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. 2022 Aug 4;22(1):671.
doi: 10.1186/s12879-022-07661-3.

Co-infection and enterovirus B: post EV-A71 mass vaccination scenario in China

Wei Guo  1   2 , Danhan Xu  1   2 , Shanri Cong  1   2 , Zengqing Du  3 , Li Li  4 , Ming Zhang  1   2 , Changzeng Feng  1   2 , Guohong Bao  5 , Hao Sun  1   2 , Zhaoqing Yang  1   2 , Shaohui Ma  6   7
Affiliations

Co-infection and enterovirus B: post EV-A71 mass vaccination scenario in China

Wei Guo et al. BMC Infect Dis. .

Abstract

Background: Hand, foot, and mouth disease (HFMD) is a common child infectious disease caused by more than 20 enterovirus (EV) serotypes. In recent years, enterovirus A71 (EV-A71) has been replaced by Coxsackievirus A6 (CV-A6) to become the predominant serotype. Multiple EV serotypes co-circulate in HFMD epidemics, and this study aimed to investigate the etiological epidemic characteristics of an HFMD outbreak in Kunming, China in 2019.

Methods: The clinical samples of 459 EV-associated HFMD patients in 2019 were used to amplify the VP1 gene region by the three sets of primers and identify serotypes using the molecular biology method. Phylogenetic analyses were performed based on the VP1 gene.

Results: Three hundred and forty-eight cases out of 459 HFMD patients were confirmed as EV infection. Of these 191 (41.61%) were single EV infections and 34.20% had co-infections. The EVs were assigned to 18 EV serotypes, of which CV-A6 was predominant (11.33%), followed by CV-B1 (8.93%), CV-A4 (5.23%), CV-A9 (4.58%), CV-A 16 (3.49%) and CV-A10 and CVA5 both 1.96%. Co-infection of CV-A6 with other EVs was present in 15.25% of these cases, followed by co-infection with CV-A16 and other EVs. The VP1 sequences used in the phylogenetic analyses showed that the CV-A6, CV-B1 and CV-A4 sequences belonged to the sub-genogroup D3 and genogroups F and E, respectively.

Conclusion: Co-circulation and co-infection of multiple serotypes were the etiological characteristic of the HFMD epidemic in Kunming China in 2019 with CV-A-6, CV-B1 and CV-A4 as the predominant serotypes. This is the first report of CV-B1 as a predominant serotype in China and may provide valuable information for the diagnosis, prevention and control of HFMD.

Keywords: Co-circulation; Co-infection; Enterovirus; Hand, foot, and mouth disease.

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Conflict of interest statement

The authors declare they have no competing interests.

Figures

Fig. 1
Fig. 1
Phylogenetic trees of coxsackievirus B1, coxsackievirus A6, and coxsackievirus A4 based on the partial VP1 sequences by the neighbor-joining algorithm implemented in MEGA (version 7.0) using the Kimura two-parameter substitution model and 1000 bootstrap pseudo-replicates, respectively. Only strong bootstrap values (> 75%) are shown. ● Indicates strains isolated in this investigation; ▲ indicates the prototype strain
See this image and copyright information in PMC

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