Surveillance for Enteroviruses Associated with Hand, Foot, and Mouth Disease, and Other Mucocutaneous Symptoms in Spain, 2006–2020

Abstract

Hand, foot, and mouth disease (HFMD) is a mild illness caused by enteroviruses (EV), although in some Asian countries, large outbreaks have been reported in the last 25 years, with a considerable incidence of neurological complications. This study describes epidemiological and clinical characteristics of EV infections involved in HFMD and other mucocutaneous symptoms from 2006 to 2020 in Spain. EV-positive samples from 368 patients were included. EV species A were identified in 85.1% of those typed EV. Coxsackievirus (CV) A6 was the prevalent serotype (60.9%), followed by EV-A71 (9.9%) and CVA16 (7.7%). Infections affected children (1–6 years old) mainly, and show seasonality with peaks in spring–summer and autumn. Clinical data indicated few cases of atypical HFMD as well as those with neurological complications (associated with the 2016 EV-A71 outbreak). Phylogenetic analysis of CVA6 VP1 sequences showed different sub-clusters circulating from 2010 to present. In conclusion, HFMD or exanthemas case reporting has increased in Spain in recent years, probably associated with an increase in circulation of CVA6, although they did not seem to show greater severity. However, EV surveillance in mucocutaneous manifestations should be improved to identify the emergence of new types or variants causing outbreaks and more severe pathologies.

First seroepidemiological investigation of human enterovirus 71 in Iran

“…Based on our study, 56.7% of the specimens were positive for anti-EV-A71 antibodies, which means that EV-A71 has had a circulation in our society. Our finding is consistent with few reports of EV-A71 in neurological diseases and no reports of HFMD cases with EV-A71 ( 30 , 31 ).…”

Genetic characteristics of Coxsackievirus A6 from children with hand, foot and mouth disease in Beijing, China, 2017–2019

“…In Hangzhou, CV-A6 was also one of the main causative pathogens of HFMD in 2017 and 2018 which was similar to this study [22]. In Spain, CVA6 emerged in 2010 and became the main cause of HFMD between 2010 to 2020, the CVA6 strains were also similar to those circulating in Europe and Asia [23]. And in Vietnam, CV-A6 was rst detected in 2011, which prevailed annually as the rst or secondary dominant serotype and became the most dominant pathogen in 2015 and 2017 [24].…”

Coxsackievirus A6 Recombinant Subclades D3/A and D3/H Were Predominant in Hand-Foot-And-Mouth Disease Outbreaks in the Paediatric Population, France, 2010–2018

“…Human diseases associated with coxsackievirus A6 (CVA6) were rarely reported in European countries before the occurrence of two outbreaks of hand-foot-and-mouth disease (HFMD) in the paediatric populations of Finland (2008) and Spain (2010–2012) [ 1 , 2 ]. After these two outbreaks, several CVA6 upsurges were reported worldwide [ 3 , 4 , 5 , 6 , 7 ]. CVA6 was mainly involved in sporadic disease cases of herpangina (HA), but mounting evidence points to its capacity to cause large seasonal outbreaks of HFMD [ 8 ] associated with atypical presentations including vesiculobullous eruption [ 9 , 10 , 11 ], adult cases [ 12 , 13 , 14 ], and neurological manifestations [ 15 ].…”