Virus, Non-Enveloped

VirusCoxsackievirus A, Coxsackievirus B
Disease(s) CausedDependent on infection by group A or B
SymptomsFever, rash, headache
Potential Complications

Group A: Aseptic meningitis, encephalitis, paralysis, hand, foot and mouth disease

Group B: Aseptic meningitis, encephalitis, paralysis, myocarditis, pneumonia

Transmission Mode

Fecal-Oral: Person-to-person contact; waterborne; contaminated fomites

Sites of Community OutbreaksDaycare centers, restaurants
Importance of Coxsackieviruses A and B

Coxsackieviruses, along with the polioviruses, echoviruses, and human enteroviruses, are members of the genus Enterovirus. They were originally isolated in 1948 from patients suffering from paralysis during an epidemic of poliovirus in Coxsackie, New York, and subsequently subcategorized into groups A and B according to symptoms observed in experimentally-infected mice.

Similar to the other enteroviruses, Coxsackieviruses are transmitted by the fecal-oral route. Infection is initiated in the gastrointestinal tract, with the potential dissemination of viable viruses to other parts of the body resulting in acute cardiovascular and neurological disorders. Hand, Foot and Mouth Disease (HFMD) is one of the more well-known illnesses caused by Coxsackievirus and is attributed to the A16 subtype, although human enterovirus 71 has also been implicated in outbreaks. The incubation period of Coxsackievirus infections generally is from 2 to 6 days, with symptoms ranging from mild febrile illness accompanied by rash to acute aseptic meningitis, paralysis, and/or myocarditis. Similar to many communicable fecal-oral viruses, Coxsackieviruses are transmitted in locations where person-to-person contact is optimal including schools, daycare centers, and in the home. They are also the most common, non-polio enterovirus isolated from contaminated groundwater, surface water, and potable water (3).

The Importance of Disinfection: Survival of Coxsackieviruses on Surfaces and Transmission Potential via Fomites

Coxsackieviruses are non-enveloped in structure and thus are more resistant to environmental stressors, such as desiccation and temperature/humidity changes relative to the enveloped viruses (e.g. Influenza viruses). Coxsackieviruses can remain viable on hard, nonporous surfaces for upwards of two weeks in conditions of high and low temperature and humidity (2). The ability of Coxsackieviruses to maintain infectivity on fomites over extended time periods, coupled with the abundance of studies demonstrating virus transfer from objects to hands and back again (1), indicates the importance of interrupting such a potential transmission route by use of chemical surface disinfectants. A comprehensive study employing a suite of non-enveloped viruses and enveloped viruses revealed that only four out of 16 disinfectants effectively inactivated Coxsackievirus B3 after a one minute contact time, including sodium hypochlorite (5,000 ppm free chlorine concentration) and 2% glutaraldehyde (4).

  1. Boone, S.A. and C.P. Gerba. 2007. Significance of fomites in the spread of respiratory and enteric viral disease. Applied and Environmental Microbiology. 73(6): 1687-1696.
  2. Mahl, M and C. Sadler. 1975. Virus survival on inanimate surfaces. Canadian Journal of Microbiology. 21: 819-823. 3.
  3. Mena, K. et al. 2003. Risk assessment of waterborne Coxsackievirus. Journal of the American Water Works Association. 95(7). 4.
  4. Sattar, S. et al. 1989. Chemical disinfection of non-porous inanimate surfaces experimentally contaminated with four human pathogenic viruses. Epidemiology and Infection. 102: 493-505.