Co-circulation of coxsackieviruses A-6, A-10, and A-16 causes hand, foot, and mouth disease in Guangzhou city, China

Jia Xie,Chang-Bin Zhang,Qian-Yi Du,Ke-Yi Chen,Hui-Ying Chai,Ai-Hua Yin,Si-Qi Hu,Hong-Yu Zhao,Xiao-Han Yang,Pan Liu,Ming-Yong Luo,Wen-Li Zhan,Hong Liu

doi:10.1186/s12879-020-04992-x

Jia Xie, Chang-Bin Zhang + Show 11 more

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https://doi.org/10.1186/s12879-020-04992-x

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Abstract

BackgroundHand, foot, and mouth disease (HFMD) is a common infectious disease occurring in children under 5 years of age worldwide, and Enterovirus A71 (EV-A71) and Coxsackievirus A16 (CVA-16) are identified as the predominant pathogens. In recent years, Coxsackievirus A6 (CVA-6) and Coxsackievirus A10 (CVA-10) have played more and more important role in a series of HFMD outbreaks. This study aimed to understand the epidemic characteristics associated with HFMD outbreak in Guangzhou, 2018.MethodsThe clinical and laboratory data of 1220 enterovirus-associated HFMD patients in 2018 were analysed in this study. Molecular diagnostic methods were performed to identify its serotypes. Phylogenetic analyses were depicted based on the complete VP1 gene.ResultsThere were 21 enterovirus serotypes detected in Guangzhou in 2018. Three serotypes of enterovirus, CVA-6 (364/1220, 29.8%), CVA-10 (305/1220, 25.0%), and CVA-16 (397/1220, 32.5%), were identified as the causative pathogens and accounted for 87.3% among all 1220 HFMD patients. In different seasons, CVA-6 was the predominant pathogen of HFMD during autumn, and CVA-10 as well as CVA-16 were more prevalent in summer. Patients infected by CVA-6, CVA-10 or CVA-16 showed similar clinical features and laboratory characteristics, and the ratios of severe HFMD were 5.8, 5.9, and 1.5% in the three serotypes. Phylogenetic analyses of VP1 sequences showed that the CVA-6, CVA-10, and CVA-16 sequences belonged to the sub-genogroup E2, genogroup E, and genogroup B1, respectively.ConclusionsCVA-6, CVA-10, and CVA-16 were the predominant and co-circulated serotypes in Guangzhou China, 2018, which should be the new target for prevention and control of HFMD. Our findings provide useful information for diagnosis, treatment, and prevention of HFMD.

Highlights

Hand, foot, and mouth disease (HFMD) is a common infectious disease occurring in children under 5 years of age worldwide, and Enterovirus A71 (EV-A71) and Coxsackievirus A16 (CVA-16) are identified as the predominant pathogens
Enterovirus seortype In 2018, 1220 children with laboratory-confirmed HFMD were enrolled in this study, and the three dominant serotypes were CVA-6 (n = 364, 29.8%), CVA-10 (n = 305, 25.0%), and CVA-16 (n = 397, 32.5%), accounting for 87.3% of all EV-positive cases
A peak in the number of cases was observed in May and June, which coincided with the co-circulation of CVA-10 and CVA-16

Summary

Introduction

Foot, and mouth disease (HFMD) is a common infectious disease occurring in children under 5 years of age worldwide, and Enterovirus A71 (EV-A71) and Coxsackievirus A16 (CVA-16) are identified as the predominant pathogens. Foot, and mouth disease (HFMD), a common contagious disorder in children under 5 years of age, is characterised by a brief, generally mild, febrile illness with multiple oral ulcers, and eruption of vesiculo-papular rashes over the hands, feet, mouth, and buttocks [1,2,3]. Over 100 recognised EV serotypes exist, classified into four groups, namely, EV-A to EV-D [6] Their genome comprises one open reading frame, which encodes four structural viral proteins (VP1, VP2, VP3, and VP4) and seven nonstructural proteins (2A-2C and 3A-3D) [7]. VP1, the main region encoding neutralising epitopes, contains virulence determinants and provides conclusive evidence regarding the phylogeny and genotype of these viruses [8]

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