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An emerging recombinant human enterovirus 71 responsible for the 2008 outbreak of Hand Foot and Mouth Disease in Fuyang city of China

Yan Zhang1, Zhen Zhu1, Weizhong Yang2, Jun Ren3, Xiaojuan Tan1, Yu Wang2, Naiying Mao1, Songtao Xu1, Shuangli Zhu1, Aili Cui1, Yong Zhang1, Dongmei Yan1, Qun Li4, Xiaoping Dong1, Jing Zhang4, Yueping Zhao3, Junfeng Wan5, Zijian Feng4, Junling Sun4, Shiwen Wang1, Dexin Li1* and Wenbo Xu12*

Author Affiliations

1 Key Laboratory for Molecular Virology & Genetic Engineering, National Institute for Viral Disease Control and Prevention, Chinese Center for Disease Control and Prevention, Beijing 100052, China

2 Chinese Center for Disease Control and Prevention, Beijing 100050, China

3 Anhui Provincial Center for Disease Control and Prevention, Hefei 230001, China

4 Office for Disease Control and Emergency Response, Chinese Center for Disease Control and Prevention, Beijing 100050, China

5 Fuyang prefecture Center for Disease Control and Prevention, Fuyang 236000, China

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Virology Journal 2010, 7:94  doi:10.1186/1743-422X-7-94

Published: 12 May 2010

Abstract

Hand, foot and mouth disease (HFMD), a common contagious disease that usually affects children, is normally mild but can have life-threatening manifestations. It can be caused by enteroviruses, particularly Coxsackieviruses and human enterovirus 71 (HEV71) with highly variable clinical manifestations. In the spring of 2008, a large, unprecedented HFMD outbreak in Fuyang city of Anhui province in the central part of southeastern China resulted in a high aggregation of fatal cases. In this study, epidemiologic and clinical investigations, laboratory testing, and genetic analyses were performed to identify the causal pathogen of the outbreak. Of the 6,049 cases reported between 1 March and 9 May of 2008, 3023 (50%) were hospitalized, 353 (5.8%) were severe and 22 (0.36%) were fatal. HEV71 was confirmed as the etiological pathogen of the outbreak. Phylogenetic analyses of entire VP1 capsid protein sequence of 45 Fuyang HEV71 isolates showed that they belong to C4a cluster of the C4 subgenotype. In addition, genetic recombinations were found in the 3D region (RNA-dependent RNA polymerase, a major component of the viral replication complex of the genome) between the Fuyang HEV71 strain and Coxsackievirus A16 (CV-A16), resulting in a recombination virus. In conclusion, an emerging recombinant HEV71 was responsible for the HFMD outbreak in Fuyang City of China, 2008.