Complete genome analysis demonstrates multiple introductions of enterovirus 71 and coxsackievirus A16 recombinant strains into Thailand during the past decade

Pirom Noisumdaeng,Kantima Sangsiriwut,Jarunee Prasertsopon,Chompunuch Klinmalai,Sunchai Payungporn,Anek Mungaomklang,Kulkanya Chokephaibulkit,Rome Buathong,Arunee Thitithanyanont,Pilaipan Puthavathana

doi:10.1038/s41426-018-0215-x

Pirom Noisumdaeng, Kantima Sangsiriwut + Show 8 more

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https://doi.org/10.1038/s41426-018-0215-x

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Hand, foot, and mouth disease (HFMD) caused by enteroviruses remains a public health threat, particularly in the Asia-Pacific region during the past two decades. Moreover, the introduction of multiple subgenotypes and the emergence of recombinant viruses is of epidemiological importance. Based on either the full genome or VP1 sequences, 32 enteroviruses (30 from HFMD patients, 1 from an encephalitic patient, and 1 from an asymptomatic contact case) isolated in Thailand between 2006 and 2014 were identified as 25 enterovirus 71 (EV71) isolates (comprising 20 B5, 1 C2, 2 C4a, and 2 C4b subgenotypes) and 7 coxsackievirus A16 (CA16) isolates (comprising 6 B1a and 1 B1b subgenotypes). The EV71 subgenotype C4b was introduced into Thailand for the first time in 2006 and was replaced by subgenotype C4a strains in 2009. Phylogenetic, similarity plot and bootscan analyses of the complete viral genomes identified 12 recombinant viruses among the 32 viral isolates. Only one EV71-B5 isolate out of 20 was a recombinant virus with one region of intratypic or intertypic recombination, while all four EV71-C4 isolates were recombinant viruses having undergone double recombination, and all seven CA16 isolates were recombinant viruses. The recombination breakpoints of these recombinants are located solely within the P2 and P3 regions. Surveillance for circulating strains and subgenotype replacement are important with respect to molecular epidemiology and the selection of the upcoming EV71 vaccine. In addition, the clinical importance of recombinant viruses needs to be further explored.

Highlights

Hand, foot, and mouth disease (HFMD) is an acute febrile illness characterized by vesicular eruptions on the palms of the hands, the feet, and in the oral cavity and is common in children under 5 years of age worldwide[1,2,3,4].HFMD was recognized as an emerging disease after large outbreaks of the disease in Malaysia in 1997 and Taiwan in 19985–8
This study identified SI01/TH(NMA)/ 06 as the first C4b strain introduced into Thailand in 2006, a virus that was isolated from a child who died of encephalitis
Molecular epidemiology and field investigations suggested that this strain originated from Shenzhen, China[46]

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Introduction

Foot, and mouth disease (HFMD) is an acute febrile illness characterized by vesicular eruptions on the palms of the hands, the feet, and in the oral cavity and is common in children under 5 years of age worldwide[1,2,3,4]. HFMD was recognized as an emerging disease after large outbreaks of the disease in Malaysia in 1997 and Taiwan in 19985–8. Outbreaks of HFMD were reported in several part of the Asia-Pacific region. HFMD is an endemic disease in the People’s. In Thailand, HFMD has been listed as a disease to be notified to the Ministry of Public Health since 2001. Noisumdaeng et al Emerging Microbes & Infections (2018)7:214

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