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.

Highlights

  • Hand, 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

  • Hand, foot and mouth disease (HFMD) is a common epidemic causing childhood infection caused by enteroviruses

  • From January 2010 to December 2012, a total of 5482 suspected HFMD cases were identified, 4111 (75%) of which were positive by the pan-EV test

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Summary

Methods

Sample collection Feces, stool, throat swabs and cerebrospinal fluid samples were collected from HFMD cases presenting at Guangzhou from 5 surveillance hospitals (Guangdong Women and Children Hospital, Guangzhou Yuexiu District Children Hospital, Zengcheng People’s Hospital, Guangzhou Huado Distrit People’s Hospital, and Huangpu Branch of the First Affiliated Hospital, Sun Yat-sen University) and 12 districts CDCs in Guangzhou. CV-A6 detection and genotyping The collected samples were amplified using the pan EV fluorescent kit (Guangzhou Huayin medical technology Inc.) for enterovirus detection. Positive samples were further sub-typed using an EV71/ CV-A16 RNA fluorescent PCR combo-test kit and a CVA6 fluorescent PCR kit (Guangzhou Huayin medical technology Inc.). Analysis of pathogen evolution Representative isolates were selected for VP1 nucleic acid sequencing, following the method described above. Authors’ contributions DB and ZY carried out the molecular genetic studies and epidemiology analysis, participated in the sequence alignment and drafted the manuscript. XH and LX carried out the sample collection, Real-time PCR and virus isolation. WD participated in the design of the study and performed the statistical analysis.

Results
Background
Results and discussion

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