title: The role of enterovirus 71 and coxsackievirus A strains in a large outbreak of hand, foot, and mouth disease in 2012 in Changsha, China.
abstract: BACKGROUND
  During 2012, Changsha experienced a large outbreak of hand, foot, and mouth disease (HFMD), resulting in 25,438 cases, including 42 severe cases and eight deaths.
  
  
  METHODS
  Seven hundred and forty-six clinical specimens were collected from hospital-based surveillance for HFMD in 2012. The detection and genotyping of enterovirus were performed by real-time RT-PCR and sequencing of the VP1 regions; phylogenetic analysis was performed based on the VP1 sequences.
  
  
  RESULTS
  A total of 545 (73.1%) enterovirus-positive samples were identified, with the most frequently presenting serotype being enterovirus 71 (EV-71; n=364, 66.8%), followed by coxsackievirus A16 (CV-A16; n=84, 15.4%), CV-A6 (n=22, 4.0%), and CV-A10 (n=19, 3.5%). Most of the affected patients were children aged ≤5 years (n=524, 96.1%). EV-71 was the major pathogen in the severe and fatal cases (n=22, 78.6%). Phylogenetic analysis of VP1 gene sequences showed the EV-71 isolates to belong to subgenotype C4a, and the CV-A16 isolates to belong to subgenotype B1. The Changsha CV-A6 and CV-A10 circulating strains were homologous to strains circulating in other areas of mainland China.
  
  
  CONCLUSIONS
  Our results demonstrate that EV-71 was the primary causative agent responsible for the HFMD outbreak in Changsha in 2012, and the co-circulation of other coxsackievirus A strains posed a potential risk to public health.
authors.affiliation: Laboratory of Microbiology, Changsha Center for Disease Control and Prevention, 149 Weier Road, Changsha 410001, China.
authors.forename: Jing-Fang
authors.initials: JF
authors.lastname: Chen
authors.affiliation: Laboratory of Microbiology, Changsha Center for Disease Control and Prevention, 149 Weier Road, Changsha 410001, China.
authors.forename: Ru-Sheng
authors.initials: RS
authors.lastname: Zhang
authors.affiliation: Laboratory of Microbiology, Changsha Center for Disease Control and Prevention, 149 Weier Road, Changsha 410001, China.
authors.forename: Xin-Hua
authors.initials: XH
authors.lastname: Ou
authors.affiliation: Laboratory of Microbiology, Changsha Center for Disease Control and Prevention, 149 Weier Road, Changsha 410001, China.
authors.forename: Fa-Ming
authors.initials: FM
authors.lastname: Chen
authors.affiliation: Laboratory of Microbiology, Changsha Center for Disease Control and Prevention, 149 Weier Road, Changsha 410001, China. Electronic address: sunbiancheng2013@163.com.
authors.forename: Bian-Cheng
authors.initials: BC
authors.lastname: Sun
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D004196:Disease Outbreaks; D029821:Enterovirus A, Human / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification; D005260:Female; D005838:Genotype; D006232:Hand, Foot and Mouth Disease / Q000453:epidemiology* / Q000821:virology*; D006801:Humans; D007223:Infant; D008297:Male; D010802:Phylogeny; D055815:Young Adult
keywords: Coxsackievirus A; Enterovirus 71; Etiology; Hand; and mouth disease; foot