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Volume 43, Number 4, August 2010

An Outbreak of Coxsackievirus A16 Infection: Comparison With Other Enteroviruses in a Preschool in Taipei 

Pei-Chieh Wu, Li-Min Huang, Chuan-Liang Kao, Tsui-Yen Fan, Ai-Ling Cheng, Luan-Yin Chang

Received: December 15, 2008    Revised: April 2, 2009    Accepted: August 14, 2009   


Corresponding author:

Luan-Yin Chang, Division of Pediatric Infectious Disease, Department of Pediatrics, National Taiwan University Hospital, College of Medicine, National Taiwan University, 7 Chung-Shan South Road, Taipei 10002, Taiwan


Background and purpose: 

The transmission rate of enteroviruses in young children remains unclear. Therefore, we carried out active surveillance in preschool children to investigate the transmission rate and clinical manifestation of enteroviruses.



From September 2006 to December 2008, we monitored infectious diseases in children 2(–3 years of age) in a preschool in Taipei. If any child had a febrile illness or symptoms/signs of enteroviral infection [e.g. herpangina or hand-foot-and-mouth disease (HFMD)], we performed viral isolation and enterovirus polymerase chain reaction. VP1 sequencing was performed to define their serotypes. We also collected clinical data and analyzed transmission rates.


There were eight episodes of enterovirus infection during the study period. The serotypes included coxsackievirus A4 (CA4), CA2 and CA16. The transmission rates of CA4 and CA2 among children in same class were 26% and 35%, respectively. Between November 28 and December 12, 2008, 13/21 (61.9%) children contracted herpangina and/or HFMD. The average age was 2.82 (range, 2.43–3.39) years. CA16 was detected in 10/13 (76.9%) of the throat swabs by polymerase chain reaction VP1 genotyping. Compared with previous CA2 and CA4 outbreaks, CA16 had a significantly higher transmission rate (p = 0.035) and resulted in more cases of HFMD (p < 0.001). The transmission duration of coxsackie A viruses within the same class ranged from 12 to 40 days.



Compared with CA2 and CA4, CA16 infections resulted in more cases of HFMD and had significantly higher transmission rates in preschoolers.


Key words:

 coxsackievirus A16  ,  enterovirus  ,  transmission rate