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. 2022 Sep:154:105245.
doi: 10.1016/j.jcv.2022.105245. Epub 2022 Jul 21.

Hand, foot, and mouth disease outbreak by Coxsackievirus A6 during COVID-19 pandemic in 2021, São Paulo, Brazil

Rita C C Carmona  1 , Bráulio C Machado  2 , Fabricio C Reis  2 , Adriana M V Jorge  2 , Audrey Cilli  2 , Amanda M N Dias  2 , Daniele R Morais  2 , Lucas Leme  2 , Ana L F Yu  3 , Marcela R Silva  3 , Telma R M P Carvalhanas  3 , Maria C S T Timenetsky  4
Affiliations

Hand, foot, and mouth disease outbreak by Coxsackievirus A6 during COVID-19 pandemic in 2021, São Paulo, Brazil

Rita C C Carmona et al. J Clin Virol. 2022 Sep.

Abstract

Introduction: Hand, foot, and mouth disease (HFMD) is an acute febrile illness characterized by fever; sore throat; and vesicular eruptions on the hands, feet, and oral mucosa. Outbreaks of HFMD in children aged <5 years have been reported worldwide and the major causative agents are Coxsackievirus (CV)A16, enterovirus (EV)-A71 and recently CVA6.

Aim and methods: The aim of this study was to investigated a large outbreak of Hand, foot, and mouth disease during COVID-19 pandemic in 2021 from clinical samples of 315 suspected cases, in São Paulo State, Brazil. Diagnostic evaluation was performed by RT-qPCR, culture cell isolation and serological neutralization assay. EV-positive were genotyped by partial VP1 genome sequencing.

Results: One hundred and forty-nine cases analyzed were positive for enterovirus (47.3%; n = 149/315) by neutralizing test (n = 10 patients) and RT-qPCR (n = 139 patients), and identified as CVA6 sub-lineage D3 by analysis of VP1 partial sequences.

Conclusions: This finding indicated the reemergence of CVA6 in HFMD, soon after the gradual easing of non-pharmaceutical interventions during-pandemic COVID-19 and the relevance of continued surveillance of circulating enterovirus types in the post-COVID pandemic era.

Keywords: Enterovirus; Foot and mouth disease; Hand; Infectious disease; Outbreaks; Preschool children.

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Conflict of interest statement

The authors declare do not have any competing interests.

Figures

Fig 1:
Fig. 1
Distribution of HFMD outbreaks (A), case-patients (B) and case-patients by age (C) in the State of São Paulo, between 01-01–2021 and 12–31–2021.
Fig 2
Fig. 2
The Maximum Likelihood tree based on partial VP1 nucleotide sequences of CVA6 (nt 2569 to 2892 according to prototype Gdula strain AY421764). The numbers at nodes (>70% were indicated) represent the percentage of 1000 bootstrap replicates that supported the distal cluster. GenBank accession numbers and location as well as year of isolation are included. Scale bar indicates branch distances per 100 nucleotides. A difference of at least 15% in the partial VP1 region was used to distinguish sub-lineage. Representative strains isolated in this study are marked with black circles indicate strains from São José do Rio Preto region; gray circles – São Paulo region; white circle Ourinhos region and withe square other Brazilian isolates.
See this image and copyright information in PMC

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