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Detection of enteroviruses during a 2018 hand, foot and mouth disease outbreak in Malaysia
M H P Lee1, Y M Chong1, C G Tay2
1Department of Medical Microbiology, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia.
Abstract:
Hand, foot, and mouth disease (HFMD) is a common childhood disease caused by enteroviruses. In 2018, a HFMD outbreak in Malaysia affected over 76,000 children. In this study, we used RT-qPCR and CODEHOP PCR to detect the causative agents in 89 clinically diagnosed HFMD patients in Kuala Lumpur and Selangor. Most (62.9%) of the children were below 3 years old. PCR with either assay detected enteroviruses in 84.2% (75/89) and CODEHOP PCR successfully typed 66.7% (50/75) of the enteroviruses. Sequencing of CODEHOP amplicons showed co-circulation of multiple enteroviruses with coxsackievirus A6 (CV-A6) and A16 as the predominant serotypes, but not the neurovirulent enterovirus A71. CV-A6 infection was more common in children less than 12 months old (p=0.01) and was more likely to cause vesicles in the gluteal area (p=0.01) compared to other enteroviruses. Establishing a robust identification method during HFMD outbreaks is important for patient management and public health responses.
Insights
Hand, foot, and mouth disease (HFMD) outbreaks in Malaysia were studied using molecular methods. Coxsackievirus A6 and A16 were predominant, highlighting the need for robust detection during public health crises.
Area of Science:
- Virology
- Public Health
- Molecular Diagnostics
Background:
- Hand, foot, and mouth disease (HFMD) is a common viral illness in children, frequently caused by enteroviruses.
- A significant HFMD outbreak in Malaysia in 2018 affected over 76,000 children, underscoring the need for effective surveillance and management strategies.
Purpose of the Study:
- To identify the enterovirus serotypes responsible for HFMD cases in Kuala Lumpur and Selangor during an outbreak.
- To evaluate the efficacy of RT-qPCR and CODEHOP PCR for enterovirus detection and typing in clinical samples.
- To investigate the epidemiological characteristics and clinical manifestations associated with different enterovirus serotypes, particularly Coxsackievirus A6 (CV-A6).
Main Methods:
- Collected clinical samples from 89 children diagnosed with HFMD in Kuala Lumpur and Selangor.
- Employed Reverse Transcription quantitative Polymerase Chain Reaction (RT-qPCR) and Consensus Degenerate Hybridization Open-Primed PCR (CODEHOP PCR) for enterovirus detection.
- Utilized sequencing of CODEHOP PCR amplicons for precise enterovirus serotyping.
Main Results:
- Enteroviruses were detected in 84.2% (75/89) of HFMD cases.
- CODEHOP PCR successfully identified the serotypes of 66.7% (50/75) of detected enteroviruses.
- Coxsackievirus A6 (CV-A6) and A16 were the predominant serotypes; the neurovirulent Enterovirus A71 (EV-A71) was not detected.
- CV-A6 infections were significantly more prevalent in infants under 12 months (p=0.01) and associated with a higher incidence of gluteal vesicles (p=0.01).
Conclusions:
- Molecular methods like RT-qPCR and CODEHOP PCR are effective for identifying enteroviruses during HFMD outbreaks.
- CV-A6 and A16 are key circulating serotypes in Malaysian HFMD outbreaks, with CV-A6 showing specific associations with age and clinical presentation.
- Robust diagnostic capabilities are crucial for effective patient management and public health interventions during enterovirus outbreaks.
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