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.

China CDC Weekly
|June 7, 2024
PubMed

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.
Abstract