High prevalence of coxsackievirus A2 in children with herpangina in Thailand in 2015

Abstract

Coxsackievirus (CV) is a member of the genus Enterovirus and the family Picornaviridae. CV infection can cause herpangina, a disease characterized by multiple ulcers on the tonsils and soft palate affecting mostly young children. CV strains are categorized by serotypes. Unfortunately, serotypes responsible for infections in patients are often undetermined. This knowledge gap partly contributes to the ineffective prevention and control of CV-associated herpangina in Southeast Asia. To characterize the viral etiology of children presented with herpangina, 295 throat swabs were tested for human enterovirus infection. Using RT-PCR specific for the viral 5 0 UTR/VP2 and the VP1 regions, two most frequent CV types found in these samples were CV-A2 (33.33%, 40/120) and CV-A4 (15.8%, 19/120). Phylogenetic analysis of the VP1 gene demonstrated that the CV-A2 strains in this study not only were closely related to those previously identified in Asia and Europe, but the majority clustered into a distinct group. Thus, infection predominantly by CV-A2 and CV-A4 caused herpangina in 2015 in Thailand.

Persistent circulation of genotype D coxsackievirus A2 in mainland of China since 2008

“…The skyline plot showed that between 2009–2011 some genetic diversity was observed, which might be a consequence of establishment of the systematic surveillance of HFMD since 2008. Another burst of the skyline plot was observed after 2011, probably because of faster and increasing branch of evolution of CV-A2 at that time which were accordance with repeated CV-A2 outbreaks reports after 2011 [ 7 , 8 ]. The genetic diversity of genotype D CV-A2 in China increased between 2011–2012.…”

“…The VP1 coding region is responsible for inducing the human neutralizing antibody response and has been found to correlate well with identified serotypes [ 2 – 4 ]. Coxsackievirus A2 (CV-A2), which belongs to species EV-A, has emerged as an active pathogen that has been implicated in several HFMD and herpangina outbreaks worldwide since 2008, including in Taiwan in 2008 [ 5 ], Hong Kong in 2012 [ 6 ], Thailand in 2015 [ 7 ], and Hangzhou, mainland of China in 2015 [ 8 ]. In this study, we analyzed entire VP1 nucleotide sequences collected from 2008 to 2017 to investigate the evolutionary dynamics of emerging CV-A2 in mainland of China.…”

Molecular epidemiology and clinical characteristics of herpangina children in Beijing, China: a surveillance study

“…There have been a number of outbreaks of herpangina in various regions of the world, most of which were dominated by CV-A2 and CV-A10 strains. CV-A2 infection was prevalent in Thailand (2015) ( Chansaenroj et al, 2017 ), Chinese Taiwan (2008) ( Lee et al, 2011 ), Guangdong (2015) ( Peng et al, 2016 ) and Zhejiang Province (2015)( Li et al, 2016c ), while CV-A10 infection was prevalent in France (2010) ( Mirand et al., 2012 ), and Tianjin City (2014-2016) ( Li et al., 2018a ; Li et al., 2016a ) of China. In addition, there are also outbreaks of CV-A5, CV-A16 and CV-A4 ( Huo et al, 2017 ; Park et al, 2012 ; Shima et al, 2007 ).…”

“…There have been multiple outbreaks of herpangina in Asian countries, including China, Thailand, Japan and Korea since 2009 ( Chansaenroj et al, 2017 ; Li et al, 2016b ; Park et al, 2012 ; Yamashita et al, 2005 ). Like hand, foot and mouth disease (HFMD), herpangina is mainly caused by enteroviruses (EVs) ( Yao et al, 2017 ), particularly coxsackievirus (CV).…”

“…Like hand, foot and mouth disease (HFMD), herpangina is mainly caused by enteroviruses (EVs) ( Yao et al, 2017 ), particularly coxsackievirus (CV). The dominant EV serotypes were CV-A2 and CV-A5 in Korea in 2009( Park et al, 2012 ), CV-A10 and CV-A6 in France in 2010 ( Mirand et al, 2012 ), CV-A2 and CV-A4 in Thailand in 2015 ( Chansaenroj et al, 2017 ), respectively. A surveillance of 10,210 herpangina cases revealed that CV-A2 was the predominant EV serotype in 2015 in Zhejiang, China ( Li et al, 2016c ).…”