{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T22:05:38Z","timestamp":1767996338634,"version":"3.49.0"},"reference-count":17,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2024,6,29]],"date-time":"2024-06-29T00:00:00Z","timestamp":1719619200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infectious Disease Reports"],"abstract":"<jats:p>Hand, foot, and mouth disease (HFMD) is a common infectious disease caused by enteroviruses. Coxsackievirus A6 (CV-A6)-associated HFMD has recently emerged as a predominant disease worldwide. Here, we describe five HFMD cases caused by CV-A6 in Japan from 2019 to 2022. All clinical courses were not severe and were self-limited, and the skin exanthema with vesicles differed from that in classical HFMD. Phylogenetic analysis showed that the major epidemic strain cluster of CV-A6 was formed independently in 2011, and our latest CV-A6 strains in Japan were detected within this cluster. The five cases described in this report indicate the recent shift in the predominant and continuous disease manifestation of CV-A6-associated HFMD.<\/jats:p>","DOI":"10.3390\/idr16040044","type":"journal-article","created":{"date-parts":[[2024,7,3]],"date-time":"2024-07-03T09:23:59Z","timestamp":1719998639000},"page":"587-593","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Clinical Features and Characteristics of Hand, Foot, and Mouth Disease Caused by Recent Coxsackievirus A6: Five Cases in Japan from 2019 to 2022"],"prefix":"10.3390","volume":"16","author":[{"given":"Kyohei","family":"Naomiya","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara City 252-0329, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takashi","family":"Ito","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara City 252-0329, Japan"},{"name":"\u014cmura Satoshi Memorial Institute, Kitasato University, 5-9-1 Shirokane, Minato-ku, Tokyo 108-8641, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ayumi","family":"Saito","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara City 252-0329, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tsukasa","family":"Igarashi","sequence":"additional","affiliation":[{"name":"\u014cmura Satoshi Memorial Institute, Kitasato University, 5-9-1 Shirokane, Minato-ku, Tokyo 108-8641, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8685-6007","authenticated-orcid":false,"given":"Tetsuo","family":"Nakayama","sequence":"additional","affiliation":[{"name":"\u014cmura Satoshi Memorial Institute, Kitasato University, 5-9-1 Shirokane, Minato-ku, Tokyo 108-8641, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7692-1151","authenticated-orcid":false,"given":"Kazuhiko","family":"Katayama","sequence":"additional","affiliation":[{"name":"\u014cmura Satoshi Memorial Institute, Kitasato University, 5-9-1 Shirokane, Minato-ku, Tokyo 108-8641, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2692-6437","authenticated-orcid":false,"given":"Kenji","family":"Ishikura","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara City 252-0329, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,6,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1007\/s10096-018-3206-x","article-title":"Hand, foot and mouth disease: Current knowledge on clinical mani-festations, epidemiology, aetiology and prevention","volume":"37","author":"Esposito","year":"2018","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_2","first-page":"408","article-title":"Hand-foot-and-mouth disease: Rapid evidence review","volume":"100","author":"Saguil","year":"2019","journal-title":"Am. Fam. Physician"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1111\/pde.15461","article-title":"Atypical cutaneous findings of hand-foot-mouth disease in children: A systematic review","volume":"41","author":"Starkey","year":"2024","journal-title":"Pediatr. Dermatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1485","DOI":"10.3201\/eid1509.090438","article-title":"Coxsackievirus A6 and hand, foot, and mouth disease, Finland","volume":"15","author":"Vuorinen","year":"2009","journal-title":"Emerg. Infect. Dis."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/S1473-3099(13)70264-0","article-title":"Atypical hand, foot, and mouth disease: A vesiculobullous eruption caused by Coxsackie virus A6","volume":"14","author":"Feder","year":"2014","journal-title":"Lancet Infect. Dis."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1016\/S1473-3099(19)30566-3","article-title":"Circulation of non-polio enteroviruses in 24 EU and EEA countries between 2015 and 2017: A retrospective surveillance study","volume":"20","author":"Bubba","year":"2020","journal-title":"Lancet Infect. Dis."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"5491","DOI":"10.1038\/s41598-017-05618-0","article-title":"Persistent circulation of coxsackievirus A6 of genotype D3 in mainland of China between 2008 and 2015","volume":"7","author":"Song","year":"2017","journal-title":"Sci. Rep."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1016\/j.vaccine.2018.12.065","article-title":"Phylogenetic and antigenic analyses of cox-sackievirus A6 isolates in Yamagata, Japan between 2001 and 2017","volume":"37","author":"Mizuta","year":"2019","journal-title":"Vaccine"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1016\/j.jcv.2003.08.016","article-title":"A sensitive and quantitative single-tube real-time reverse transcriptase-PCR for detection of enteroviral RNA","volume":"30","author":"Mohamed","year":"2004","journal-title":"J. Clin. Virol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2698","DOI":"10.1128\/JCM.00542-06","article-title":"Sensitive, seminested PCR amplification of VP1 sequences for direct identification of all enterovirus serotypes from original clinical specimens","volume":"44","author":"Nix","year":"2006","journal-title":"J. Clin. Microbiol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1016\/j.jcv.2018.01.008","article-title":"Recommendations for enterovirus diagnostics and characterisation within and beyond Europe","volume":"101","author":"Harvala","year":"2018","journal-title":"J. Clin. Virol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"564","DOI":"10.7883\/yoken.66.564","article-title":"A case of atypical hand-foot-and-mouth disease caused by coxsackievirus A6: Differential diagnosis from varicella in a pediatric intensive care unit","volume":"66","author":"Yasui","year":"2013","journal-title":"Jpn. J. Infect. Dis."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Gonzalez, G., Carr, M.J., Kobayashi, M., Hanaoka, N., and Fujimoto, T. (2019). Enterovirus-associated hand-foot and mouth disease and neurological complications in Japan and the rest of the world. Int. J. Mol. Sci., 20.","DOI":"10.3390\/ijms20205201"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"388","DOI":"10.7883\/yoken.JJID.2018.073","article-title":"Coxsackievirus A6 (CV-A6) Encephalomyelitis in an Immunocompromised Child: A Case Report and Brief Review of the Literature","volume":"71","author":"Sabeena","year":"2018","journal-title":"Jpn. J. Infect. Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"678","DOI":"10.15585\/mmwr.mm6526a3","article-title":"Notes from the field: Outbreak of hand, foot, and mouth disease caused by coxsackievirus A6 among basic military trainees\u2014Texas, 2015","volume":"65","author":"Banta","year":"2016","journal-title":"MMWR Morb. Mortal Wkly. Rep."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.jcv.2013.12.012","article-title":"Coxsackievirus A6-related hand foot and mouth disease: Skin manifestations in a cluster of adult patients","volume":"59","author":"Shulman","year":"2014","journal-title":"J. Clin. Virol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"337","DOI":"10.3201\/eid1802.111147","article-title":"Hand, foot, and mouth disease caused by cox-sackievirus A6, Japan, 2011","volume":"18","author":"Fujimoto","year":"2012","journal-title":"Emerg. Infect. 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