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Evolutionary Diversity of Coxsackievirus A6 Causing Severe Hand, Foot, and Mouth Disease - China, 2012-2023
Huanhuan Lu1, Jinbo Xiao1, Wenhui Wang2
1National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases; World Health Organization Polio Reference Laboratory for the Western Pacific Region; Key Laboratory of Laboratory Biosafety, National Health and Key Laboratory of Laboratory Biosafety of the National Health Commission, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing, China.
Insights
Coxsackievirus A6 (CVA6) causes severe hand, foot, and mouth disease (HFMD), primarily in young children. This evolving virus shows increased genetic diversity and population expansion, necessitating enhanced surveillance for outbreak prevention.
Area of Science:
- Virology
- Epidemiology
- Molecular Evolution
Background:
- Coxsackievirus A6 (CVA6) is a significant cause of severe hand, foot, and mouth disease (HFMD).
- Understanding CVA6's demographic impact and viral evolution is crucial for effective disease management and surveillance.
Purpose of the Study:
- To delineate demographic characteristics of severe CVA6-associated HFMD cases.
- To analyze the viral evolution and population dynamics of CVA6 strains from severe HFMD cases.
Main Methods:
- Analysis of 74 CVA6 strains isolated from severe HFMD cases (2012-2023).
- Sequencing and phylogenetic analysis of the CVA6 VP1 gene.
- Utilized BEAST, DnaSP6, and PopART for population historical dynamics and evolutionary analysis.
Main Results:
- Severe HFMD cases predominantly affected children under 5 years old (94.4%).
- Most CVA6 strains belonged to the D3a sub-genotype, with evidence of increasing genetic distance and population diversity over time.
- Three significant population expansions were identified during 2012-2013, 2013-2014, and 2019-2020, leading to increased haplotype diversity.
Conclusions:
- CVA6 is an evolving pathogen associated with severe HFMD, posing an outbreak risk.
- Enhanced surveillance of severe HFMD cases is essential for timely detection and response to CVA6 outbreaks.
Introduction:
Coxsackievirus A6 (CVA6) has emerged as a significant pathogen responsible for severe cases of hand, foot, and mouth disease (HFMD). This study aims to delineate the demographic characteristics and analyze the viral evolution of severe HFMD associated with CVA6, thereby assisting in its surveillance and management.
Methods:
In this investigation, 74 strains of CVA6 were isolated from samples collected from severe HFMD cases between 2012 and 2023. The VP1 gene sequences of CVA6 were amplified and analyzed to assess population historical dynamics and evolutionary characteristics using BEAST, DnaSP6, and PopART.
Results:
A significant portion (94.4%) of severe CVA6-associated HFMD cases (51 out of 54, with 20 lacking age information) were children under 5 years old. Among the 74 CVA6 strains analyzed, 72 belonged to the D3a sub-genotype, while only two strains were D2 sub-genotype. The average genetic distance between VP1 sequences prior to 2015 was 0.027, which increased to 0.051 when compared to sequences post-2015. Historical population dynamics analysis indicated three significant population expansions of severe CVA6-associated HFMD during 2012-2013, 2013-2014, and 2019-2020, resulting in the formation of 65 distinct haplotypes. Consistent with the MCC tree findings, transitioning between regional haplotypes required multiple base substitutions, showcasing an increase in population diversity during the evolutionary process (from 14 haplotypes in 2013 to 55 haplotypes over the subsequent decade).
Conclusions:
CVA6, associated with severe HFMD, is evolving and presents a risk of outbreak occurrence. Thus, enhanced surveillance of severe HFMD is imperative.
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