Key Points
- To investigate the spatial dissemination patterns, evolutionary timeframes, and recombinant origins of Coxsackievirus A16 causing hand, foot, and mouth disease globally.
- Assembled 168 VP1 sequences collected during prospective sentinel surveillance of hand, foot, and mouth disease in France (2010–2014) alongside 416 publicly available global sequences (N=584 total).
- Applied time-resolved Bayesian phylogenetic reconstruction, Bayes factor migration analysis, and comparative genomics to evaluate spatial spread and recombination events.
- Classified viral sequences into genogroup B (estimated origin 1978, 95% CI 1973–1981) and newly identified clade D (estimated origin 2004, 95% CI 2001–2007).
- Demonstrated an intertype recombinant origin for clade D with sustained transmission over four years across French townships traced ancestral connections back to Peru.
- Identified reciprocal transcontinental migration pathways within and between Europe and Asia sustaining global Coxsackievirus A16 persistence.
Structured PICO
PPopulation168 VP1 sequences of Coxsackievirus A16 from France (2010-2014) and 416 publicly available sequences of various geographic origins
Phylogeographic analysis of Coxsackievirus A16 reveals global transmission pathways and the emergence of a recombinant genogroup, highlighting the impact of virus movements on HFMD epidemiology.