■手,脚,口蹄疫(HFMD)是全球公共卫生问题,特别是在亚太地区。最近,导致许多国家手足口病爆发的主要病原体,包括中国,柯萨奇病毒(CV)A6,是世界上最普遍的肠道病毒之一。它是一种经过基因重组和进化的新变种,这不仅可能导致HFMD临床表现的改变,而且由于核苷酸突变的积累而增加了其致病性。
■该研究评估了中国手足口病的流行病学特征,并表征了引起手足口病的主要病原体(CV-A6)的分子流行病学。我们试图通过分子流行病学研究建立疾病进展与病毒遗传进化之间的关联。
■利用中国疾病预防控制中心2021-2023年的监测数据,分析河南省手足口病的流行季节和高峰,中国,并捕获手足口病病原体分型结果。我们分析了NCBI数据库中所有全长CV-A6序列和河南分离序列的进化特征。为了表征CV-A6的分子进化,估计了有关CV-A6序列的时间缩放树和历史种群动态。此外,与原型CV-A6菌株相比,我们分析了分离的菌株的突变或缺失的氨基酸位点。
■河南手足口病2021-2023年流行季节通常从6月持续到8月,高峰在六月和七月左右。高峰期的每月病例报告率从20.7%(4854/23,440)到35%(12,135/34,706)不等。对2850例实验室确诊病例的病原体组成分析,确定了8种肠道病毒血清型,其中CV-A6所占比例最高(652/2850,22.88%)。CV-A6在2022年(203/732,27.73%)和2023年(262/708,37.01%)成为HFMD的主要病原体。我们分析了NCBI数据库中的所有CV-A6全长序列以及河南分离的病毒的进化特征。在中国,D3亚型从2011年开始逐渐出现,到2019年,所有CV-A6病毒株都属于D3亚型。河南地区的VP1序列分析表明,其亚型与国家亚型一致。此外,我们使用贝叶斯系统发育分析了CV-A6的分子进化特征,发现CV-A6D3的最新共同祖先可以追溯到2006年在中国,早于2011年手足口病爆发。此外,与原始菌株相比,2023年分离的菌株在几个氨基酸位点发生了突变。
CV-A6病毒可能是在大规模手足口病爆发之前在中国秘密引入和传播的。我们的实验室测试数据证实了CV-A6患病率的波动和周期性模式。我们的研究为理解CV-A6的进化动力学提供了有价值的见解。
UNASSIGNED: Hand, foot, and mouth disease (
HFMD) is a global public health concern, notably within the Asia-Pacific region. Recently, the primary pathogen causing
HFMD outbreaks across numerous countries, including China, is coxsackievirus (CV) A6, one of the most prevalent enteroviruses in the world. It is a new variant that has undergone genetic recombination and evolution, which might not only induce modifications in the clinical manifestations of HFMD but also heighten its pathogenicity because of nucleotide mutation accumulation.
UNASSIGNED: The study assessed the epidemiological characteristics of HFMD in China and characterized the molecular epidemiology of the major pathogen (CV-A6) causing
HFMD. We attempted to establish the association between disease progression and viral genetic evolution through a molecular epidemiological study.
UNASSIGNED: Surveillance data from the Chinese Center for Disease Control and Prevention from 2021 to 2023 were used to analyze the epidemiological seasons and peaks of HFMD in Henan, China, and capture the results of
HFMD pathogen typing. We analyzed the evolutionary characteristics of all full-length CV-A6 sequences in the NCBI database and the isolated sequences in Henan. To characterize the molecular evolution of CV-A6, time-scaled tree and historical population dynamics regarding CV-A6 sequences were estimated. Additionally, we analyzed the isolated strains for mutated or missing amino acid sites compared to the prototype CV-A6 strain.
UNASSIGNED: The 2021-2023 epidemic seasons for HFMD in Henan usually lasted from June to August, with peaks around June and July. The monthly case reporting rate during the peak period ranged from 20.7% (4854/23,440) to 35% (12,135/34,706) of the total annual number of cases. Analysis of the pathogen composition of 2850 laboratory-confirmed cases identified 8 enterovirus serotypes, among which CV-A6 accounted for the highest proportion (652/2850, 22.88%). CV-A6 emerged as the major pathogen for
HFMD in 2022 (203/732, 27.73%) and 2023 (262/708, 37.01%). We analyzed all CV-A6 full-length sequences in the NCBI database and the evolutionary features of viruses isolated in Henan. In China, the D3 subtype gradually appeared from 2011, and by 2019, all CV-A6 virus strains belonged to the D3 subtype. The VP1 sequences analyzed in Henan showed that its subtypes were consistent with the national subtypes. Furthermore, we analyzed the molecular evolutionary features of CV-A6 using Bayesian phylogeny and found that the most recent common ancestor of CV-A6 D3 dates back to 2006 in China, earlier than the 2011 HFMD outbreak. Moreover, the strains isolated in 2023 had mutations at several amino acid sites compared to the original strain.
UNASSIGNED: The CV-A6 virus may have been introduced and circulating covertly within China prior to the large-scale HFMD outbreak. Our laboratory testing data confirmed the fluctuation and periodic patterns of CV-A6 prevalence. Our study provides valuable insights into understanding the evolutionary dynamics of CV-A6.