Enterovirus Unit, National Centre for Microbiology, Instituto de Salud Carlos III, 28220 Madrid, Spain.
Microbiological and Paediatric Departments, Hospital San Joan de Déu, 08950 Barcelona, Spain.
Viruses. 2021 Apr 28;13(5):781. doi: 10.3390/v13050781.
Hand, foot, and mouth disease (HFMD) is a mild illness caused by enteroviruses (EV), although in some Asian countries, large outbreaks have been reported in the last 25 years, with a considerable incidence of neurological complications. This study describes epidemiological and clinical characteristics of EV infections involved in HFMD and other mucocutaneous symptoms from 2006 to 2020 in Spain. EV-positive samples from 368 patients were included. EV species A were identified in 85.1% of those typed EV. Coxsackievirus (CV) A6 was the prevalent serotype (60.9%), followed by EV-A71 (9.9%) and CVA16 (7.7%). Infections affected children (1-6 years old) mainly, and show seasonality with peaks in spring-summer and autumn. Clinical data indicated few cases of atypical HFMD as well as those with neurological complications (associated with the 2016 EV-A71 outbreak). Phylogenetic analysis of CVA6 VP1 sequences showed different sub-clusters circulating from 2010 to present. In conclusion, HFMD or exanthemas case reporting has increased in Spain in recent years, probably associated with an increase in circulation of CVA6, although they did not seem to show greater severity. However, EV surveillance in mucocutaneous manifestations should be improved to identify the emergence of new types or variants causing outbreaks and more severe pathologies.
手足口病（HFMD）是由肠道病毒（EV）引起的轻度疾病，尽管在过去 25 年中，一些亚洲国家报告了大规模暴发，并伴有相当比例的神经系统并发症。本研究描述了 2006 年至 2020 年期间在西班牙，HFMD 和其他黏膜皮肤症状中涉及的 EV 感染的流行病学和临床特征。共纳入 368 例 EV 阳性样本。对其中已分型的 EV 进行鉴定，发现 85.1%为 EV 型 A。柯萨奇病毒（CV）A6 是最常见的血清型（60.9%），其次是 EV-A71（9.9%）和 CVA16（7.7%）。感染主要影响儿童（1-6 岁），具有季节性，春夏季和秋季为高峰期。临床数据表明，不典型 HFMD 以及伴有神经系统并发症的病例较少（与 2016 年 EV-A71 暴发有关）。CVA6 VP1 序列的系统进化分析显示，从 2010 年至今，不同的亚群一直在循环。总之，近年来西班牙的 HFMD 或出疹病例报告有所增加，这可能与 CVA6 的循环增加有关，尽管它们似乎没有表现出更高的严重程度。然而，应加强对黏膜皮肤表现的 EV 监测，以发现引起暴发和更严重病理的新型或变异型。
