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Published on: November 15, 2017
First detection of multiple cases related to CV-A16 strain of B1c clade in Beijing in 2022
Zhichao Liang1, Changying Lin1, Da Huo1
1Institute for Infectious Disease and Endemic Disease Control, Beijing Center for Disease Prevention and Control, Beijing, China.
Insights
Coxsackievirus A16 (CV-A16) clade B1c infections, previously unreported in Beijing, emerged in 2022. These hand, foot, and mouth disease cases in Shunyi District were linked to an Indian strain, necessitating enhanced surveillance.
Area of Science:
- Virology
- Epidemiology
- Public Health
Background:
- Coxsackievirus A16 (CV-A16) is a major cause of hand, foot, and mouth disease (HFMD) and herpangina (HA), potentially leading to severe neurological complications.
- CV-A16 clades B1a and B1b circulated in Beijing from 2019-2021.
- Clade B1c infections had not been previously reported in Beijing.
Purpose of the Study:
- To investigate the emergence and characteristics of CV-A16 B1c clade infections in Beijing.
- To analyze the genetic relatedness and identify unique mutations of the circulating CV-A16 B1c strains.
Main Methods:
- Retrospective analysis of 400 HFMD and 493 HA cases from Beijing's surveillance system (2019-2022).
- Real-time RT-PCR for enterovirus detection.
- Full-length VP1 gene and whole-genome sequencing for CV-A16 positive cases.
- Phylogenetic analysis and comparative sequence analysis.
Main Results:
- CV-A16 was detected in 18.89% of enterovirus-positive cases.
- Clades B1a, B1b, and B1c were identified in 14, 3, and 5 cases, respectively.
- A cluster of five CV-A16 B1c cases occurred in Shunyi District in mid-2022, genetically linked to a 2018 Indian strain with over 98% sequence similarity.
- Three unique amino acid variations (P3S, V25A, I235V) were identified in the B1c strains.
Conclusions:
- The 2022 Shunyi District cases represent the first spatiotemporally correlated CV-A16 B1c clade infections in Beijing.
- These findings highlight the need for increased surveillance of CV-A16 B1c in HFMD and HA cases in the region.
- Genetic analysis revealed potential adaptations in the emerging B1c strains.
Abstract:
Coxsackievirus A16 (CV-A16) is a significant etiologic agent of hand, foot, and mouth disease (HFMD) and herpangina (HA), with the capacity to progress to severe complications, including encephalitis, aseptic meningitis, acute flaccid paralysis, myocarditis, and other critical conditions. Beijing's epidemiological surveillance system, established in 2008, encompasses 29 hospitals and 16 district disease control centers. From 2019 to 2021, the circulation of CV-A16 was characterized by the co-circulation of B1a and B1b clades. Multiple cases of HFMD linked to clade B1c has not been reported in Beijing until 2022. This study enrolled 400 HFMD and 493 HA cases. Employing real-time RT-PCR, 368 enterovirus-positive cases were identified, with 180 selected for sequencing. CV-A16 was detected in 18.89% (34/180) of the cases, second only to CV-A6, identified in 63.33% (114/180). Full-length VP1 gene sequences were successfully amplified and sequenced in 22 cases, revealing the presence of clades B1a, B1b, and B1c in 14, 3, and 5 cases, respectively. A cluster of five B1c clade cases occurred between June 29 and July 17, 2022, within a 7-km diameter region in Shunyi District. Phylogenetic analysis of five complete VP1 gene sequences and two full-genome sequences revealed close clustering with the 2018 Indian strain (GenBank accession: MH780757.1) within the B1c India branch, with NCBI BLAST results showing over 98% similarity. Comparative sequence analysis identified three unique amino acid variations (P3S, V25A, and I235V). The 2022 Shunyi District HFMD cases represent the first instances of spatiotemporally correlated CV-A16 B1c clade infections in Beijing, underscoring the necessity for heightened surveillance of B1c clade CV-A16 in HFMD and HA in this region.
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