Molecular #epidemiology of #coxsackievirus A6 circulating in #HK reveals common #neurological manifestations and emergence of novel recombinant groups (J Clin Virol., abstract)

[Source: Journal of Clinical Virology, full page: (LINK). Abstract, edited.]

Molecular epidemiology of coxsackievirus A6 circulating in Hong Kong reveals common neurological manifestations and emergence of novel recombinant groups

Susanna K.P. Lau, Pyrear S.H. Zhao1, Siddharth Sridhar, Cyril C.Y. Yip, Kam Leng Aw-Yong, Elaine Y.Y. Chow, Kelvin C.M. Cheung, Rex W.H. Hui, Ryan Y.H. Leung, Yuki S.K. Lai, Alan K.L. Wu, Kelvin K.W. To, Patrick C.Y. Woo, Kwok-Yung Yuen


Published online: September 08, 2018 – Accepted: September 7, 2018 – Received in revised form: August 21, 2018 – Received: May 28, 2018



  • HFMD was the most common diagnosis among patients with CV-A6 infection.
  • Neurological manifestations were commonly observed (25%).
  • CV-A6 circulating in Hong Kong mainly belonged to genotype D5.
  • Three novel recombinant strains (two novel groups RL and RM) were identified.
  • 3D gene was a common recombination site in CV-A6.




Coxsackievirus A6 (CV-A6) represents the predominant enterovirus serotype in Hong Kong, but its epidemiology in our population was unknown.


To examine the clinical and molecular epidemiology of CV-A6 and detect emerging recombinant strains in Hong Kong.

Study design

Nasopharyngeal aspirates (NPAs) from patients with febrile or respiratory illness were subject to RT-PCR for CV-A6 and sequencing of 5′-NCR and VP1. CV-A6-positive samples were further subject to 2C and 3D gene sequencing. Complete genome sequencing was performed on potential recombinant strains.


Thirty-six (0.35%) NPAs were positive for CV-A6 by 5’-NCR RT-PCR and sequencing, 28 of which confirmed by partial VP1 gene sequencing. Among the 28 patients (mainly young children) with CV-A6 infection, hand-foot-and-mouth disease (HFMD) (43%), herpangina (18%) and tonsillitis (11%) were the most common diagnoses. Seven (25%) patients had neurological manifestations, including febrile seizures, encephalitis and meningitis. VP1 gene analysis showed that 24 CV-A6 strains circulating in Hong Kong belonged to genotype D5, while 4 strains belonged to D4. Further 2C and 3D gene analysis revealed eight potential recombinant strains. Genome sequencing of five selected strains confirmed four recombinant strains: HK459455/2013 belonging to recombination group RJ arisen from CV-A6/CV-A4, HK458288/2015 and HK446377/2015 representing novel group RL arisen from CV-A6/CV-A4, and HK462069/2015 representing novel group RM arisen from CV-A6/EV-A71. Recombination breakpoints located at 3D were identified in the latter three recombinant strains, with HK462069/2015 (from a child with encephalitis) having acquired 3D region from EV-A71.


We identified novel recombinant CV-A6 strains in Hong Kong, with 3D being a common recombination site.

Keywords: coxsackievirus A6, hand-foot-and-mouth disease, novel, recombination, epidemiology, Hong Kong

1 Authors contributed the same to the manuscript.

© 2018 Published by Elsevier B.V.

Keywords: HFMD; Coxsackievirus A6; Encephalitis; Meningitis; HK PRC SAR.


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Giuseppe Michieli

I am an Italian blogger, active since 2005 with main focus on emerging infectious diseases such as avian influenza, SARS, antibiotics resistance, and many other global Health issues. Other fields of interest are: climate change, global warming, geological and biological sciences. My activity consists mainly in collection and analysis of news, public services updates, confronting sources and making decision about what are the 'signals' of an impending crisis (an outbreak, for example). When a signal is detected, I follow traces during the entire course of an event. I started in 2005 my blog ''A TIME'S MEMORY'', now with more than 40,000 posts and 3 millions of web interactions. Subsequently I added an Italian Language blog, then discontinued because of very low traffic and interest. I contributed for seven years to a public forum ( in the midst of the Ebola epidemic in West Africa in 2014, I left the site to continue alone my data tracking job.