Hand, Foot, and Mouth Disease Outbreak and Coxsackievirus A6, Northern Spain, 2011

To the Editor: Hand, foot, and mouth disease (HFMD) is an acute, febrile viral infection characterized by vesicular exanthema on the palms of the hands, soles of the feet, and oral mucosa. The infection is transmitted through oral and respiratory secretions, vesicular fluid, and/or feces of affected persons. The most common etiologic agents are coxsackievirus (CV) A16 and human enterovirus (HEV) 71, but other HEVs, mainly belonging to species A, have also been associated with illness (1). HFMD mainly affects infants and children <5 years of age. On May 10, 2011, an outbreak of HFMD was reported in a daycare center in the city of Irun in Basque Country, Spain. Monitoring subsequently was conducted for HFMD cases among children in the health district that contained the daycare center (a total of 4,540 children <14 years of age). Children with fever and vesicular rash on the palms and/or soles and in the mouth were considered HFMD patients. Pharyngeal and/or dermal exudate and/or feces were collected for virologic confirmation from 37 representative HFMD patients (17 with multiple specimens) selected by sentinel pediatricians in outpatient clinics. Viral RNA was extracted directly from specimens (NucliSENS Easy-Mag, Bio-Mèrieux, Marcy-l'Étoile, France) and was used in the amplification methods. Enterovirus RNA was detected by an in-house real-time PCR that amplified a fragment within the 5′ untranslated region by using described primers (2). For genotyping, the viral 676 Emerging BLOCKINInfectious BLOCKINDiseases BLOCKIN • BLOCKINwww.cdc.gov/eid BLOCKIN • BLOCKINVol.