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Use of Viral Entry Assays and Molecular Docking Analysis for the Identification of Antiviral Candidates against Coxsackievirus A16
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Genetic Analysis of Coxsackievirus A4 Among Healthy Children - Xizang Autonomous Region, China, 1996-2024

Kaitao Xiao1,2, Mei Hong3, Mengyi Xiao1,2

  • 1School of Public Health and Health Management, Shandong First Medical University (Shandong Academy of Medical Sciences), Jinan City, Shandong Province, China.

China CDC Weekly
|May 22, 2026
PubMed

Insights

Coxsackievirus A4 (CVA4) genotype C has spread in high-altitude regions, increasing among healthy carriers since 2018. This highlights the virus

Area of Science:

  • Virology
  • Epidemiology
  • Public Health

Background:

  • Coxsackievirus A4 (CVA4) is an enterovirus responsible for diseases like hand, foot, and mouth disease (HFMD) and herpangina.
  • Understanding CVA4 epidemiology in unique environments like high-altitude regions is crucial for disease control.

Purpose of the Study:

  • To analyze the phylogenetic characteristics and epidemiological patterns of CVA4 isolates in the Xizang Autonomous Region.
  • To investigate the genetic diversity and geographic spread of CVA4 in high-altitude areas.

Main Methods:

  • Virus isolation and Sanger sequencing of the VP1 coding region of CVA4 isolates.
  • Phylogenetic analysis using MEGA software and construction of a maximum likelihood tree.
  • Phylogeographic analysis using the BEAST toolkit to generate a maximum clade credibility tree.

Main Results:

  • A significant increase in CVA4 prevalence among healthy carriers was observed from 2018 onwards (62.12%).
  • Most isolates belonged to genotype C, with some classified as D2. Genotype C has been spreading since 2011.
  • Genotype C caused multiple asymptomatic infections in various prefectures between 2020 and 2024.

Conclusions:

  • The transmission of CVA4 genotype C in high-altitude areas indicates significant environmental adaptability.
  • Enhanced enterovirus surveillance and control strategies, including targeted CVA4 monitoring, are necessary in these regions.
Abstract

Keywords:
Coxsackievirus A4 (CVA4)Xizang Autonomous Regionphylogenetic analysisphylogeographic analysis.

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