Hand, Foot, and Mouth Disease Caused by Coxsackievirus A6, Japan, 2011

Q: What is the clinical evidence from this study?

Study design: Letter. Population: Hand, foot, and mouth disease (HFMD) (n=108). Intervention: Coxsackievirus A6 (CVA6) infection. Primary outcome: Detection of Coxsackievirus A6 (CVA6) by reverse transcription PCR and sequence analysis.

Q: What does this research mean for the field?

Coxsackievirus A6 was the predominant pathogen driving the nationwide 2011 hand, foot, and mouth disease outbreak in Japan, frequently manifesting with subsequent onychomadesis. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.NEUTRAL.

Tsuguto Fujimoto; Setsuko Iizuka; Miki Enomoto; Katsuhiko Abe; Kazuyo YAMASHITA; Nozomu Hanaoka; Nobuhiko Okabe; Hiromu Yoshida; Yoshinori Yasui; M. Kobayashi; Yoshiki Fujii; Hiroko Tanaka; Miwako Yamamoto; Hiroyuki Shimizu

doi:10.3201/eid1802.111147

January 11, 2012Emerging infectious diseasesOpen Access

Hand, Foot, and Mouth Disease Caused by Coxsackievirus A6, Japan, 2011

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Key result

Coxsackievirus A6 identified in ~69% of hand, foot, and mouth disease cases in Japan.

n=108

Key Points

To characterize the nationwide surge, molecular epidemiology, and clinical presentations of hand, foot, and mouth disease associated with Coxsackievirus A6 in Japan during 2011.
Monitored clinical reports from approximately 3,000 pediatric sentinel clinics and hospitals participating in the National Epidemiologic Surveillance of Infectious Diseases System.
Tested 93 clinical specimens (throat swabs and feces) from 108 hand, foot, and mouth disease case-patients in four prefectures using enterovirus-specific reverse transcription PCR and sequence analysis of VP4/VP2 or VP1 regions.
Sentinel reporting peaked at 10.97 cases per site in week 28 of 2011, with 709 hand, foot, and mouth disease cases and 156 herpangina cases testing positive for Coxsackievirus A6 nationwide as of September 18, 2011.
Molecular analysis identified 74 of 108 case-patients as Coxsackievirus A6 positive, displaying 82.3%–82.5% nucleotide identity and 94.8%–95.4% amino acid identity across the entire VP1 region relative to the prototype Gdula strain.
Infections presented with fever, mucosal vesicles, and blisters on the limbs and buttocks, with some patients developing onychomadesis 1–2 months later, and one patient with acute encephalitis had viral detection in cerebrospinal fluid.

Structured PICO

P

Population

108 patients with hand, foot, and mouth disease (93 clinical samples analyzed) from pediatric sentinel sites across four prefectures in Japan during the 2011 outbreak.

E

Exposure

Reverse transcription PCR and sequence analysis of the partial viral protein (VP)4/VP2 or VP1 region for enterovirus screening and Coxsackievirus A6 (CVA6) identification

O

Outcome

Identification of Coxsackievirus A6 (CVA6) positive cases by molecular detection and sequence analysissurrogate

Limitations

CVA6 was not isolated from clinical samples in a cell culture system
More detailed genetic, phenotypic, and epidemiologic analyses of CVA6 are needed to determine its role in HFMD outbreaks
More detailed genetic, phenotypic, and epidemiologic analyses of CVA6 are needed to determine the role of CVA6 in HFMD outbreaks with or without onychomadesis

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Implication

This surveillance letter documents a major 2011 outbreak of hand, foot, and mouth disease in Japan driven by Coxsackievirus A6, highlighting associated delayed onychomadesis and rare neurologic complications.

Abstract

Institute (Madrid, Spain) for providing test kits and positive controls.

Discussion

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Cite This Study

Fujimoto et al. (2012) conducted a letter in Hand, foot, and mouth disease (HFMD) (n=108). Coxsackievirus A6 (CVA6) infection was evaluated on Detection of Coxsackievirus A6 (CVA6) by reverse transcription PCR and sequence analysis. Coxsackievirus A6 was identified by sequence analysis in 74 of 108 hand, foot, and mouth disease case-patients from sentinel sites in Japan during the 2011 outbreak.

synapsesocial.com/papers/6a6f5ef278a11c550e091110 https://doi.org/10.3201/eid1802.111147

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Hand, Foot, and Mouth Disease Caused by Coxsackievirus A6, Japan, 2011

Key Points

Structured PICO

Limitations

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Implication

Abstract

Discussion

Cite This Study

Hand, Foot, and Mouth Disease Caused by Coxsackievirus A6, Japan, 2011

Key Points

Structured PICO

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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