Fourteen types of co-circulating recombinant enterovirus were associated with hand, foot, and mouth disease in children from Wenzhou, China.
J Clin Virol. 2015 Sep; 70:29-38.JC

Abstract

BACKGROUND

Although hand, foot, and mouth disease (HFMD) is a major public concern in China, the prevalence and clinical symptoms associated with the different agents of HFMD in this country remain poorly understood.

OBJECTIVES

We investigated the clinical and molecular characteristics of enteroviruses in patients with HFMD from Wenzhou, China.

STUDY DESIGN

Patients with laboratory-confirmed HFMD admitted to the Yuying Children's Hospital in Wenzhou, China during 2013 were included in this study. Viral RNA sequences were amplified using RT-PCR, determined by sequencing, and compared by phylogenetic analysis.

RESULTS

A total of 955 clinically diagnosed HFMD cases were determined using PCR, with whole viral genomes obtained for each enterovirus type. 14 types of enterovirus belonging to two viral species were identified. Notably, Coxsackievirus A6 (CV-A6) was the most common species detected (77.8%), followed by EV-A71 (8.2%) and CV-A10 (8.1%). Phylogenetic analysis revealed multiple independent introductions of these viruses into Wenzhou. In addition, the enterovirus observed in Wenzhou had a recombinant history, with two or three recombination breakpoints. Although the illness associated with CV-A6 was milder than that of EV-A71, CV-A6 infection caused more widespread rash, larger blisters, and subsequent skin peeling and/or nail shedding.

CONCLUSION

Our study revealed the co-circulation of 14 types of enteroviruses in a single location - Wenzhou, China - with CV-A6 virus the predominant agent of HFMD. This work highlights the need to perform larger-scale surveillance to fully understand the epidemiology of enteroviruses in China and the wider Asia-Pacific region.

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Authors+Show Affiliations

Guo WP

State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Changping Liuzi 5, 102206 Beijing, China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China.

Lin XD

Wenzhou Center for Disease Control and Prevention, Wenzhou 325001, Zhejiang Province, China.

Chen YP

The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China.

Liu Q

The Second Affiliated Hospital & Yuying Children's Hospital of Wenzhou Medical University, Wenzhou 325027, Zhejiang Province, China.

Wenzhou Center for Disease Control and Prevention, Wenzhou 325001, Zhejiang Province, China.

Shi M

State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Changping Liuzi 5, 102206 Beijing, China; Marie Bashir Institute for Infectious Diseases and Biosecurity, Charles Perkins Centre, School of Biological Sciences and Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia.

Holmes EC

State Key Laboratory for Infectious Disease Prevention and Control, National Institute for Communicable Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Changping Liuzi 5, 102206 Beijing, China; Marie Bashir Institute for Infectious Diseases and Biosecurity, Charles Perkins Centre, School of Biological Sciences and Sydney Medical School, The University of Sydney, Sydney, NSW 2006, Australia.

Zhang YZ

MeSH

ChildChild, PreschoolChinaComorbidityEnterovirusFemaleGenotypeHand, Foot and Mouth DiseaseHumansInfantMalePhylogenyPopulation SurveillanceRNA, ViralReassortant VirusesRecombination, Genetic

Pub Type(s)

Journal Article

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

Language

eng

PubMed ID

26305816

Citation

Guo, Wen-Ping, et al. "Fourteen Types of Co-circulating Recombinant Enterovirus Were Associated With Hand, Foot, and Mouth Disease in Children From Wenzhou, China." Journal of Clinical Virology : the Official Publication of the Pan American Society for Clinical Virology, vol. 70, 2015, pp. 29-38.

Guo WP, Lin XD, Chen YP, et al. Fourteen types of co-circulating recombinant enterovirus were associated with hand, foot, and mouth disease in children from Wenzhou, China. J Clin Virol. 2015;70:29-38.

Guo, W. P., Lin, X. D., Chen, Y. P., Liu, Q., Wang, W., Wang, C. Q., Li, M. H., Sun, X. Y., Shi, M., Holmes, E. C., & Zhang, Y. Z. (2015). Fourteen types of co-circulating recombinant enterovirus were associated with hand, foot, and mouth disease in children from Wenzhou, China. Journal of Clinical Virology : the Official Publication of the Pan American Society for Clinical Virology, 70, 29-38. https://doi.org/10.1016/j.jcv.2015.06.093

Guo WP, et al. Fourteen Types of Co-circulating Recombinant Enterovirus Were Associated With Hand, Foot, and Mouth Disease in Children From Wenzhou, China. J Clin Virol. 2015;70:29-38. PubMed PMID: 26305816.

* Article titles in AMA citation format should be in sentence-case

TY - JOUR T1 - Fourteen types of co-circulating recombinant enterovirus were associated with hand, foot, and mouth disease in children from Wenzhou, China. AU - Guo,Wen-Ping, AU - Lin,Xian-Dan, AU - Chen,Yi-Ping, AU - Liu,Qi, AU - Wang,Wen, AU - Wang,Cai-Qiao, AU - Li,Ming-Hui, AU - Sun,Xiao-Yu, AU - Shi,Mang, AU - Holmes,Edward C, AU - Zhang,Yong-Zhen, Y1 - 2015/07/02/ PY - 2015/02/13/received PY - 2015/06/03/revised PY - 2015/06/07/accepted PY - 2015/8/26/entrez PY - 2015/8/26/pubmed PY - 2016/5/25/medline KW - Coxsackievirus A6 KW - Enterovirus 71 KW - Enteroviruses KW - Hand, foot and mouth disease KW - Recombination SP - 29 EP - 38 JF - Journal of clinical virology : the official publication of the Pan American Society for Clinical Virology JO - J Clin Virol VL - 70 N2 - BACKGROUND: Although hand, foot, and mouth disease (HFMD) is a major public concern in China, the prevalence and clinical symptoms associated with the different agents of HFMD in this country remain poorly understood. OBJECTIVES: We investigated the clinical and molecular characteristics of enteroviruses in patients with HFMD from Wenzhou, China. STUDY DESIGN: Patients with laboratory-confirmed HFMD admitted to the Yuying Children's Hospital in Wenzhou, China during 2013 were included in this study. Viral RNA sequences were amplified using RT-PCR, determined by sequencing, and compared by phylogenetic analysis. RESULTS: A total of 955 clinically diagnosed HFMD cases were determined using PCR, with whole viral genomes obtained for each enterovirus type. 14 types of enterovirus belonging to two viral species were identified. Notably, Coxsackievirus A6 (CV-A6) was the most common species detected (77.8%), followed by EV-A71 (8.2%) and CV-A10 (8.1%). Phylogenetic analysis revealed multiple independent introductions of these viruses into Wenzhou. In addition, the enterovirus observed in Wenzhou had a recombinant history, with two or three recombination breakpoints. Although the illness associated with CV-A6 was milder than that of EV-A71, CV-A6 infection caused more widespread rash, larger blisters, and subsequent skin peeling and/or nail shedding. CONCLUSION: Our study revealed the co-circulation of 14 types of enteroviruses in a single location - Wenzhou, China - with CV-A6 virus the predominant agent of HFMD. This work highlights the need to perform larger-scale surveillance to fully understand the epidemiology of enteroviruses in China and the wider Asia-Pacific region. SN - 1873-5967 UR - https://www.unboundmedicine.com/medline/citation/26305816/Fourteen_types_of_co_circulating_recombinant_enterovirus_were_associated_with_hand_foot_and_mouth_disease_in_children_from_Wenzhou_China_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1386-6532(15)00278-4 DB - PRIME DP - Unbound Medicine ER -

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Fourteen types of co-circulating recombinant enterovirus were associated with hand, foot, and mouth disease in children from Wenzhou, China.J Clin Virol. 2015 Sep; 70:29-38.JC