{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T02:16:38Z","timestamp":1789611398331,"version":"build-2803163510"},"reference-count":44,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2021,4,28]],"date-time":"2021-04-28T00:00:00Z","timestamp":1619568000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>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\u20136 years old) mainly, and show seasonality with peaks in spring\u2013summer 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.<\/jats:p>","DOI":"10.3390\/v13050781","type":"journal-article","created":{"date-parts":[[2021,4,28]],"date-time":"2021-04-28T22:29:07Z","timestamp":1619648947000},"page":"781","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Surveillance for Enteroviruses Associated with Hand, Foot, and Mouth Disease, and Other Mucocutaneous Symptoms in Spain, 2006\u20132020"],"prefix":"10.3390","volume":"13","author":[{"given":"Nieves","family":"Mart\u00ednez-L\u00f3pez","sequence":"first","affiliation":[{"name":"Enterovirus Unit, National Centre for Microbiology, Instituto de Salud Carlos III, 28220 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5586-404X","authenticated-orcid":false,"given":"Carmen","family":"Mu\u00f1oz-Almagro","sequence":"additional","affiliation":[{"name":"Microbiological and Paediatric Departments, Hospital San Joan de D\u00e9u, 08950 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0913-9303","authenticated-orcid":false,"given":"Cristian","family":"Launes","sequence":"additional","affiliation":[{"name":"Microbiological and Paediatric Departments, Hospital San Joan de D\u00e9u, 08950 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ana","family":"Navascu\u00e9s","sequence":"additional","affiliation":[{"name":"Microbiological Department, Complejo Hospitalario de Navarra, 31008 Navarra, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Imaz-P\u00e9rez","sequence":"additional","affiliation":[{"name":"Microbiological Department, Hospital de Basurto, 48013 Bilbao, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3276-1176","authenticated-orcid":false,"given":"Jordi","family":"Reina","sequence":"additional","affiliation":[{"name":"Microbiological Department, Hospital Son Espases, 07020 Palma de Mallorca, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mar\u00eda Pilar","family":"Romero","sequence":"additional","affiliation":[{"name":"Microbiological and Paediatric Departments, Hospital La Paz, 28220 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6503-3423","authenticated-orcid":false,"given":"Cristina","family":"Calvo","sequence":"additional","affiliation":[{"name":"Microbiological and Paediatric Departments, Hospital La Paz, 28220 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3558-2763","authenticated-orcid":false,"given":"Montserrat","family":"Ruiz-Garc\u00eda","sequence":"additional","affiliation":[{"name":"Microbiological Department, Hospital de Elche, 03203 Alicante, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4759-6465","authenticated-orcid":false,"given":"Gregoria","family":"Megias","sequence":"additional","affiliation":[{"name":"Microbiological and Paediatrics Department, Complejo Hospitalario de Burgos, 09006 Burgos, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Valencia-Ramos","sequence":"additional","affiliation":[{"name":"Microbiological and Paediatrics Department, Complejo Hospitalario de Burgos, 09006 Burgos, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Almudena","family":"Otero","sequence":"additional","affiliation":[{"name":"Enterovirus Unit, National Centre for Microbiology, Instituto de Salud Carlos III, 28220 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7054-5696","authenticated-orcid":false,"given":"Mar\u00eda","family":"Cabrerizo","sequence":"additional","affiliation":[{"name":"Enterovirus Unit, National Centre for Microbiology, Instituto de Salud Carlos III, 28220 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,4,28]]},"reference":[{"key":"ref_1","unstructured":"Cohen, J., Opal, S.M., Powderly, W.G., and Calandra, T. 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