Coxsackievirus A6 and hand, foot, and mouth disease, Finland

Abstract

During fall 2008, an outbreak of hand, foot, and mouth disease (HFMD) with onychomadesis (nail shedding) as a common feature occurred in Finland. We identified an unusual enterovirus type, coxsackievirus A6 (CVA6), as the causative agent. CVA6 infections may be emerging as a new and major cause of epidemic HFMD.

Figure 1

Vesicular eruptions in A) hand, B) foot, and C) mouth of a 6.5-year-old boy from Turku, Finland, with coxsackievirus (CV) A6 infection. Several of his fingernails shed 2 months after the pictures were taken. D) Onychomadesis in a 10-year-old boy from Seinäjoki, Finland, 2 months after hand, foot and mouth disease with CVA6 infection. Photographs courtesy of H. Kujari (A–C) and M. Linna (D).

Figure 2

Phylogenetic analysis of coxsackievirus (CV) A6 partial (289 bp) viral protein 1 sequences showing the relationships between the recent clinical CVA6 samples isolated in Finland (triangles), selected CVA6 isolates from GenBank, and prototypes of CVA6, CVA16, and enterovirus (EV) 71. GenBank accession numbers are included. Scale bar indicates nucleotide substitutions per position.