Epidemiology and genetic characteristics of coxsackievirus A16 associated with hand-foot-mouth disease in Hangzhou city, Zhejiang province from 2021 to 2024

Figures

• 

  Figure 1. (A) Yearly distribution of laboratory-diagnosed cases of HFMD and CV-A16 during 2021–2024 in Hangzhou, China. (B) The percentage of laboratory-diagnosed CV-A16 cases in each district and county of Hangzhou City from 2021 to 2024. The shade of the color is used to indicate the proportion of CV-A16.

• 

  Figure 2. (A) The number distribution of laboratory-diagnosed CV-A16 cases in Hangzhou by month between 2021 and 2024. (B) The monthly detection rate distribution of CV-A16 cases confirmed by laboratories in Hangzhou during the period from 2021 to 2024.

• 

  Figure 3. (A) The proportion of laboratory-diagnosed HFMD cases in Hangzhou between 2021 and 2024 by gender. (B) The proportion of laboratory-diagnosed CV-A16 cases between 2021 and 2024 by gender. (C) Detection rate of laboratory-diagnosed CV-A16 cases in Hangzhou between 2021 and 2024 by gender. (D) Age distribution of l laboratory-diagnosed CV-A16 cases in Hangzhou city, 2021–2024. Categorize the whole population into the following groups: 0–1, 1–2, 2–3, 3–4, 4–5, 5–6, 6–7, 7–8, 8–9, 10–11, 11–12, 12–13 and over 13 years old. The four colors represent different years, and the height of the bar graph represents the corresponding number of cases.

• 

  Figure 4. (A) Maximum likelihood tree constructed based on the 282 complete genome sequences of CV-A16 in Hangzhou from 2021 to 2024. The outer grid represents CV-A16 sequences from different years, with the grids from the inside out representing the years 2021, 2022, 2023, and 2024, and marked with asterisks. The inner circle represents different gene clusters/sub-gene clusters, labeled with different colors. The ends of each leaf are represented by circles of different colors for the reference sequences and the sequences from Hangzhou. The green circles represent the references sequence, and the purple circles represent the Hangzhou sequences. (B) The temporal distribution of CVA16 subgenotypes (B1a, B1b and B1c) in Hangzhou 2021–2024.

• 

  Figure 5. The entropy value of nucleotide sites for different gene segments of CV-A16. (A–K) represent the diagrams of entropy of the nucleic acid sites of the VP1, VP2, VP3, VP4, 2A, 2B, 2C, 3A, 3B, 3C and 3D, respectively.

• 

  Figure 6. Molecular clock for evolutionary analysis of CV-A16 genotype B1 based on the whole genome sequence. (A) Evolutionary time signal through root-to-tip divergence analysis. (B) Population history of CV-A16 genotype B1 inferred by Bayesian skyline model. The x-axis represents the time scale in years, and the y-axis represents the effective population size. (C) Bayesian Maximum Evolutionary Branch Confidence (MCC) phylogenetic tree.