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Genetic Diversity of Enterovirus A71, India - Volume 21, Number 1—January 2015 - Emerging Infectious Disease journal - CDC

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Genetic Diversity of Enterovirus A71, India - Volume 21, Number 1—January 2015 - Emerging Infectious Disease journal - CDC


Volume 21, Number 1—January 2015


Genetic Diversity of Enterovirus A71, India

Vinay K. Saxena, Sudhir Sane, Sushma S. Nadkarni, Deepa K. Sharma, and Jagadish M. DeshpandeComments to Author 
Author affiliations: Enterovirus Research Centre, Mumbai, India (V.K. Saxena, S.S. Nadkarni, D.K. Sharma, J.M. Deshpande)Jupiter Hospital, Thane, India (S. Sane)


We have identified circulation of 3 genogroups of enterovirus (EV) A71 in India. A new genogroup (proposed designation G) was discovered during this study. We isolated genogroups D and G in wide geographic areas but detected subgenogroup C1 only in 1 focus in western India. A systematic nationwide search for EV-A71 is warranted.
Enterovirus A71 (EV-A71; enterovirus species A, genus Enterovirus, family Picornaviridae) was first isolated in 1969 from the cerebrospinal fluid of a patient with encephalitis in California, USA. EV-A71 is known to cause encephalitis; meningitis; hand, foot and mouth disease (HFMD); and acute flaccid paralysis (AFP) (1,2). EV-A71 epidemic activity has increased substantially throughout the World Health Organization South-East Asia and Western Pacific Regions since the 1997 outbreak of HFMD with severe neurologic complications and high case-fatality rates reported in Sarawak and peninsular Malaysia (3). In many countries, EV-A71 circulated for several years before large-scale outbreaks were reported (4). In China, several hundred thousand cases of HFMD have been reported in recent years (5). In India, the epidemiology of EV-A71 has remained largely unexplored. A small outbreak of HFMD in Kerala in 2003 and 36 (42%) of 87 encephalitis cases reported in western Uttar Pradesh during July 2004–November 2006 were attributed to EV-A71 infections only on the basis of serologic evidence (6,7). Isolation of EV-A71 from a patient with AFP in India was reported for the first time in 2001 (8). Recently, 2 research groups have reported frequent isolation of EV-A71 from persons with AFP in Uttar Pradesh, Karnataka, and Kerala (9,10).
EV-A71 strains isolated worldwide are classified into 4 genogroups: A–D (11). Genogroups B and C have been differentiated into subgenogroups B0–B5 and C1–C5 (11). Bessaud et al. proposed 2 new genogroups in sub-Saharan Africa (genogroup E) and Madagascar (genogroup F) (12). Other new subgenogroups proposed recently include C4a, C4b, C6, C7, and B6 (9,13). We detected 14 EV-A71 among nonpolio enterovirus (NPEV) isolates from persons with AFP, HFMD, and encephalitis reported in Mumbai and surrounding areas during 2008–2012. The objective of this study was to evaluate the phylogenetic relationship of the Indian EV-A71 strains in the global context.

Dr. Saxena is a research scientist at Enterovirus Research Centre, Mumbai, India. His primary research interest is molecular characterization of enteroviruses.


We thank Uma Nalavade for the NPEV used in this study. We also thank the 2 anonymous reviewers for suggestions that led to substantial improvement of the manuscript.
This study was supported by intramural funds from the Indian Council of Medical Research, New Delhi, India.


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Technical Appendix

Suggested citation for this article: SaxenaVK, Sane S, Nadkarni SS, Sharma DK, Deshpande JM. Genetic diversity of enterovirus A71, India. Emerg Infect Dis [Internet]. 2015 Jan [date cited]. http://dx.doi.org/10.3201/eid2101.140743
DOI: 10.3201/eid2101.140743

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