Hand, foot, and mouth disease outbreak by Coxsackievirus A6 during COVID-19 pandemic in 2021, São Paulo, Brazil

• Published in: Journal of clinical virology Vol. 154; p. 105245
• Main Authors: Carmona, Rita C.C., Machado, Bráulio C., Reis, Fabricio C., Jorge, Adriana M.V., Cilli, Audrey, Dias, Amanda M.N., Morais, Daniele R., Leme, Lucas, Yu, Ana L.F., Silva, Marcela R., Carvalhanas, Telma R.M.P., Timenetsky, Maria C.S.T.
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.09.2022
• Subjects: Brazil - epidemiology; Child; China - epidemiology; COVID-19 - epidemiology; Disease Outbreaks; Enterovirus; Enterovirus Infections - epidemiology; Foot and mouth disease; Hand; Hand, Foot and Mouth Disease - epidemiology; Humans; Infant; Infectious disease; Outbreaks; Pandemics; Preschool children; Short Communication; Brazil; China; Foot and mouth disease; Infectious disease; Outbreaks; Enterovirus; Preschool children; Hand
• ISSN: 1386-6532; 1873-5967
• DOI: 10.1016/j.jcv.2022.105245

•HFMD is a pediatric illness frequently associated with EV-A71, CVA16 and CVA6.•CVA6 D3 sub-lineage was exclusively associated with large HFMD outbreak in São Paulo, Brazil, during the COVID-19 pandemic in 2021.•The incidence of HFMD by CVA6 is increasing worldwide. Hand, foot, and mouth disease (HFMD) is an acute febrile illness characterized by fever; sore throat; and vesicular eruptions on the hands, feet, and oral mucosa. Outbreaks of HFMD in children aged <5 years have been reported worldwide and the major causative agents are Coxsackievirus (CV)A16, enterovirus (EV)-A71 and recently CVA6. The aim of this study was to investigated a large outbreak of Hand, foot, and mouth disease during COVID-19 pandemic in 2021 from clinical samples of 315 suspected cases, in São Paulo State, Brazil. Diagnostic evaluation was performed by RT-qPCR, culture cell isolation and serological neutralization assay. EV-positive were genotyped by partial VP1 genome sequencing. One hundred and forty-nine cases analyzed were positive for enterovirus (47.3%; n = 149/315) by neutralizing test (n = 10 patients) and RT-qPCR (n = 139 patients), and identified as CVA6 sub-lineage D3 by analysis of VP1 partial sequences. This finding indicated the reemergence of CVA6 in HFMD, soon after the gradual easing of non-pharmaceutical interventions during-pandemic COVID-19 and the relevance of continued surveillance of circulating enterovirus types in the post-COVID pandemic era.