An outbreak of Coxsackievirus A6–associated hand, foot, and mouth disease in a kindergarten in Beijing in 2015

Abstract

BackgroundCoxsackievirus A6 (CVA6) is one of the major agents to cause hand, foot and mouth disease (HFMD) outbreaks globally. The objective of this study is to investigate the epidemiologic and clinical manifestations of CVA6 outbreak, and thus guide the diagnosis and treatment of the disease, as well as disease prevention.MethodsAn HFMD outbreak in a kindergarten was reported to Shijingshan District Center for Disease Control and Prevention (SCDC) on November 2, 2015 in Beijing, China. Epidemiological investigation was conducted. We performed a nine-week follow-up study to collect and analyze the clinical manifestations of HFMD cases.ResultsThe outbreak yield 56 (15.7%) clinical diagnosed HFMD cases out of 357 registered children in the kindergarten with the mean age of 3.5 years old. This outbreak lasted for three days and ceased after initiating infectious disease controlling procedures, including periodical suspension of the kindergarten activities, environmental disinfection, and family health education. Fifty-one cases were followed for nine weeks. The positive rate of clinical manifestations of rash, fever, desquamation, pigmentation and onychomadesis were 100.0%, 84.3%, 68.6%, 17.6% and 43.1%, respectively. Children developed desquamation within the first 4 weeks after disease onset and developed onychomadesis between the 3th and 8th week after disease onset. Children with desquamation had 9.3 (95%CI: 1.836–47.437) times higher odds of developing onychomadesis compared to those without this manifestation. Ten out of 14 collected samples were CVA6 positive, and five positive samples shared a high degree of similarity in the VP1 nucleotide and amino acid sequences (99.9–100.0% and 100%).ConclusionThis HFMD outbreak was caused by CVA6, featured with delayed symptoms. Emerging CVA6-associated HFMD and its delayed symptoms should be paid more attention to reduce outbreaks and provide more information to doctors and parents.Electronic supplementary materialThe online version of this article (10.1186/s12887-018-1253-1) contains supplementary material, which is available to authorized users.

Hand‐foot‐and‐mouth disease in uruguay: Coxsackievirus A6 identified as causative of an outbreak in a rural childcare center

“…Coxsackievirus A6 has emerged linked to severe and atypical forms of HFMD apart classical forms of the disease . Nevertheless, cases from CC‐8 outbreak resemble more to classical symptomatology of HFMD.…”

“…Nevertheless, cases from CC‐8 outbreak resemble more to classical symptomatology of HFMD. During this study, the follow up of children during the convalescent period was not carried out, and conditions, such as onychomadesis or skin desquamation (whose onsets often happen during this period in most of the atypical HFMD cases associated with CV‐A6) could have appeared without being registered by this study …”

“…The highly contagious character of the disease helps it to spread quickly in educative institutions where children are living together and in close contact several hours a day . This leads to the occurrence of outbreaks, which must be contained to mitigate the impact of the disease and prevent new infections.…”

“…In fact, CV‐A6 is nowadays, identified among the predominant types causing HFMD . The CV‐A6 is known to cause both pediatric and adult's outbreaks, and many reports have shown presentations of the disease with more severe symptoms than typical HFMD cases, indeed involving the CNS …”

“…In fact, CV-A6 is nowadays, identified among the predominant types causing HFMD. 17 The CV-A6 is known to cause both pediatric and adult's outbreaks, 10,18,19 and many reports have shown presentations of the disease with more severe symptoms than typical HFMD cases, indeed involving the CNS. 20,21 From several years ago, Uruguay registers cases of HFMD, but up to nowadays, the enterovirus types associated with the disease remain unknown due to the lack of studies in this regard.…”