All the serotyping assays used in the current study including the EV-A71 specific RT-PCR, VP1 and VP4/VP2 sequencing had previously shown their efficient performance in clinical samples. The application of these assays in samples of CNS patients would help to improve serotyping yield. However, the overall successful serotyping rate for CNS patient of the current study was low (58%) as compared to previous studies. This may be due to low viral load or samples have been degraded after long-term storage. The low successful serotyping rate (25%) of respiratory samples can be explainable by the sole use of VP4/VP2 sequencing assay. However, sample degradation and possible missed EV diagnostic interpretation from the primary studies due to the use of generic EV diagnostic assays for high rate of RV co-infected cohorts (68.5%) could not be excluded. Other drawbacks of the current study included the small sample size, the sporadic and expanded geographical distribution of cases that hampered our further analyses for serotype-associated seasonality and geographics. Despite these limitations, however, our study revealed diverse enterovirus serotypes have been circulating in Viet NamVietnam in association with respiratory and CNS infections.

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