Co-Circulation of Echovirus 6 and 30 with Coxsackievirus A6 Among Children with Hand, Foot, and Mouth Disease in Ahvaz, Southwest Iran

Objectives: The aim of this study was to evaluate the etiologic agents of a hand, foot, and mouth disease (HFMD) outbreak in Ahvaz, Southwest Iran and their evolutionary analysis by phylogenetic construction and Simplot analysis. Methods: We collected 16 serum samples in an outbreak of HFMD in Ahvaz in October 2013. RNA was extracted from the samples and subjected to reverse transcription polymerase chain reaction for detection of Enterovirus group A and B. Positive cases were sequenced and subjected to phylogenetic and Simplot analysis for detecting the signs of recombination. Results: Of the 16 specimens, nine (56.25%) were PCR-positive with the universal primers for the Enterovirus 5’UTR region. Coxsackievirus A6 was detected as a predominant agent of HFMD with two cases of Echovirus 6 and Echovirus 30. In the case of Echovirus 6, the signs of recombination in the 5’UTR region were observed based on phylogenetic and Simplot analysis. Conclusions: Coxsackievirus A6 is the main agent of HFMD in Ahvaz. The evidence of recombination in this isolate of Echovirus 6 in this study emphasizes common hygiene practices and sanitation to prevent the circulation of this isolate in community and the advent of new strains.