Phylogenetic Analysis of Enterovirus 71 Circulating in Beijing, China from 2007 to 2009

Junping Zhu,Na Gao,Hui Chen,Juan Wang,Dongying Fan,Yan Zhang,Zigang Xu,Guoling Ping,Zhen Zhou,Zhen Luo,Jing An,Dong-Yan Jin

doi:10.1371/journal.pone.0056318

Abstract

The major pathogens of hand, foot and mouth disease (HFMD) in Beijing, China from 2007 to 2009 were identified in this study. A total of 186 HFMD cases were included, and 136 cases (73%) were positive for enterovirus (EV). In 2007, 75% (27/36) were Coxsackievirus A16 (CA16) positive and 19% (7/36) were Enterovirus 71 (EV71) positive cases. However, EV71 was the predominant virus in 2008, when 56% (31/55) of the cases were positive for EV71 and 22% (12/55) were positive for CA16. In 2009, EV71 and CA16, with positive rates of 36% (16/45) and 29% (13/45), respectively, were still the major pathogens of HFMD. Phylogenetic analysis revealed that the dominant genotype of EV71 was C4, with co-circulation of genotype A in 2009. The prevalent cluster of the EV71 subgenotype C4 changed over time. A proposed new sublineage of EV71, C4a-2, was the predominant virus associated with the Beijing and nationwide HFMD outbreaks since 2008 and amino acid substitution, which possibly link to the central nervous system tropism of EV71, was found in genotype A viruses. Persistent surveillance of HFMD-associated pathogens is required for predicting potential emerging viruses and related disease outbreaks.

Highlights

Hand, foot and mouth disease (HFMD) is a common childhood viral infection characterized by mucocutaneous papulovesicular lesions on the hands, feet, mouth and buttocks
The disease is primarily caused by human enterovirus group A (HEV-A) members, which belong to the Picornaviridae family
We demonstrated that Coxsackievirus A16 (CA16) was the dominant virus in 2007, while Enterovirus 71 (EV71) became the predominant virus in the 2008 outbreak, and both EV71 and CA16 were major pathogens in 2009

Summary

Introduction

Foot and mouth disease (HFMD) is a common childhood viral infection characterized by mucocutaneous papulovesicular lesions on the hands, feet, mouth and buttocks. The disease is primarily caused by human enterovirus group A (HEV-A) members, which belong to the Picornaviridae family. HEV-A consists of many viruses, including Coxsackievirus A (CA) 2, CA3, CA4, CA5, CA6, CA7, CA8, CA10, CA12, CA14, CA16 and Enterovirus (EV) 71. EV71 and CA16 are the major etiologic agents of HFMD. During recent years, it was frequently reported that patients with EV71 infection had severe complications such as acute flaccid paralysis, myocarditis, aseptic meningitis, brainstem encephalitis, neurogenic pulmonary edema and fatal encephalitis. CA16-associated HFMD with severe complications is rarely observed in clinics [1,2,3]

Objectives

Methods

Results

Conclusion