CVA24 10 7 4 21 ( Yao et al, 2017 ; Yang et al, 2019 ; Ai et al, 2021 ; Kim et al, 2023 ; Zhao et al, 2020 ; Wenner, 1972 ; Cherry and Krogstad, 2009 ; Cherry, 1982 ) Acute respiratory tract infection CVA2, CVA4, CVA5, CVA6, CVA7, CVA8, CVA10, CVA12, CVA14, CVA16 CVA9, CVB1-B6 CVA21, CVA24 10 7 2 19 ( Xiang et al, 2012 ; Zou et al, 2017 ; Hang et al, 2017 ; B'Krong et al, 2018 ; Jacques et al, 2008 ; Suryadevara et al, 2022 ; Anon., Reports on Isolation/Detection of Viruses, 2005 ) …”

Seasonal Testing, Results, and Effect of the Pandemic on Coxsackievirus Serum Studies

“…The majority of enteroviral serotypes causing herpangina and HFMD belong to coxsackievirus A [ 23 , 24 , 25 , 26 ]. Outbreaks of HFMD have emerged most commonly with coxsackievirus A6 [ 25 , 27 , 28 , 29 , 30 ], A10 [ 31 , 32 ], A16 [ 33 , 34 ], and EV-A71 [ 34 , 35 ]. Although CVA infections are typically mild, there have been rare reports of fatalities associated with coxsackievirus A16 infection, including cases of infantile myocarditis [ 36 ] and pneumonitis in an adult [ 37 ].…”

Hand, foot, and mouth disease: could EPs® 7630 be a treatment option? A prospective randomized open-label multicenter clinical study

“…It is caused by picornaviruses, specifically human enteroviruses (EVs) and coxsackieviruses (CVs) ( 2 ). Although CV-A16 and EV-A71 were the most frequently responsible serotypes for a long time, CV-A6 and CV-A10 have been linked to various outbreaks in Asia, America, and Europe in recent years ( 3 – 6 ). The disease is characterized by fever, painful oral enanthem, and a macular, maculopapular, or vesicular rash on the hands and feet ( 1 , 7 , 8 ).…”