Multiple Transmission Pathways of Coxsackievirus A10 Leading to its Global Spread: A Phylogenetic and Spatiotemporal Analysis Based on Virological Surveillance.

Coxsackievirus A10 (CVA10) has been reported frequently in many infectious diseases and cases associated with hand, foot, and mouth disease (HFMD) emerging increasingly in recent years. Based on the National HFMD System Surveillance, 180 CVA10 strains were isolated from the mainland of China between 2008 and 2023. These strains were analyzed alongside 103 representative full VP1 sequences obtained from GenBank, with a focus on global-scale phylogenetic analysis and spatiotemporal dynamics of CVA10. Eight genotypes (A-H) were defined, of which the genotype C was the dominant gene subtype in Chinese mainland. Bayesian analysis indicated that the most renascent common ancestor (tMRCA) of CVA10 originated in 1932 (95% HPD:1867-1958), with a high evolutionary rate of 3.32 × 10-3 substitutions/site/year (95% HPD: 2.62 × 10-3 to 3.40 × 10-3). By analyzing the spatial propagation paths, the global CVA10 exhibited distinct regional characteristics. Though the origin of CVA10 could be in the USA, regional dissemination was mainly located around the Asia-Europe region. The spatiotemporal dynamics of CVA10 exhibited frequent viral traffic among localities, and virus from East and South China have played a central role in spreading around the mainland of China. Our phylogenetic description and phylogeographic analyses indicate the importance of large spatial- and temporal-scale studies in understanding epidemiological dynamics of CVA10, particularly the diffusion routes will be of great importance to global control efforts.