An emerging and expanding clade accounts for the persistent outbreak of Coxsackievirus A6-associated hand, foot, and mouth disease in China since 2013

• Published in: Virology (New York, N.Y.) Vol. 518; pp. 328 - 334
• Main Authors: He, Shuizhen, Chen, Mengyuan, Wu, Wenhui, Yan, Qiang, Zhuo, Zhihao, Su, Xiaosong, Zhang, Shiyin, Ge, Shengxiang, Xia, Ningshao
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2018
• Subjects: Coxsackievirus A6 (CV-A6); Epidemic; Evolution analysis; Hand, foot, and mouth disease (HFMD); Human enteroviruses (human EVs); Epidemic; Human enteroviruses (human EVs); Hand, foot, and mouth disease (HFMD); Evolution analysis; Coxsackievirus A6 (CV-A6)
• ISSN: 0042-6822; 1096-0341
• DOI: 10.1016/j.virol.2018.03.012

Enterovirus (EV)-A71 and Coxsackievirus (CV)-A16 have historically been the major pathogens of hand, foot, and mouth disease (HMFD) in China; however, CV-A6， which had previously received little attention, became the predominant pathogen in 2013, and has remained one of the common pathogens since then. In this work, we conducted a molecular epidemiology study of CV-A6-associated HFMD in Xiamen from 2009 to 2015. The data showed CV-A6 pandemics had a certain periodicity rather than occurring randomly. Evolution analysis based on near-complete VP1 nucleotide sequences showed subgenotype D5 lineage 4 strains account for the persistent outbreak of CV-A6-associated HFMD in China since 2013. Alignment analysis revealed eight candidate amino acid substitutions in VP1, which may provide useful information for the research of CV-A6 virulence enhancement. This study contributed to elucidating the circulation patterns and genetic characteristics of CV-A6 in China; however, further surveillance and intervention in CV-A6 epidemics is recommended. •CV-A6 became the primary pathogen in China in 2013 and 2015.•D5.4 Lineage strains were responsible for CV-A6 epidemics since 2013 in China.•Eight VP1 candidate substitutions were identified between different CV-A6 lineage strains.