title: The Epidemiological Study of Coxsackievirus A6 revealing Hand, Foot and Mouth Disease Epidemic patterns in Guangdong, China.
abstract: Enterovirus A71 (EVA71) and Coxsackievirus A16 (CVA16) are regarded as the two major causative pathogens in hand, foot and mouth disease (HFMD) epidemics. However, CVA6, previously largely ignored, became the predominant pathogen in China in 2013. In this study, we describe the epidemiological trends of CVA6 during the annual HFMD outbreaks from 2008 to 2013 in Guangdong, China. The study results show that CVA6 has been one of three major causative agents of HFMD epidemics since 2009. The periodic rotation and dominance of the three pathogens, EVA71, CVA16 and CVA6, may have contributed to the continuously increasing HFMD epidemics. Moreover, phylogenetic analysis of the VP1 gene shows that major circulating CVA6 strains collected from 2009 to 2013 are distinct from the earlier strains collected before 2009. In conclusion, the discovery from this research investigating epidemiological trends of CVA6 from 2008 to 2013 explains the possible pattern of the continuous HFMD epidemic in China. The etiological change pattern also highlights the need for improvement for pathogen surveillance and vaccine strategies for HFMD control in China.
authors.affiliation: 1] Key Laboratory for Repository and Application of Pathogenic Microbiology, Research Center for Pathogens Detection Technology of Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China [2] WHO Collaborating Centre for Surveillance, Research and Training of Emerging Infectious Diseases, Guangzhou, 511430, China.
authors.forename: Hanri
authors.initials: H
authors.lastname: Zeng
authors.affiliation: 1] Key Laboratory for Repository and Application of Pathogenic Microbiology, Research Center for Pathogens Detection Technology of Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China [2] Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China [3] WHO Collaborating Centre for Surveillance, Research and Training of Emerging Infectious Diseases, Guangzhou, 511430, China.
authors.forename: Jing
authors.initials: J
authors.lastname: Lu
authors.affiliation: 1] Key Laboratory for Repository and Application of Pathogenic Microbiology, Research Center for Pathogens Detection Technology of Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China [2] WHO Collaborating Centre for Surveillance, Research and Training of Emerging Infectious Diseases, Guangzhou, 511430, China.
authors.forename: Huanying
authors.initials: H
authors.lastname: Zheng
authors.affiliation: 1] Key Laboratory for Repository and Application of Pathogenic Microbiology, Research Center for Pathogens Detection Technology of Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China [2] Guangdong Provincial Institute of Public Health, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China [3] WHO Collaborating Centre for Surveillance, Research and Training of Emerging Infectious Diseases, Guangzhou, 511430, China.
authors.forename: Lina
authors.initials: L
authors.lastname: Yi
authors.affiliation: 1] Key Laboratory for Repository and Application of Pathogenic Microbiology, Research Center for Pathogens Detection Technology of Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China [2] WHO Collaborating Centre for Surveillance, Research and Training of Emerging Infectious Diseases, Guangzhou, 511430, China.
authors.forename: Xue
authors.initials: X
authors.lastname: Guo
authors.affiliation: 1] Key Laboratory for Repository and Application of Pathogenic Microbiology, Research Center for Pathogens Detection Technology of Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China [2] WHO Collaborating Centre for Surveillance, Research and Training of Emerging Infectious Diseases, Guangzhou, 511430, China.
authors.forename: Leng
authors.initials: L
authors.lastname: Liu
authors.affiliation: Centre for Environment and Population Health, Nathan campus, Griffith University, 170 Kessels Road, Nathan Brisbane, Queensland 4111, Australia.
authors.forename: Shannon
authors.initials: S
authors.lastname: Rutherford
authors.affiliation: Key Laboratory for Repository and Application of Pathogenic Microbiology, Research Center for Pathogens Detection Technology of Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China.
authors.forename: Limei
authors.initials: L
authors.lastname: Sun
authors.affiliation: Key Laboratory for Repository and Application of Pathogenic Microbiology, Research Center for Pathogens Detection Technology of Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China.
authors.forename: Xiaohua
authors.initials: X
authors.lastname: Tan
authors.affiliation: 1] Key Laboratory for Repository and Application of Pathogenic Microbiology, Research Center for Pathogens Detection Technology of Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China [2] WHO Collaborating Centre for Surveillance, Research and Training of Emerging Infectious Diseases, Guangzhou, 511430, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Li
authors.affiliation: 1] Key Laboratory for Repository and Application of Pathogenic Microbiology, Research Center for Pathogens Detection Technology of Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China [2] WHO Collaborating Centre for Surveillance, Research and Training of Emerging Infectious Diseases, Guangzhou, 511430, China.
authors.forename: Changwen
authors.initials: C
authors.lastname: Ke
authors.affiliation: 1] Key Laboratory for Repository and Application of Pathogenic Microbiology, Research Center for Pathogens Detection Technology of Emerging Infectious Diseases, Guangdong Provincial Center for Disease Control and Prevention, Guangzhou, China [2] WHO Collaborating Centre for Surveillance, Research and Training of Emerging Infectious Diseases, Guangzhou, 511430, China.
authors.forename: Jinyan
authors.initials: J
authors.lastname: Lin
mesh_terms: D000293:Adolescent; D000328:Adult; D001483:Base Sequence; D036022:Capsid Proteins / Q000145:classification / Q000235:genetics; D002648:Child; D002675:Child, Preschool; D002681:China / Q000453:epidemiology; D003384:Coxsackievirus Infections / Q000453:epidemiology / Q000473:pathology; D003710:Demography; D004770:Enterovirus / Q000145:classification / Q000235:genetics* / Q000302:isolation & purification; D005260:Female; D005838:Genotype; D006232:Hand, Foot and Mouth Disease / Q000453:epidemiology* / Q000473:pathology / Q000821:virology; D006801:Humans; D007223:Infant; D008297:Male; D008969:Molecular Sequence Data; D010802:Phylogeny; D017423:Sequence Analysis, RNA; D055815:Young Adult
chemical_list: D036022:Capsid Proteins; C442501:VP1 protein, Foot-and-mouth disease virus