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J Clin Virol. 2010 May;48(1):49-54. doi: 10.1016/j.jcv.2010.02.002. Epub 2010 Feb 26.

Co-circulation of coxsackieviruses A6 and A10 in hand, foot and mouth disease outbreak in Finland.

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1
National Institute for Health and Welfare (THL), Department of Infectious Disease Surveillance and Control, Gastrointestinal Infections Unit, PO Box 30, 00271 Helsinki, Finland. soile.blomqvist@thl.fi

Abstract

BACKGROUND:

A nationwide outbreak of hand, foot and mouth disease (HFMD) occurred in Finland in autumn 2008. The outbreak was untypical since a considerable number of clinically diagnosed patients were adults. Furthermore, many of the patients suffered from onychomadesis several weeks after the acute phase of HFMD.

OBJECTIVES:

Detection, identification and phylogenetic analysis of human enteroviruses (HEV) that caused the outbreak.

STUDY DESIGN:

A total of 420 clinical specimens were obtained from 317 HFMD cases all over the country. The presence of HEV in the specimens was analysed by virus isolation and/or direct real-time RT-PCR; selected HEV strains were further typed by molecular methods. The genetic similarities of HEV strains were assessed by phylogenetic analyses on partial VP1 sequences.

RESULTS:

HEV were detected in 212 HFMD cases, including both children and adults, throughout Finland. Two HEV types, coxsackieviruses A6 (CV-A6) and A10 (CV-A10), were identified as the causative agents of the outbreak. One genetic variant of CV-A6 predominated, but, additionally, three other genetically distinct CV-A6 strains were found. All CV-A10 strains segregated into one genetic cluster distinct from previously reported CV-A10 sequences.

CONCLUSIONS:

The Finnish 2008 HFMD outbreak was caused by two infrequently detected, co-circulating, coxsackie A viruses. Our data suggest endemic circulation of both CV-A types in Northern Europe and that the outbreak was due to the emergence of new genetic variants of these viruses.

PMID:
20189452
DOI:
10.1016/j.jcv.2010.02.002
[Indexed for MEDLINE]

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