CVA10 sheds longer than CVA16 in children’s hand, foot and mouth disease

Children infected with coxsackievirus A10 shed viral RNA for significantly longer than children infected with coxsackievirus A16, according to a prospective study of hand, foot and mouth disease cases in Jiangsu Province, China. Among 63 cases followed in 2024, children with CVA10 had a mean shedding duration of 9.5 days, compared with 8.0 days for those infected with CVA16, a difference the researchers report as statistically significant (P = 0.012).

The study, published in BMC Pediatrics, was designed to compare the viral shedding duration and clinical features of the two serotypes during HFMD outbreaks. Hand, foot and mouth disease remains a major public health challenge in China and across many parts of Asia, and after widespread implementation of enterovirus A71 vaccination, CVA10 and CVA16 have emerged as the dominant serotypes associated with outbreaks in children.

Between symptom onset and day 14, the researchers collected pharyngeal swabs once at symptom onset and again on days 3, 7, 10 and 14 post-onset, both from cases and from close contacts. All specimens were tested by RT-PCR for nucleic acid detection and serotype identification. The 63 cases were followed prospectively with daily monitoring of symptom progression throughout 2024.

The two serotypes produced distinct clinical pictures. CVA16 infection was associated with more symptomatic cases, particularly a higher incidence of rash, and with increased healthcare-seeking behavior. CVA10, by contrast, was linked to the longer shedding duration, suggesting that the two viruses may drive transmission through different mechanisms.

Viral load dynamics followed a clear pattern: the researchers observed a sharp drop in viral load from days 1 to 4 after symptom onset. Among symptomatic children, symptom duration was positively correlated with viral shedding duration, with a correlation coefficient of r = 0.33. Notably, 91.7 percent of children tested negative for viral RNA within five days after their symptoms resolved.

Based on these findings, the authors suggest that symptom resolution may provide a potential reference point for evaluating isolation strategies, since most children cleared viral RNA from pharyngeal swabs shortly after symptoms ended. They also emphasize that early monitoring is critical because of the rapid decline in viral load during the first days of illness, and that symptom duration may serve as an indicator of viral RNA shedding duration.

The study’s conclusions point toward serotype-specific management. Given CVA10’s prolonged viral shedding and CVA16’s symptom-driven transmission, the authors write that tailored management strategies may be valuable for HFMD control. In practice, this could mean that isolation and follow-up decisions might be informed by which serotype is circulating, as well as by the individual child’s symptom course.

The authors are careful to note the study’s limitations. Infectivity was not directly assessed, meaning that the detection of viral RNA by RT-PCR does not demonstrate that a child was still contagious. The findings should therefore be further validated using viral culture, which can determine whether virus detected in swabs remains capable of replication. The study also reflects a single province and a single year of outbreaks, so the results may not generalize to all settings where CVA10 and CVA16 circulate.

As an open-access research article published on 29 October 2026, the study adds to the evidence base for optimizing case management and outbreak control for HFMD at a time when the two serotypes have become dominant following enterovirus A71 vaccination. The authors state that the work was intended to generate evidence for exactly this purpose, and their data on shedding duration and symptom correlation provide a quantitative starting point for future studies of isolation policy and serotype-specific outbreak response.

Subject of Research: Viral shedding duration and clinical differences between coxsackievirus A16 and A10 in children's hand, foot and mouth disease

Article Title: Viral shedding and clinical differences in hand, foot and mouth disease associated with coxsackievirus A16 and coxsackievirus A10

Article References: Wu, B., Tong, Y., Wang, Y., Yang, H., Hang, H., Lu, M., Ling, L., Wang, J., Fan, H., Liu, F., Zhu, L., & Ji, H. (2026). Viral shedding and clinical differences in hand, foot and mouth disease associated with coxsackievirus A16 and coxsackievirus A10. BMC Pediatrics. https://doi.org/10.1186/s12887-026-07700-x

Image Credits: AI Generated

DOI: 10.1186/s12887-026-07700-x

Keywords: hand, foot and mouth disease, coxsackievirus A16, coxsackievirus A10, viral shedding, enterovirus, RT-PCR, viral load, children, China, outbreak control, isolation strategies, BMC Pediatrics