Circulating Recombinant Coxsackievirus A16, China | CDC EID :: Volume 17, Number 8–August 2011

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Volume 17, Number 8–August 2011
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Circulating Coxsackievirus A16 Identified as Recombinant Type A Human Enterovirus, China

Ke Zhao, Xue Han, Guanjun Wang, Wei Hu, Wenyan Zhang, and Xiao-Fang Yu Comments to Author

Author affiliations: First Hospital of Jilin University, Changchun, People's Republic of China (K. Zhao, X. Han, G. Wang, W. Hu, W. Zhang, X.-F. Yu); and Johns Hopkins University, Baltimore, Maryland, USA (K. Zhao, X.-F. Yu)

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Abstract
To determine the relationship of coxsackievirus A16 (CA16) to prototype CA16-G10, we conducted a phylogenetic analysis of circulating CA16 strains in China. Complex recombinant forms of CA16-related viruses involving multiple human enteroviruses, subgroup A (CA4, CA16, and enterovirus 71), are prevalent among patients with hand, foot, and mouth disease.

Coxsackievirus A16 (CA16) is a member of the family Picornaviridae, genus Human enterovirus (HEV). These viruses can be further divided into 4 subgroups on the basis of molecular typing: HEV-A, HEV-B, HEV-C, and HEV-D. The first, and prototype, CA16 strain, CA16-G10, was isolated in South Africa almost 60 years ago (1) and was subsequently sequenced in 1994 (2). CA16, along with enterovirus71 (EV71), CA2, and CA4, is a member of the HEV-A subgroup. CA16 is commonly associated with hand, foot, and mouth disease (HFMD) in children and sometimes causes aseptic meningitis, encephalitis, myocarditis, and poliomyelitis-like paralysis (3).

Enteroviruses related to HFMD have been endemic to Southeast Asia and the Pacific region for decades (4–7). Recently, a dramatic increase in HFMD prevalence has been reported in the People's Republic of China (8–10). Partial viral sequencing (e.g., of the viral protein [VP] 1 region), serologic characterization, or both, have shown that 10%–50% of viruses from HFMD patients are related to prototype CA16-G10, and thus they have been classified as CA16 strains (11). The relationship of circulating CA16-related viruses to CA16-G10 has not been well studied. Therefore, we conducted a serial phylogenetic analysis of existing and new CA16 sequences from northern, central, and southern China to examine whether CA16–G10 truly is the parental strain of circulating CA16 strains. As a result, we found that current CA16 strains in China, although still related to CA16–G10, are recombinant HEV-A.

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Suggested Citation for this Article

Zhao K, Han X, Wang G, Hu W, Zhang W, Yu X-F. Coxsackievirus A16 identified as circulating recombinant type A human enterovirus, China. Emerg Infect Dis [serial on the Internet]. 2011 Aug [date cited]. http://www.cdc.gov/EID/content/17/8/101719.htm

DOI: 10.3201/eid1708.101719

Comments to the Authors

Please use the form below to submit correspondence to the authors or contact them at the following address:

Xiao-Fang Yu, Johns Hopkins University, Room E5148, 615 N Wolfe St, Baltimore, MD 21205-2103, USA; email: xfyu@jhsph.edu