ArticleScientific reports2019
Emerging recombination of the C2 sub-genotype of HFMD-associated CV-A4 is persistently and extensively circulating in China.
Article in Scientific reports, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
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14 citing papers in PubMed, 17 citations in OpenAlex.
- Genetic variation, recombinant characteristics, and seroprevalence analysis of echovirus 3 causing severe and mild cases of hand, foot, and mouth disease in Guizhou Province.Microbiology spectrum · 2026Article
- Genetic Analysis of Coxsackievirus A4 Among Healthy Children - Xizang Autonomous Region, China, 1996-2024.China CDC weekly · 2026Article
- Whole-genome analysis of CVA4 in children with herpangina in two cities of Shandong, China.Scientific reports · 2026Article
- Molecular characterization of Coxsackievirus A2 isolated from hand, foot and mouth disease in eastern China.Microbial genomics · 2025Article
- A lethal juvenile mouse model for the evaluation of antiviral reagents against coxsackievirus A4.iScience · 2025Article
- Molecular epidemiology, coinfection, and diversity of enteroviruses detected in respiratory samples collected from patients with influenza-like illness in Hangzhou, China, in 2023.Virology journal · 2025Article
- Genome Analysis of Coxsackievirus A4 Identified from Herpangina Children in Northern China.Current microbiology · 2025Article
- Genetic diversity and spread of recombinant coxsackievirus A4 in hand, foot, and mouth disease cases in Bangkok, Thailand: 2017-2023.Scientific reports · 2024Article
- Changing Epidemiology of Hand, Foot, and Mouth Disease Causative Agents and Contributing Factors.The American journal of tropical medicine and hygiene · 2024Review
- Metagenomic Surveillance of Viral Gastroenteritis in a Public Health Setting.Microbiology spectrum · 2023Article
- An outbreak of a novel recombinant Coxsackievirus A4 in a kindergarten, Shandong province, China, 2021.Emerging microbes & infections · 2022Article
- Genomic epidemiology of coxsackievirus A16 in mainland of China, 2000-18.Virus evolution · 2020Article
- The Structure, Function, and Mechanisms of Action of Enterovirus Non-structural Protein 2C.Frontiers in microbiology · 2020Review
- Article
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19 authors at 9 institutions in 1 country.
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No grant is acknowledged in the PubMed record.
Abstract
Sporadic outbreaks caused by coxsackievirus A4 (CV-A4) have been reported worldwide. To further elucidate the detailed genetic characteristics and evolutionary recombination events of CV-A4, virus samples from nationwide hand, foot and mouth disease (HFMD) surveillance, encompassing 27 out of the 31 provinces in China, were investigated. Comprehensive and systematic phylogenetic analyses were performed by using 29 complete genomes, 142 complete CV-A4 VP1 sequences. Four genotypes (A, B, C and D) and five sub-genotypes (C1-C5) were re-identified based on the complete VP1 sequences. C2 is the predominant sub-genotype of CV-A4 associated with HFMD and has evolved into 3 clusters. Cluster 1 is a major cluster that has been persistently and extensively circulating in China since 2006 and has been associated with all severe cases. All the sequences showed high homology with the CV-A4 prototype in the P1 region, while higher identities with CV-A5, CV-14 and CV-16 in the P2 and P3 regions. Recombination analysis revealed that C2 had two specific genetic recombination patterns with other EV-A prototypes in the 5'-UTR and 3D region compared with C5. These recombination patterns might be associated with the increased transmissibility of C2 viruses, which were obtained due to their persistent and extensive circulation in populations.
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