Ongoing change of severe hand, foot, and mouth disease pathogens in Yunnan, China, 2012 to 2016

Hand, foot, and mouth disease (HFMD) is a common infectious disease caused by enteroviruses (EVs). In this study, a total of 341 children with serious HFMD were admitted to a pediatric hospital in Yunnan, China in 2012 to 2016. EVs were detected in 283 specimens (83.0%) and were assigned to 17 EV types. Enterovirus A71 (EV‐A71) was predominant, accounting for 41.6%, and was followed by coxsackievirus A16 (CV‐A16; 18.8%), CV‐A6 (9.1%), CV‐A10 and E‐9 (2.9%), CV‐B5 (1.8%), CV‐A9 (1.2%), E‐30 (0.9%), E‐18, CV‐A4, C‐B3, and CV‐A2 (0.6%) and other EV types such as CV‐A8, CV‐A14, E‐14, E‐11, and CV‐B4 (0.3%). All of the EV‐A71 isolates belonged to C4a; the CV‐A16 belonged to B1b or B1a, although the B1b strains were predominant; and CV‐A6 belonged to D3. In 2012 to 2014, E‐9 was the third most frequent serotype (8.2%, 5.0%, and 6.5%, respectively). E‐9 was not detected in 2015 and 2016. CV‐A6 was not detected in 2012 but was the second most frequent serotype (25.3%) in 2015. Active etiological surveillance of HFMD makes it necessary to be aware of these emerging pathogens. Highlights A total of 341 children with serious HFMD were admitted to a pediatric hospital in Yunnan, China in 2012 to 2016. EVs were detected in 283 specimens (83.0%) and were assigned to 17 EV types. EV‐A71, CV‐A16, and CV‐A6 were the main pathogens and belonged to epidemic strains in mainland China. The EV types that predominate will change over time. Active etiological surveillance of HFMD makes it necessary to be aware of these emerging pathogens.