An outbreak of hand, foot, and mouth disease primarily
caused by coxsackievirus A6 occurred in four states between November 2011 and
February 2012, according to a report from the CDC.
From Nov. 7, 2011, to Feb. 29, 2012, the CDC received
reports of 63 patients with signs and symptoms of hand, foot and mouth disease
(HFMD) or with fever and atypical rash. Reports came from Alabama (38 cases),
California (seven), Connecticut (one) and Nevada (17).
The cases were identified as unusual by health care
providers or by a department of health that contacted CDC for diagnostic
assistance because HFMD is not a reportable disease in the United States.
Clinical specimens were collected from patients in 34 of
the 63 cases. Coxsackievirus A6 (CVA6) was detected in 25 (74%) of those 34
patients by reverse transcriptase polymerase chain reaction and partial
sequencing of the VP1 gene at CDC or at the California Department of Public
Health. No enteroviruses were detected in the other nine patients, according to
Forty (63%) of the 63 patients in the outbreak were aged
2 years or younger, and 15 (24%) were adults aged 18 years and older. Most of
the patients had exposure to a child care facility or school; contact with
children in child care where cases of HFMD were reported; provided medical
care; or were related to a child with HFMD.
Rash and fever were more severe and hospitalization was
more common with patients in this outbreak compared with typical HFMD. Signs of
HFMD included fever (48 patients [76%]); rash on the hands or feet, or in the
mouth (42 [67%]); and rash on the arms or legs (29 [46%]), face (26 [41%]),
buttocks (22 [35%]), and trunk (12 [19%]). Of 46 patients with rash variables
reported, the rash typically was maculopapular; vesicles were reported in 32
(70%) patients and scabs in 30 (65%) patients. Shedding of nails occurred after
initial infection in two (4%) patients.
Of the 63 patients, 51 (81%) sought care from a
clinician, and 12 (19%) were hospitalized. Reasons for hospitalization varied
and included dehydration and/or severe pain. No deaths were reported, but
CVA6-associated HFMD cases continue to be reported to CDC.
According to the CDC, the age ranges of patients,
severity of illness, seasonality of disease, and identification of CVA6 in
these cases were unusual for HFMD in the United States. CVA6 has been
associated with more severe and extensive rash than HFMD caused by other
enteroviruses, and this is the first outbreak like this to be reported in the
- CDC. MMWR. 2012; 61:213-214.
- The researchers report no relevant financial disclosures.