{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,19]],"date-time":"2026-06-19T01:01:50Z","timestamp":1781830910114,"version":"3.54.5"},"reference-count":37,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2017,3,14]],"date-time":"2017-03-14T00:00:00Z","timestamp":1489449600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Journal of Medical Virology"],"published-print":{"date-parts":[[2017,8]]},"abstract":"<jats:sec><jats:label\/><jats:p>Coxsackievirus A6 (CV\u2010A6) is an enterovirus, which is known to cause herpangina. However, since 2009 it has frequently been isolated from children with hand, foot, and mouth disease (HFMD). In Japan, CV\u2010A6 has been linked to HFMD outbreaks in 2011 and 2013. In this study, the full\u2010length genome sequencing of CV\u2010A6 strains were analyzed to identify the association with clinical manifestations. Five thousand six hundred and twelve children with suspected enterovirus infection (0\u201017 years old) between 1999 and 2013 in Hyogo Prefecture, Japan, were enrolled. Enterovirus infection was confirmed with reverse transcriptase\u2010PCR in 753 children (791 samples), 127 of whom (133 samples) were positive for CV\u2010A6 based on the direct sequencing of the VP4 region. The complete genomes of CV\u2010A6 from 22 positive patients with different clinical manifestations were investigated. A phylogenetic analysis divided these 22 strains into two clusters based on the VP1 region; cluster I contained strains collected in 1999\u20102009 and mostly related to herpangina, and cluster II contained strains collected in 2011\u20102013 and related to HFMD outbreak. Based on the full\u2010length polyprotein analysis, the amino acid differences between the strains in cluster I and II were 97.7\u2009\u00b1\u20090.28%. Amino acid differences were detected in 17 positions within the polyprotein. Strains collected in 1999\u20102009 and those in 2011\u20102013 were separately clustered by phylogenetic analysis based on 5\u2032UTR and 3Dpol region, as well as VP1 region. In conclusion, HFMD outbreaks by CV\u2010A6 were recently frequent in Japan and the accumulation of genomic change might be associated with the clinical course.<\/jats:p><\/jats:sec>","DOI":"10.1002\/jmv.24798","type":"journal-article","created":{"date-parts":[[2017,2,23]],"date-time":"2017-02-23T02:32:39Z","timestamp":1487817159000},"page":"1395-1403","source":"Crossref","is-referenced-by-count":25,"title":["Characterization of genome sequences and clinical features of coxsackievirus A6 strains collected in Hyogo, Japan in 1999\u20102013"],"prefix":"10.1002","volume":"89","author":[{"given":"Miki","family":"Ogi","sequence":"first","affiliation":[{"name":"Hyogo Prefectural Institute of Public Health and Consumer Sciences Public Health Science Research Center Hyogo Japan"},{"name":"Center for Infectious Diseases Kobe University Graduate School of Medicine Hyogo 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