Abstract
A total of 807 entire VP1 sequences of Coxsackievirus A6 (CV-A6) from mainland of China from 1992 to 2015, including 520 in this study and 287 from the GenBank database, were analysed to provide a basic framework of molecular epidemiological characteristics of CV-A6 in China. Sixty-five VP1 sequences including 46 representative CV-A6 isolates from 807 Chinese strains and 19 international strains from GenBank were used for describing the genotypes and sub-genotypes. The results revealed that CV-A6 strains can be categorised into 4 genotypes designated as A, B, C, and D according to previous data and can be further subdivided into B1–B2, C1–C2, and D1–D3 sub-genotypes. D3 is the predominant sub-genotype that circulated in recent years in mainland of China and represents 734 of 807 Chinese isolates. Sixty-six strains belong to D2, whereas B1 and C1 comprise a single strain each, and five AFP strains formed B2. Sub-genotype D3 first circulated in 2008 and has become the predominant sub-genotype since 2009 and then reached a peak in 2013, while D2 was mostly undetectable in the past years. These data revealed different transmission stages of CV-A6 in mainland of China and that sub-genotype D3 may have stronger transmission ability.
Highlights
Human enterovirus (EV), which belongs to the genus Enterovirus, family Picornaviridae, is a small non-enveloped, positive sense, single-stranded RNA virus[1]
Since 2013, repeated larger-scale HFMD outbreaks caused by Coxsackievirus A6 (CV-A6) have occurred in China, and CV-A6 has become an important virus on the HFMD pathogen spectrum, even replaced EV-A71 and CV-A16 as the leading HFMD pathogen in many Provinces of China in 2013 and 201522, 23
Studies have focused mostly on the predominant serotypes EV-A71 and CV-A16, whereas information about other EVs is still limited because other EV types usually have only caused sporadic cases
Summary
Human enterovirus (EV), which belongs to the genus Enterovirus, family Picornaviridae, is a small non-enveloped, positive sense, single-stranded RNA virus[1]. EV infections are associated with a wide spectrum of illnesses, including mild diseases like a febrile illness and sometimes severe neurological disorders such as aseptic meningitis, myocarditis, acute flaccid paralysis, and encephalitis. In recent years, CV-A6-associated HFMD outbreaks have taken place worldwide, first in Finland in 2008, and this disease circulated in France, Spain, and other European countries from 2009 to 2011. Severe cases caused by CV-A6 were reported in China, characterised by high fever with shorter duration and twitching, as compared with EV-A71-associated severe cases[26], and sometimes cause brainstem encephalitis and aseptic meningitis[27]. The results of this study will provide important basic data for the prevention and control of enteroviral diseases in China and has crucial public health significance and practical utility for the development of effective HFMD prevention and control measures
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