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

Shuizhen He; Mengyuan Chen; Wenhui Wu; Qiang Yan; Zhihao Zhuo; Xiaosong Su; Shiyin Zhang; Shengxiang Ge; Ningshao Xia

doi:10.1016/j.virol.2018.03.012

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

Virology. 2018 May:518:328-334. doi: 10.1016/j.virol.2018.03.012. Epub 2018 Mar 26.

Authors

Shuizhen He¹, Mengyuan Chen², Wenhui Wu³, Qiang Yan⁴, Zhihao Zhuo⁵, Xiaosong Su⁶, Shiyin Zhang⁷, Shengxiang Ge⁸, Ningshao Xia⁹

Affiliations

¹ Xiamen Center for Disease Control and Prevention, Shengguang Rd., Jimei District, Xiamen, China. Electronic address: szhe@xmu.edu.cn.
² State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Xiamen University, Xiang'an Campus of Xiamen University, South Xiang'an Rd., Xiamen, China; National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Xiamen University, Xiang'an Campus of Xiamen University, South Xiang'an Rd., Xiamen, China; School of Public Health, Xiamen University, Xiang'an Campus of Xiamen University, South Xiang'an Rd., Xiamen, China. Electronic address: 452999304@qq.com.
³ State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Xiamen University, Xiang'an Campus of Xiamen University, South Xiang'an Rd., Xiamen, China; National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Xiamen University, Xiang'an Campus of Xiamen University, South Xiang'an Rd., Xiamen, China; School of Public Health, Xiamen University, Xiang'an Campus of Xiamen University, South Xiang'an Rd., Xiamen, China. Electronic address: 1217446906@qq.com.
⁴ National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Xiamen University, Xiang'an Campus of Xiamen University, South Xiang'an Rd., Xiamen, China. Electronic address: yanqiang@xmu.edu.cn.
⁵ State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Xiamen University, Xiang'an Campus of Xiamen University, South Xiang'an Rd., Xiamen, China; National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Xiamen University, Xiang'an Campus of Xiamen University, South Xiang'an Rd., Xiamen, China. Electronic address: 1228741762@qq.com.
⁶ State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Xiamen University, Xiang'an Campus of Xiamen University, South Xiang'an Rd., Xiamen, China; National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Xiamen University, Xiang'an Campus of Xiamen University, South Xiang'an Rd., Xiamen, China; School of Public Health, Xiamen University, Xiang'an Campus of Xiamen University, South Xiang'an Rd., Xiamen, China. Electronic address: suxiaosong@xmu.edu.cn.
⁷ State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Xiamen University, Xiang'an Campus of Xiamen University, South Xiang'an Rd., Xiamen, China; National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Xiamen University, Xiang'an Campus of Xiamen University, South Xiang'an Rd., Xiamen, China; School of Public Health, Xiamen University, Xiang'an Campus of Xiamen University, South Xiang'an Rd., Xiamen, China. Electronic address: zhangshiyin@xmu.edu.cn.
⁸ State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Xiamen University, Xiang'an Campus of Xiamen University, South Xiang'an Rd., Xiamen, China; National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Xiamen University, Xiang'an Campus of Xiamen University, South Xiang'an Rd., Xiamen, China; School of Public Health, Xiamen University, Xiang'an Campus of Xiamen University, South Xiang'an Rd., Xiamen, China. Electronic address: sxge@xmu.edu.cn.
⁹ State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, Xiamen University, Xiang'an Campus of Xiamen University, South Xiang'an Rd., Xiamen, China; National Institute of Diagnostics and Vaccine Development in Infectious Diseases, Xiamen University, Xiang'an Campus of Xiamen University, South Xiang'an Rd., Xiamen, China; School of Public Health, Xiamen University, Xiang'an Campus of Xiamen University, South Xiang'an Rd., Xiamen, China. Electronic address: nsxia@xmu.edu.cn.

PMID: 29587191
DOI: 10.1016/j.virol.2018.03.012

Abstract

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.

Keywords: Coxsackievirus A6 (CV-A6); Epidemic; Evolution analysis; Hand, foot, and mouth disease (HFMD); Human enteroviruses (human EVs).

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

China / epidemiology
Disease Outbreaks*
Enterovirus / classification*
Enterovirus / genetics*
Enterovirus / isolation & purification
Genotype*
Hand, Foot and Mouth Disease / epidemiology*
Hand, Foot and Mouth Disease / virology*
Molecular Epidemiology
Sequence Analysis, DNA
Viral Structural Proteins / genetics

Substances

Viral Structural Proteins