title: Circulation of Coxsackievirus A6 in hand-foot-mouth disease in Guangzhou, 2010-2012.
abstract: BACKGROUND
  Hand, foot and mouth disease (HFMD) is usually caused by Enterovirus 71(EV71), and Coxsackievirus A16 (CV-A16) in Guangzhou, the biggest city of South China. However, Coxsackievirus A6 (CV-A6) were observed increased dramatically from 2010-2012.
  
  
  METHODS
  In order to understand and to describe the epidemiologic and genetic characteristics of CV-A6, specimens of 5482 suspected HFMD cases were collected and examined by real-time fluorescence PCR. All samples positive for enteroviruses were analyzed by descriptive statistics. Phylogenetic analysis of CV-A6 based on the VP1 sequences was performed to investigate molecular and evolutionary characteristics.
  
  
  RESULTS
  Coxsackievirus A6 increased dramatically from 9.04% in 2010 to 23.21% in 2012 and became one of the main causative agents of HFMD in Guangzhou. CV-A6 attack rates were highest in one to two year olds (33.14%). Typical clinic symptoms of CV-A6 HFMD include fever (589/720, 81.81%), maculopopular rash and vesicular exanthema around the perioral area (408/720, 56.66%), intraoral (545/720, 75.69%), the buttock (395/720, 54.86%), the trunk (244/720, 33.89%), the knee (188/720, 26.11%), and the dorsal aspects of hands (437/720, 60.69%). Phylogenetic analysis showed the CV-A6 isolates in this study belonged to Cluster A1 and were similar to those found in Shanghai in 2011 and 2012 (JX495148, KC414735), Shenzhen in 2011 (JX473394), Japan in 2011 (AB649243, AB649246), France in 2010(HE572928), Thailand in 2012(JX556564) and Israel in 2012 and 2013(.KF991010, KF991012).
authors.forename: Biao
authors.initials: B
authors.lastname: Di
authors.forename: Ying
authors.initials: Y
authors.lastname: Zhang
authors.forename: Huaping
authors.initials: H
authors.lastname: Xie
authors.forename: Xiaoquan
authors.initials: X
authors.lastname: Li
authors.forename: Chun
authors.initials: C
authors.lastname: Chen
authors.forename: Peng
authors.initials: P
authors.lastname: Ding
authors.forename: Peng
authors.initials: P
authors.lastname: He
authors.forename: Dahu
authors.initials: D
authors.lastname: Wang
authors.forename: Jinmei
authors.initials: J
authors.lastname: Geng
authors.forename: Lei
authors.initials: L
authors.lastname: Luo
authors.forename: Zhijun
authors.initials: Z
authors.lastname: Bai
authors.forename: Zhicong
authors.initials: Z
authors.lastname: Yang
authors.affiliation: Guangzhou Center for Disease Control and Prevention, NO,1, Qide Road, Baiyun District, Guangzhou, Guangdong, 510440, China. wangming@gzcdc.org.cn.
authors.forename: Ming
authors.initials: M
authors.lastname: Wang
mesh_terms: D002555:Cerebrospinal Fluid / Q000821:virology; D002681:China / Q000453:epidemiology; D004770:Enterovirus / Q000145:classification* / Q000235:genetics; D005243:Feces / Q000821:virology; D006232:Hand, Foot and Mouth Disease / Q000453:epidemiology* / Q000821:virology*; D006801:Humans; D010614:Pharynx / Q000821:virology; D010802:Phylogeny; D013997:Time Factors