title: A novel recombinant lineage's contribution to the outbreak of coxsackievirus A6-associated hand, foot and mouth disease in Shanghai, China, 2012-2013.
abstract: Since late 2012, coxsackievirus A6 (CVA6) has gradually become the predominant pathogen responsible for hand-foot-mouth disease (HFMD) in several provinces of China. A total of 626 patients diagnosed with HFMD in Shanghai, China from January 2012 to September 2013 were enrolled in this study. Of these, 292 CVA6 infected cases were subjected to clinical analyses. Whole-genome sequencing, recombination and phylogenetic analyses were also performed. A recombinant CVA6 monophyletic lineage was found during an outbreak of CVA6-associated HFMDs in Shanghai, China in November 2012, and accounted for 21.9% (64/292) of the CVA6 strains during the study period. Recombination analyses showed that the 2C gene of the novel CVA6 virus was probably derived from a coxsackievirus A4 (CVA4) strain circulating in the population. Clinical observation showed that this recombinant CVA6 virus led to a more generalized rash than did the non-recombinant CVA6 virus. This newly emerged CVA6 lineage was associated with a considerable proportion of HFMD cases from 2012 to 2013 in Shanghai, and poses a potential threat to public health.
authors.affiliation: Department of Dermatology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Xiaobo
authors.initials: X
authors.lastname: Feng
authors.affiliation: Pathogen Diagnosis and Biosafety Department, Shanghai Public Health Clinical Center, Key Lab of Medical Molecular Virology, Fudan University, Shanghai, China.
authors.forename: Wencai
authors.initials: W
authors.lastname: Guan
authors.affiliation: Department of Dermatology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Yifeng
authors.initials: Y
authors.lastname: Guo
authors.affiliation: Department of Pediatrics, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Huiju
authors.initials: H
authors.lastname: Yu
authors.affiliation: Pathogen Diagnosis and Biosafety Department, Shanghai Public Health Clinical Center, Key Lab of Medical Molecular Virology, Fudan University, Shanghai, China.
authors.forename: Xiaoling
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Dermatology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Ruhong
authors.initials: R
authors.lastname: Cheng
authors.affiliation: Department of Dermatology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Wang
authors.affiliation: Department of Dermatology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Zhen
authors.initials: Z
authors.lastname: Zhang
authors.affiliation: Department of Dermatology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Jia
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Dermatology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Huaguo
authors.initials: H
authors.lastname: Li
authors.affiliation: Department of Dermatology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Yin
authors.initials: Y
authors.lastname: Zhuang
authors.affiliation: Department of Dermatology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Dermatology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Zhiyong
authors.initials: Z
authors.lastname: Lu
authors.affiliation: Department of Dermatology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Ming
authors.initials: M
authors.lastname: Li
authors.affiliation: Department of Dermatology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Hong
authors.initials: H
authors.lastname: Yu
authors.affiliation: Department of Pediatrics, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Yixiao
authors.initials: Y
authors.lastname: Bao
authors.affiliation: Pathogen Diagnosis and Biosafety Department, Shanghai Public Health Clinical Center, Key Lab of Medical Molecular Virology, Fudan University, Shanghai, China.
authors.forename: Yunwen
authors.initials: Y
authors.lastname: Hu
authors.affiliation: Department of Dermatology, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China.
authors.forename: Zhirong
authors.initials: Z
authors.lastname: Yao
mesh_terms: D002681:China / Q000453:epidemiology; D004196:Disease Outbreaks; D029822:Enterovirus B, Human / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification; D006232:Hand, Foot and Mouth Disease / Q000175:diagnosis* / Q000453:epidemiology / Q000821:virology; D059014:High-Throughput Nucleotide Sequencing; D006801:Humans; D010802:Phylogeny; D015995:Prevalence; D012367:RNA, Viral / Q000737:chemistry / Q000378:metabolism; D060888:Real-Time Polymerase Chain Reaction; D011995:Recombination, Genetic; D017423:Sequence Analysis, RNA; D065288:Serogroup; D014764:Viral Proteins / Q000235:genetics
chemical_list: D012367:RNA, Viral; D014764:Viral Proteins