A review and meta‐analysis of the epidemiology and clinical presentation of coxsackievirus A6 causing hand‐foot‐mouth disease in China and global implications

Summary Coxsackievirus A6 (CV‐A6) has been associated with increasingly occurred sporadic hand‐foot‐mouth disease (HFMD) cases and outbreak events in many countries. In order to understand epidemiological characteristics of CV‐A6, we collected the information describing HFMD caused by CV‐A6 to describe the detection rate, severe rate and onychomadesis rate, which is defined as one or more nails defluvium, caused by CV‐A6 from 2007 to 2017. The results showed that there was an outbreak of CV‐A6 every other year, and overall trend of the epidemic of CA6‐associated HFMD was increasing in China. The detection rate of CV‐A6 in other countries was 32.0% (95% CI: 25.0%~40.0%) before 2013 and 28.0% (95% CI: 20.0%~36.0%) after 2013, respectively. Although the severe rate of HFMD caused by CV‐A6 was low (0.10%, 95% CI: 0.01%~0.20%), CV‐A6 can cause a high incidence of onychomadesis (28.0%, 95%CI: 21.9%‐34.3%). Thus, it would be worthwhile to research and develop an effective multivalent vaccine for CV‐A6 to achieve a more powerful prevention of HMFD.