Hand, Foot, and Mouth Disease Caused by Coxsackievirus A6

Emerging Infectious Diseases (Impact Factor: 6.75). 10/2012; 18(10):1702-4. DOI: 10.3201/eid1810.120813
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TO THE EDITOR: Coxsackievirus A6 (CVA6) is a human enterovirus associated with herpangina in infants. In the winter of 2012, we evaluated a cluster of 8 patients, 4 months-3 years of age, who were brought for treatment at Boston Children's Hospital (Boston, MA, USA) with a variant of hand, foot, and mouth disease (HFMD) that has now been linked to CVA6 (Table). During this same period, the Boston Public Health Commission's syndromic surveillance system detected a 3.3-fold increase in emergency department discharge diagnoses of HFMD. In the United States, HFMD typically occurs in the summer and early autumn and is characterized by a febrile enanthem of oral ulcers and macular or vesicular lesions on the palms and soles; the etiologic agents are most often CVA16 and enterovirus 71.

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    • "In the Boston HFMD outbreak caused by CV-A6 in the winter of 2012, perioral papules and perirectal eruption exhibited as the characteristic feature in patients [13]. But perirectal eruption was not observed obviously in Finland series CVA6 outbreaks in 2008 and Taiwan CVA6 outbreak in 2010[13, 23]. In our study, perirectal eruption was not found visibly. "
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    ABSTRACT: Background Hand, foot and mouth disease (HFMD) is usually caused by Enterovirus 71(EV71), and Coxsackievirus A16 (CV-A16) in Guangzhou, the biggest city of South China. However, Coxsackievirus A6 (CV-A6) were observed increased dramatically from 2010–2012. Methods In order to understand and to describe the epidemiologic and genetic characteristics of CV-A6, specimens of 5482 suspected HFMD cases were collected and examined by real-time fluorescence PCR. All samples positive for enteroviruses were analyzed by descriptive statistics. Phylogenetic analysis of CV-A6 based on the VP1 sequences was performed to investigate molecular and evolutionary characteristics. Results Coxsackievirus A6 increased dramatically from 9.04% in 2010 to 23.21% in 2012 and became one of the main causative agents of HFMD in Guangzhou. CV-A6 attack rates were highest in one to two year olds (33.14%). Typical clinic symptoms of CV-A6 HFMD include fever (589/720, 81.81%), maculopopular rash and vesicular exanthema around the perioral area (408/720, 56.66%), intraoral (545/720, 75.69%), the buttock (395/720, 54.86%), the trunk (244/720, 33.89%), the knee (188/720, 26.11%), and the dorsal aspects of hands (437/720, 60.69%). Phylogenetic analysis showed the CV-A6 isolates in this study belonged to Cluster A1 and were similar to those found in Shanghai in 2011 and 2012 (JX495148, KC414735), Shenzhen in 2011 (JX473394), Japan in 2011 (AB649243, AB649246), France in 2010(HE572928), Thailand in 2012(JX556564) and Israel in 2012 and 2013(.KF991010, KF991012). Electronic supplementary material The online version of this article (doi:10.1186/1743-422X-11-157) contains supplementary material, which is available to authorized users.
    Virology Journal 09/2014; 11(1):157. DOI:10.1186/1743-422X-11-157 · 2.18 Impact Factor
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    • "Studies on clinical complications caused by specific types of enteroviruses have been reported. Among multiple enterovirus types associated with recent HFMD and herpangina outbreaks, CAV6 has been recognized as an emerging causative virus since the epidemics in Finland and Singapore in 2008 [26]–[28] and its global dissemination thereafter in Taiwan in 2010 [29], Japan and Spain in 2011 [30], [31] and the United State in 2012 [32]. In our previous study, we have reported on large scale outbreaks of HFMD and herpangina in Thailand during the rainy season in 2012 with approximately 40,000 suspected cases all over the country, and shown that CAV6 played an important role during the outbreak in 2012 [33]. "
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    ABSTRACT: Hand, foot, and mouth disease (HFMD) and herpangina are common infectious diseases caused by several genotypes of human enterovirus species A and frequently occurring in young children. This study was aimed at analyzing enteroviruses from patients with these diseases in Thailand in 2012. Detection and genotype determination of enteroviruses were accomplished by reverse transcription-polymerase chain reaction and sequencing of the VP1 region. Enterovirus-positive samples were differentiated into 17 genotypes (coxsackievirus A4 (CAV4), A5, A6, A8, A9, A10, A12, A16, A21, B1, B2, B4, B5, echovirus 7, 16, 25 and Enterovirus 71). The result showed CAV6 (33.5%), followed by CAV16 (9.4%) and EV71 (8.8%) as the most frequent genotypes in HFMD, CAV8 (19.3%) in herpangina and CAV6 (1.5%) in influenza like illness. Enterovirus infections were most prevalent during July with 34.4% in HFMD, 39.8% in herpangina and 1.6% in ILI. The higher enterovirus infection associated with HFMD and herpangina occurred in infants over one year-old. This represents the first report describing the circulation of multiple enteroviruses in Thailand.
    PLoS ONE 06/2014; 9(6):e98888. DOI:10.1371/journal.pone.0098888 · 3.23 Impact Factor
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    • "According to meteorological parameters provided by the Meteorological Bureau of Shandong Province, the mean temperature of Linyi City during the winter of 2010 was 0.6°C higher than that in 2009. Flett et al. suggested that atypical seasonality of HFMD outbreaks during winter might be related to unusually mild temperatures [24]. Research in Hong Kong has also indicated that altered disease etiology of HFMD might be explained by increased winter temperatures [25]. "
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    ABSTRACT: To analyze the epidemiological characteristics and pathogenic molecular characteristics of an hand, foot, and mouth disease (HFMD) outbreak caused by enterovirus 71 in Linyi City, Shandong Province, China during November 30 to December 28, 2010. One hundred and seventy three stool specimens and 40 throat samples were collected from 173 hospitalized cases. Epidemiologic and clinical investigations, laboratory testing, and genetic analyses were performed to identify the causal pathogen of the outbreak. Among the 173 cases reported in December 2010, the male-female ratio was 1.88: 1; 23 cases (13.3%) were severe. The majority of patients were children aged < 5 years (95.4%). Some patients developed respiratory symptoms including runny nose (38.2%), cough (20.2%), and sore throat (14.5%). One hundred and thirty eight EV71 positive cases were identified based on real time reverse-transcription PCR detection and 107 isolates were sequenced with the VP1 region. Phylogenetic analysis of full-length VP1 sequences of 107 Linyi EV71 isolates showed that they belonged to the C4a cluster of the C4 subgenotype and were divided into 3 lineages (Lineage I, II and III). The two amino acid substitutions (Gly and Gln for Glu) at position 145 within the VP1 region are more likely to appear in EV71 isolates from severe cases (52.2%) than those recovered from mild cases (8.3%). This outbreak of HMFD was caused by EV71 in an atypical winter. EV71 strains associated with this outbreak represented three separate chains of transmission. Substitution at amino acid position 145 of the VP1 region of EV71 might be an important virulence marker for severe cases. These findings suggest that continued surveillance for EV71 variants has the potential to greatly impact HFMD prevention and control.
    BMC Infectious Diseases 03/2014; 14(1):123. DOI:10.1186/1471-2334-14-123 · 2.61 Impact Factor
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