Multirecombinant Enterovirus A71 Subgenogroup C1 Isolates Associated with Neurologic Disease, France, 2016–2017

Figure 1. Geographic locations and numbers of enterovirus A71 (EV-A71) subgenogroup C1v2015 infections reported during 2015–2017. A) Countries in which EV-A71 C1v2015 was reported. The year the virus was first reported is indicated. The size of Europe is increased for easier visualization. B) Geographic distribution and number of cases of EV-A71 C1v2015 infection reported in hospitals, by department, France, 2016–2017. C) Geographic distribution of clinical manifestations associated with EV-A71 C1v2015 infection reported in hospitals, by department, France, 2016–2017. The size of a select set of departments is enlarged for easier visualization. HFMD, hand, foot and mouth disease.

Figure 2. Nucleotide similarity and phylogenetic analyses of EV-A71 subgenogroup C1v2015 isolates, France, 2016–2017, constructed to determine temporal origin of C1v2015 lineage. A) Nucleotide similarity patterns between EV-A71 C1v2015 and other EV-A lineages indicate the C1v2015 genome has a mosaic structure. The genome of the virus from patient 10’s throat swab (10|PMB250102|FRA|2016) was used as the query sequence. The similarity plots determined with the other C1v2015 genomes (except 14|COC286037|FRA|2016) were similar. A schematic diagram of the enterovirus genome is shown at the bottom of the panel. Nucleotide similarity was calculated by the sliding window method (window of 300 nt moving every 30 nt). Four genomic modules (labeled at top of panel) with different genetic origins are identified. The 99% CIs of the nucleotide boundaries assessed for the genomic modules (indicated in dark gray) were determined as described in Hassel et al. (11). The 3′ end of module 1 and 5′ end of module 2 were located at the end of the 5′ UTR but were not determined precisely. The 3′ end of module 2 was located between nucleotides 3,532 and 3,722. The 5′ end of module 4 was located at the end of the…