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

Authors

  • Adriana Luchs Instituto Adolfo Lutz, Centro de Virologia, Núcleo de Doenças Entéricas, São Paulo, São Paulo, Brazil http://orcid.org/0000-0003-4131-990X
  • Lais Sampaio de Azevedo Instituto Adolfo Lutz, Centro de Virologia, Núcleo de Doenças Entéricas, São Paulo, São Paulo, Brazil
  • Ellen Viana de Souza Instituto Adolfo Lutz, Centro de Virologia, Núcleo de Doenças Entéricas, São Paulo, São Paulo, Brazil
  • Roberta Salzone Medeiros Instituto Adolfo Lutz, Centro de Virologia, Núcleo de Doenças Entéricas, São Paulo, São Paulo, Brazil
  • Yasmin França Viana Pires de Souza Instituto Adolfo Lutz, Centro de Virologia, Núcleo de Doenças Entéricas, São Paulo, São Paulo, Brazil
  • Dalane Loudal Florentino Teixeira Secretaria de Estado da Saúde da Paraíba, Laboratório Central de Saúde Pública, João Pessoa, Paraíba, Brazil
  • Thiago Franco de Oliveira Carneiro Secretaria de Estado da Saúde da Paraíba, Laboratório Central de Saúde Pública, João Pessoa, Paraíba, Brazil
  • Gabriela Maria Fernandes de Alencar Secretaria de Estado da Saúde da Paraíba, Hospital Infantil Arlinda Marques, João Pessoa, Paraíba, Brazil
  • Fernanda Lúcia de Sousa Leite Morais Secretaria de Estado da Saúde da Paraíba, Hospital Infantil Arlinda Marques, João Pessoa, Paraíba, Brazil
  • Diana de Fátima Alves Pinto Secretaria de Estado da Saúde da Paraíba, Centro de Informações Estratégicas em Vigilância em Saúde, João Pessoa, Paraíba, Brazil
  • Thelma Suely Okay Universidade de São Paulo, Faculdade de Medicina, Departamento de Pediatria, São Paulo, São Paulo, Brazil Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil http://orcid.org/0000-0001-9316-7288
  • Lidia Yamamoto Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil http://orcid.org/0000-0003-1666-1762
  • Vanessa dos Santos Morais Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil http://orcid.org/0000-0002-3813-3154
  • Emerson Luiz Lima Araújo Ministério da Saúde, Secretaria de Vigilância em Saúde, Departamento de Articulação Estratégica de Vigilância em Saúde, Coordenação-Geral de Laboratórios de Saúde Pública, Distrito Federal, Brasília, Brazil http://orcid.org/0000-0002-7684-2883
  • Elcio Leal Universidade Federal do Pará, Instituto de Ciências Biológicas, Belém, Pará, Brazil http://orcid.org/0000-0003-3463-0492
  • Antonio Charlys da Costa Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, São Paulo, São Paulo, Brazil http://orcid.org/0000-0001-5516-5177

DOI:

https://doi.org/10.1590/S1678-9946202264016

Keywords:

Hand foot and mouth disease, Enterovirus, Coxsackievirus, Surveillance

Abstract

Hand-foot-and-mouth disease (HFMD) is a highly contagious viral disease commonly associated to Enteroviruses (EV). During 2018, Brazil faced massive HFMD outbreaks spread across the country. This study aimed to characterize the EV responsible for the HFMD outbreak that occurred in Paraiba State, Brazilian Northeastern region, in 2018, followed by a phylogenetic analysis to detail information on its genetic diversity. A total of 49 serum samples (one from each patient) collected from children ≤ 15 years old, clinically diagnosed with HFMD were tested for EV using conventional RT-PCR and RT-qPCR. EV infection was confirmed in 71.4% (35/49) of samples. The mean and median ages were 1.83 years and one year old, respectively. Twenty-two EV-positive samples were successfully sequenced and classified as EV-A species; 13 samples were also identified with the CV-A6 genotype. The phylogenetic analysis (VP1 region) of three samples revealed that the detected CV-A6 strains belonged to sub-lineage D3. The CV-A6 strains detected here clustered with strains from South America, Europe and West Asia strains that were also involved in HFMD cases during the 2017-2018 seasons, in addition to the previously detected Brazilian CV-A6 strains from 2012 to 2017, suggesting a global co-circulation of a set of different CV-A6 strains introduced in the country at different times. The growing circulation of the emerging CV-A6 associated with HFMD, together with the detection of more severe cases worldwide, suggests the need for a more intense surveillance system of HFMD in Brazil. In addition, this investigation was performed exclusively on serum samples, and the analysis of whole blood samples should be considered and could have shown advantages when employed in the diagnosis of enteroviral HFMD outbreaks.

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Published

2022-05-16

How to Cite

Luchs, A. ., Azevedo, L. S. de ., Souza, E. V. de ., Medeiros, R. S. ., Souza, Y. F. V. P. de ., Teixeira, D. L. F. ., Carneiro, T. F. de O. ., Alencar, G. M. F. de ., Morais, F. L. de S. L. ., Pinto, D. de F. A. ., Okay, T. S. ., Yamamoto, L. ., Morais, V. dos S. ., Araújo, E. L. L. ., Leal, E., & Costa, A. C. da . (2022). Coxsackievirus A6 strains causing an outbreak of hand-foot-and-mouth disease in Northeastern Brazil in 2018. Revista Do Instituto De Medicina Tropical De São Paulo, 64, e16. https://doi.org/10.1590/S1678-9946202264016

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