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

Abstract

To know the epidemiological context of hand‐foot‐and‐mouth disease (HFMD) in a region of Uruguay and to identify the Enterovirus responsible for an outbreak in a rural childcare center in 2018. Swab samples from skin lesions and/or stools samples were collected from children suffering HFMD during an outbreak in a rural childcare center. Samples were subject to viral RNA extraction and reverse‐transcription polymerase chain reaction towards VP1 coding segment, to identify the Enterovirus type by sequencing and phylogenetic analysis. Total of 149 cases of HFMD affecting 98 boys and 51 girls were reported in Salto Province‐Uruguay in 2018. Total 60% of the cases were originated from outbreaks, which occurred in ten educative and childcare institutions from both urban and rural areas. Coxsackievirus‐6 (CV‐A6) was identified as responsible for one of the rural outbreaks. Uruguayan strains were more related to strains reported in Russia, Turkey, and Germany (2014‐2017) than to strains reported in Brazil and Argentina from 2015 to 2016. This is the first report of CV‐A6‐associated HFMD in Uruguay, evidencing a wide geographic range of the virus in the Latin American region. Our report also warns about CV‐A6‐associated HFMD during winter, contrarily to most reports that register HFMD during summer and fall seasons.

First evidence of enterovirus A71 and echovirus 30 in Uruguay and genetic relationship with strains circulating in the South American region

“…Interestingly, our results show the Enterovirus A species type replacement along the two sampling periods. In 2011–2012, CVA16 circulated predominantly, although in 2017–2018 other types emerged as CVA6 or CVA10, coinciding with reports of HFMD epidemics attributed to these pathogens since 2018 in this geographic region [ 45 , 46 ]. Nevertheless, EV-A71 was not detected during the study of clinical cases from these epidemics in spite of its detection in wastewater samples collected in Uruguay in September and October, 2017.…”

Coxsackievirus A6 strains causing an outbreak of hand-foot-and-mouth disease in Northeastern Brazil in 2018

“…In Latin America, CV-A6 associated with HFMD cases began to circulate between 2011 and 2012, with reports from Cuba 35 and Brazil 6 , reaching Peru in 2016 36 . Since 2018, CV-A6 has been more frequently detected in HFMD outbreaks, as well as in sporadic cases in the region 3,5,7,37 . The present study reinforces the importance of the emergence of CV-A6 causing HFMD in Latin America.…”

“…Seven EVs species have been associated with human disease: EV-A to -D and rhinovirus A to C 1,2 . EV-A is responsible for more than 90% of HFMD cases worldwide 3,4 . Enterovirus A 71 (EV-A71), coxsackievirus A6 (CVA6) and coxsackievirus A16 (CVA16) are the leading pathogens associated with HFMD outbreaks globally [2][3][4] .…”

“…EV-A is responsible for more than 90% of HFMD cases worldwide 3,4 . Enterovirus A 71 (EV-A71), coxsackievirus A6 (CVA6) and coxsackievirus A16 (CVA16) are the leading pathogens associated with HFMD outbreaks globally [2][3][4] . Although EVs have long been recognized as the most common etiological agents of HFMD1 1 , they have been poorly investigated in Brazil [5][6][7] .…”

Genetic Polymorphisms of Foot-and-Mouth Disease Virus

“…These blisters later transform into ulcers. The clinical manifestation of FMDV in children is more pronounced, and the clinical signs are sometimes similar to intoxication [8].…”