{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T13:04:53Z","timestamp":1771851893466,"version":"3.50.1"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T00:00:00Z","timestamp":1769644800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"},{"start":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T00:00:00Z","timestamp":1771804800000},"content-version":"vor","delay-in-days":25,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"funder":[{"name":"Linyi Key Research and Development Project","award":["2024YX0002"],"award-info":[{"award-number":["2024YX0002"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Infect Dis"],"DOI":"10.1186\/s12879-026-12710-2","type":"journal-article","created":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T12:47:41Z","timestamp":1769690861000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Molecular epidemiology and genetic characteristics of enterovirus A identified in pediatric patients with hand, foot, and mouth disease and herpangina in Linyi, China, 2023\u20132024, following the relaxation of COVID-19 policies"],"prefix":"10.1186","volume":"26","author":[{"given":"Jie","family":"Chen","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pengfei","family":"You","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yingming","family":"Li","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaoyan","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Na","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chunling","family":"Ma","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yanli","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1872-5210","authenticated-orcid":false,"given":"Tiegang","family":"Lv","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,1,29]]},"reference":[{"key":"12710_CR1","unstructured":"International Committee on Taxonomy of Viruses (ICTV); 10. May 2024. Available online: https:\/\/ictv.global\/report\/chapter\/picornaviridae\/picornaviridae\/enterovirus"},{"key":"12710_CR2","doi-asserted-by":"publisher","first-page":"1165","DOI":"10.3390\/v16071165","volume":"16","author":"Z Xie","year":"2024","unstructured":"Xie Z, Khamrin P, Maneekarn N, Kumthip K. Epidemiology of enterovirus genotypes in association with human diseases. Viruses. 2024;16:1165. https:\/\/doi.org\/10.3390\/v16071165.","journal-title":"Viruses"},{"key":"12710_CR3","doi-asserted-by":"publisher","first-page":"418","DOI":"10.1016\/S1473-3099(20)30841-0","volume":"21","author":"X Wei","year":"2021","unstructured":"Wei X, Yang J, Gao L, Wang L, Liao Q, Qiu Q, et al. The transfer and decay of maternal antibodies against enterovirus A71, and dynamics of antibodies due to later natural infections in Chinese infants: A longitudinal, paired mother-neonate cohort study. Lancet Infect Dis. 2021;21:418\u201326. https:\/\/doi.org\/10.1016\/S1473-3099(20)30841-0.","journal-title":"Lancet Infect Dis"},{"key":"12710_CR4","doi-asserted-by":"publisher","first-page":"211","DOI":"10.1007\/3-540-26397-7_8","volume":"299","author":"VI Agol","year":"2006","unstructured":"Agol VI. Molecular mechanisms of poliovirus variation and evolution. Curr Top Microbiol Immunol. 2006;299:211\u201359. https:\/\/doi.org\/10.1007\/3-540-26397-7_8.","journal-title":"Curr Top Microbiol Immunol"},{"key":"12710_CR5","doi-asserted-by":"publisher","first-page":"829","DOI":"10.3967\/bes2020.113","volume":"33","author":"W Chen","year":"2020","unstructured":"Chen W, Weng YW, He WX, Zhu Y, Yu TT, Xie JF, et al. RT-nPCR assays for amplification and sequencing of VP1 genes in human enterovirus A-D from clinical specimens. Biomed Environ Sci. 2020;33:829\u201338. https:\/\/doi.org\/10.3967\/bes2020.113.","journal-title":"Biomed Environ Sci"},{"key":"12710_CR6","doi-asserted-by":"publisher","first-page":"199367","DOI":"10.1016\/j.virusres","volume":"344","author":"RS Machado","year":"2024","unstructured":"Machado RS, Tavares FN, Sousa IP Jr. Global landscape of coxsackieviruses in human health. Virus Res. 2024;344:199367. https:\/\/doi.org\/10.1016\/j.virusres. 2024.199367.","journal-title":"Virus Res"},{"key":"12710_CR7","doi-asserted-by":"publisher","first-page":"740","DOI":"10.4269\/ajtmh.23-0852","volume":"111","author":"N Kalam","year":"2024","unstructured":"Kalam N, Balasubramaniam V. Changing epidemiology of Hand, Foot, and mouth disease causative agents and contributing factors. Am J Trop Med Hyg. 2024;111:740\u201355. https:\/\/doi.org\/10.4269\/ajtmh.23-0852.","journal-title":"Am J Trop Med Hyg"},{"key":"12710_CR8","doi-asserted-by":"publisher","first-page":"258","DOI":"10.1016\/j.cmi.2024.09.020","volume":"31","author":"Y Liu","year":"2025","unstructured":"Liu Y, Song Y, Liu F, Chen Y, Liu Y, Shi J, et al. Effectiveness of the enterovirus A71 vaccine on hand, foot, and mouth disease: a real-world study in China. Clin Microbiol Infect. 2025;31:258\u201365. https:\/\/doi.org\/10.1016\/j.cmi.2024.09.020.","journal-title":"Clin Microbiol Infect"},{"key":"12710_CR9","doi-asserted-by":"publisher","first-page":"3581","DOI":"10.1002\/jmv.27806","volume":"94","author":"J Zhang","year":"2022","unstructured":"Zhang J, Cao J, Ye Q. Nonpharmaceutical interventions against the COVID-19 pandemic significantly decreased the spread of enterovirus in children. J Med Virol. 2022;94:3581\u20138. https:\/\/doi.org\/10.1002\/jmv.27806.","journal-title":"J Med Virol"},{"key":"12710_CR10","doi-asserted-by":"publisher","first-page":"1472944","DOI":"10.3389\/fpubh.2024","volume":"12","author":"Z Ding","year":"2024","unstructured":"Ding Z, Lu Q, Wu H, Wu C, Lin J, Wang X, et al. Trend of hand, foot and mouth disease before, during, and after china\u2019s COVID control policies in Zhejiang, China. Front Public Health. 2024;12:1472944. https:\/\/doi.org\/10.3389\/fpubh.2024.","journal-title":"Front Public Health"},{"key":"12710_CR11","doi-asserted-by":"publisher","first-page":"1786","DOI":"10.3390\/v16111786","volume":"16","author":"JCS Pun","year":"2024","unstructured":"Pun JCS, Tao KP, Yam SLS, Hon KL, Chan PKS, Li AM, et al. Respiratory viral infection patterns in hospitalised children before and after COVID-19 in Hong Kong. Viruses. 2024;16:1786. https:\/\/doi.org\/10.3390\/v16111786.","journal-title":"Viruses"},{"key":"12710_CR12","doi-asserted-by":"publisher","first-page":"e0323782","DOI":"10.1371\/journal.pone.0323782","volume":"20","author":"X Yan","year":"2025","unstructured":"Yan X, Liu Y, Chen F, Chang Z, Zhang Z, Pons-Salort M, et al. The efficacy and effectiveness of enterovirus A71 vaccines against hand, foot, and mouth disease: A systematic review and meta-analysis. PLoS ONE. 2025;20:e0323782. https:\/\/doi.org\/10.1371\/journal.pone.0323782.","journal-title":"PLoS ONE"},{"key":"12710_CR13","doi-asserted-by":"publisher","first-page":"21","DOI":"10.1007\/s12250-019-00169-2","volume":"35","author":"X Fu","year":"2020","unstructured":"Fu X, Wan Z, Li Y, Hu Y, Jin X, Zhang C. National epidemiology and evolutionary history of four Hand, foot and mouth Disease-Related enteroviruses in China from 2008 to 2016. Virol Sin. 2020;35:21\u201333. https:\/\/doi.org\/10.1007\/s12250-019-00169-2.","journal-title":"Virol Sin"},{"key":"12710_CR14","doi-asserted-by":"publisher","first-page":"262","DOI":"10.1016\/j.jcv.2009.02.002","volume":"4","author":"Y Zhang","year":"2009","unstructured":"Zhang Y, Tan XJ, Wang HY, Yan DM, Zhu SL, Wang DY, et al. An outbreak of hand, foot, and mouth disease associated with subgenotype C4 of human enterovirus 71 in Shandong, China. J Clin Virol. 2009;4:262\u20137. https:\/\/doi.org\/10.1016\/j.jcv.2009.02.002.","journal-title":"J Clin Virol"},{"key":"12710_CR15","doi-asserted-by":"publisher","unstructured":"Yin DQ, Wang CB, Wang CB, Xiao-Zhou, Ji SX. Epidemiology characteristics of human Coxsackie-virus A16 and enterovirus 71 Circulating in Linyi, China, from 2009 to 2017. Jpn J Infect Dis. 2018;6(470\u20133). https:\/\/doi.org\/10.7883\/yoken.JJID.2018.035.","DOI":"10.7883\/yoken."},{"key":"12710_CR16","unstructured":"National Health Commission of the People\u2019s Republic of China. 2018. https:\/\/www.nhc.gov.cn\/ewebeditor\/uploadfile\/2018\/03\/20180330100114132.pdf. Accessed 30 Mar 2018."},{"key":"12710_CR17","doi-asserted-by":"publisher","first-page":"2698","DOI":"10.1128\/JCM.00542-06","volume":"44","author":"WA Nix","year":"2006","unstructured":"Nix WA, Oberste MS, Pallansch MA. Sensitive, seminested PCR amplification of VP1 sequences for direct identification of all enterovirus serotypes from original clinical specimens. J Clin Microbiol. 2006;44:2698\u2013704. https:\/\/doi.org\/10.1128\/JCM.00542-06.","journal-title":"J Clin Microbiol"},{"key":"12710_CR18","doi-asserted-by":"publisher","first-page":"vev003","DOI":"10.1093\/ve\/vev003","volume":"1","author":"DP Martin","year":"2015","unstructured":"Martin DP, Murrell B, Golden M, Khoosal A, Muhire B. RDP4: detection and analysis of recombination patterns in virus genomes. Virus Evol. 2015;1:vev003. https:\/\/doi.org\/10.1093\/ve\/vev003.","journal-title":"Virus Evol"},{"key":"12710_CR19","doi-asserted-by":"publisher","first-page":"piae069","DOI":"10.1093\/jpids\/piae069","volume":"14","author":"MC Freeman","year":"2025","unstructured":"Freeman MC, Messacar K. Enterovirus and parechovirus neurologic infections in children: clinical presentations and neuropathogenesis. J Pediatr Infect Dis Soc. 2025;14:piae069. https:\/\/doi.org\/10.1093\/jpids\/piae069.","journal-title":"J Pediatr Infect Dis Soc"},{"key":"12710_CR20","doi-asserted-by":"publisher","first-page":"e2361","DOI":"10.1002\/rmv.2361","volume":"32","author":"R Kinobe","year":"2022","unstructured":"Kinobe R, Wiyatno A, Artika IM, Safari D. Insight into the enterovirus A71: A review. Rev Med Virol. 2022;32:e2361. https:\/\/doi.org\/10.1002\/rmv.2361.","journal-title":"Rev Med Virol"},{"key":"12710_CR21","doi-asserted-by":"publisher","first-page":"1028","DOI":"10.3390\/vaccines12091028","volume":"12","author":"Q Hu","year":"2024","unstructured":"Hu Q, Xie Y, Ji F, Zhao F, Song X, Lu S, et al. Effectiveness of EV-A71 vaccine and its impact on the incidence of Hand, foot and mouth disease: A systematic review. Vaccines. 2024;12:1028. https:\/\/doi.org\/10.3390\/vaccines12091028.","journal-title":"Vaccines"},{"key":"12710_CR22","doi-asserted-by":"publisher","first-page":"442","DOI":"10.46234\/ccdcw2024.086","volume":"6","author":"H Lu","year":"2024","unstructured":"Lu H, Xiao J, Wang W, Yan D, Ji T, Yang Q, et al. Evolutionary diversity of coxsackievirus A6 causing severe Hand, Foot, and mouth Disease - China, 2012\u20132023. China CDC Wkly. 2024;6:442\u20139. https:\/\/doi.org\/10.46234\/ccdcw2024.086.","journal-title":"China CDC Wkly"},{"key":"12710_CR23","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1111\/pde.15461","volume":"41","author":"SY Starkey","year":"2024","unstructured":"Starkey SY, Mar K, Khaslavsky S, Seeburruth D, Khalid B, Virmani D, et al. Atypical cutaneous findings of hand-foot-mouth disease in children: A systematic review. Pediatr Dermatol. 2024;41:23\u20137. https:\/\/doi.org\/10.1111\/pde.15461.","journal-title":"Pediatr Dermatol"},{"key":"12710_CR24","doi-asserted-by":"publisher","first-page":"1067","DOI":"10.1099\/vir.0.000062","volume":"96","author":"E Gaunt","year":"2015","unstructured":"Gaunt E, Harvala H, \u00d6sterback R, Sreenu VB, Thomson E, Waris M, et al. Genetic characterization of human coxsackievirus A6 variants associated with atypical hand, foot and mouth disease: a potential role of recombination in emergence and pathogenicity. J Gen Virol. 2015;96:1067\u201379. https:\/\/doi.org\/10.1099\/vir.0.000062.","journal-title":"J Gen Virol"},{"key":"12710_CR25","doi-asserted-by":"publisher","first-page":"245","DOI":"10.1007\/s00705-024-06171-8","volume":"169","author":"WX Zhang","year":"2024","unstructured":"Zhang WX, Zou L, Cui Y, Zhou Y, Zhang SS, Yang H, et al. Molecular epidemiology of herpangina in the subcenter of Beijing, china: a surveillance study during 2021\u20132022. Arch Virol. 2024;169:245. https:\/\/doi.org\/10.1007\/s00705-024-06171-8.","journal-title":"Arch Virol"},{"key":"12710_CR26","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1016\/j.ympev.2017.09.014","volume":"118","author":"P Chen","year":"2018","unstructured":"Chen P, Wang H, Tao Z, Xu A, Lin X, Zhou N, et al. Multiple transmission chains of coxsackievirus A4 co-circulating in China and neighboring countries in recent years: phylogenetic and Spatiotemporal analyses based on virological surveillance. Mol Phylogenet Evol. 2018;118:23\u201331. https:\/\/doi.org\/10.1016\/j.ympev.2017.09.014.","journal-title":"Mol Phylogenet Evol"},{"key":"12710_CR27","doi-asserted-by":"publisher","first-page":"8900","DOI":"10.1038\/s41598-017-09196-z","volume":"7","author":"J Wang","year":"2017","unstructured":"Wang J, Hu T, Sun D, Ding S, Carr MJ, Xing W, Li S, Wang X, Shi W. Epidemiological characteristics of hand, foot, and mouth disease in Shandong, China, 2009\u20132016. Sci Rep. 2017;7:8900. https:\/\/doi.org\/10.1038\/s41598-017-09196-z.","journal-title":"Sci Rep"},{"key":"12710_CR28","doi-asserted-by":"publisher","first-page":"e29796","DOI":"10.1002\/jmv.29796","volume":"96","author":"Z Liang","year":"2024","unstructured":"Liang Z, Lin C, Huo D, Yang Y, Feng Z, Cui S, et al. First detection of multiple cases related to CV-A16 strain of B1c clade in Beijing in 2022. J Med Virol. 2024;96:e29796. https:\/\/doi.org\/10.1002\/jmv.29796.","journal-title":"J Med Virol"},{"key":"12710_CR29","doi-asserted-by":"publisher","first-page":"916","DOI":"10.3390\/v14050916","volume":"14","author":"FG Alnaji","year":"2022","unstructured":"Alnaji FG, Bentley K, Pearson A, Woodman A, Moore J, Fox H, et al. Generated randomly and selected functionally? The nature of enterovirus recombination. Viruses. 2022;14:916. https:\/\/doi.org\/10.3390\/v14050916.","journal-title":"Viruses"},{"key":"12710_CR30","doi-asserted-by":"publisher","first-page":"100115","DOI":"10.1016\/j.imj.2024.100115","volume":"3","author":"Z Wang","year":"2024","unstructured":"Wang Z, Wen H. A review of the recombination events, mechanisms and consequences of coxsackievirus A6. Infect Med (Beijing). 2024;3:100115. https:\/\/doi.org\/10.1016\/j.imj.2024.100115.","journal-title":"Infect Med (Beijing)"}],"container-title":["BMC Infectious Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12879-026-12710-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-026-12710-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12879-026-12710-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T12:17:45Z","timestamp":1771849065000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12879-026-12710-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,29]]},"references-count":30,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["12710"],"URL":"https:\/\/doi.org\/10.1186\/s12879-026-12710-2","relation":{},"ISSN":["1471-2334"],"issn-type":[{"value":"1471-2334","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,29]]},"assertion":[{"value":"17 September 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 January 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"29 January 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was in compliance with the Helsinki Declaration and approved by the Ethics Committee of Women and Children\u2019s Health Care Hospital of Linyi, and the approval number is [2022]007.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"443"}}