Coxsackievirus A6 and Hand, Foot, and Mouth Disease, Finland

University of Turku, Turku, Finland.
Emerging Infectious Diseases (Impact Factor: 6.75). 09/2009; 15(9):1485-8. DOI: 10.3201/eid1509.090438
Source: PubMed


During fall 2008, an outbreak of hand, foot, and mouth disease (HFMD) with onychomadesis (nail shedding) as a common feature occurred in Finland. We identified an unusual enterovirus type, coxsackievirus A6 (CVA6), as the causative agent. CVA6 infections may be emerging as a new and major cause of epidemic HFMD.

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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.
    Full-text · Article · Sep 2014 · Virology Journal
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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.
    Full-text · Article · Jun 2014 · PLoS ONE
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    • "Interestingly, CV-A6 appeared sporadically since 2008 until it became the major genotype in 2012. It is noteworthy that CV-A6 was associated with HFMD and HA outbreaks in Japan [64,65], Finland [66,67], Singapore [53], Taiwan [68], China [69,70], Spain [71,72], and France [73] between 2005 and 2012. "
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    ABSTRACT: Human enterovirus 71 (EV71) is an important pathogen caused large outbreaks in Asian-Pacific region with severe neurological complications and may lead to death in young children. Understanding of the etiological spectrum and epidemic changes of enterovirus and population's immunity against EV71 are crucial for the implementation of future therapeutic and prophylactic intervention. A total of 1,182 patients who presented with the symptoms of hand foot and mouth disease (67.3%) or herpangina (HA) (16.7%) and admitted to the hospitals during 2008-2013 were tested for enterovirus using pan-enterovirus PCR targeting 5[prime]-untranslated region and specific PCR for viral capsid protein 1 gene. Overall, 59.7% were pan-enterovirus positive comprising 9.1% EV71 and 9.1% coxsackievirus species A (CV-A) including 70.5% CV-A6, 27.6% CV-A16, 1.1% CV-A10, and 0.8% CV-A5. HFMD and HA occurred endemically during 2008-2011. The number of cases increased dramatically in June 2012 with the percentage of the recently emerged CV-A6 significantly rose to 28.4%. Co-circulation between different EV71 genotypes was observed during the outbreak. Total of 161 sera obtained from healthy individuals were tested for neutralizing antibodies (NAb) against EV71 subgenotype B5 (EV71-B5) using microneutralization assay. The seropositive rate of EV71-B5 was 65.8%. The age-adjusted seroprevalence for individuals was found to be lowest in children aged >6 months to 2 years (42.5%). The seropositive rate remained relatively low in preschool children aged > 2 years to 6 years (48.3%) and thereafter increased sharply to more than 80% in individuals aged > 6 years. This study describes longitudinal data reflecting changing patterns of enterovirus prevalence over 6 years and demonstrates high seroprevalences of EV71-B5 NAb among Thai individuals. The rate of EV71 seropositive increased with age but without gender-specific significant difference. We identified that relative lower EV71 seropositive rate in early 2012 may demonstrate widely presented of EV71-B5 in the population before account for a large outbreak scale epidemic occurred in 2012 with due to a relatively high susceptibility of the younger population.
    Full-text · Article · Feb 2014 · Journal of Biomedical Science
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