Clinical and Etiological Characteristics of Enterovirus 71-Related Diseases during a Recent 2-Year Period in Korea

Abstract

Human enterovirus 71 (EV 71) has caused large-scale outbreaks of hand-foot-and-mouth disease (HFMD), particularly in the Asian-Pacific region. In this study, we report a major outbreak of EV 71 infection in Korea and describe the clinical differences between EV 71 and non-EV 71 enterovirus infections. We prospectively enrolled patients with suspected viral infections during a recent 2-year period through a nationwide surveillance system. We identified 719 patients with suspected HFMD or herpangina using real-time PCR and genotyping based on VP1 sequence analysis. The major pathogen causing HFMD changed substantially from 2008 to 2009, with EV 71 becoming the most common cause of HFMD in Korea in 2009. We successfully identified the enteroviral genotypes for 218 of the 719 patients. Patients with EV 71 infections tended to be younger than those with non-EV 71 enteroviral infections and presented with HFMD and meningoencephalitis. In addition, the occurrence of fever, headache, and neck stiffness was significantly higher in patients with EV 71 infections. Multivariable analysis showed that for patients presenting with HFMD, fever, or a sore throat, each covariate was independently associated with EV 71 infection; the adjusted odds ratios (with 95% confidence intervals in parentheses) for these variables were 31.86 (10.04 to 101.09), 4.76 (1.71 to 13.25), and 0.18 (0.04 to 0.77), respectively. Our results indicate that EV 71 was a major cause of HFMD in Korea during the study period. In addition, we found that clinical symptoms may be helpful in the early identification of patients with EV 71 infections.Human enterovirus 71 (EV 71) is an important emerging pathogen of hand-foot-and-mouth disease (HFMD) (1, 6, 30). In particular, several major outbreaks of EV 71 have been documented in the Asia-Pacific region since 1997 (3,4,7,9,25). EV 71 infection causes HFMD, a common exanthema of young children that is characterized by a fever, rashes on the palms and the bottoms of the feet, and ulcers in the oral cavity. In general, patients with HFMD experience a mild course of disease; however, some patients develop severe neurological complications, especially as a result of EV 71 (18).Given that EV 71 infection could cause severe neurological complications, its early detection in patients with HFMD is an important part of intensive care efforts and efforts to prevent mortality. Unfortunately, current methods for the detection of EV 71 do not enable early detection (23). Here we report an outbreak of EV 71 infection in Korea. As part of this nationwide surveillance study, we examined the clinical differences between EV 71 and non-EV 71 enteroviral infections, and we investigated whether these differences are clinically applicable to the early detection of EV 71 in patients with complications of HFMD. MATERIALS AND METHODS Patients.A nationwide surveillance system for infection with enterovirus (EV) in Korea was initiated in 2005. Sixty-two clinics (8 primary clinics, 14 secondary hospitals, and 40 tertiary hospitals located...

Circulation of Coxsackievirus A10 and A6 in Hand-Foot-Mouth Disease in China, 2009–2011

“…HFMD is benign and self-limiting, but severe HFMD with complications are also developed. Numerous major epidemics of HFMD have occurred in eastern and southeastern Asian countries and regions in the past decade, with EV-71 as the most commonly responsible enterovirus type [21], [22], [23], [24]. However, other types, especially CV-A10 and CV-A6, began to co-circulate with increasingly frequencies in recent years, turning into equally common causes of HFMD as CV-16 and EV-71in certain regions [12], [21], [25].…”

Enterovirus 71 infection and neurological complications

“…In Korea, epidemics of EV71 infection occurred between 2009 and 2013 and included fatal cases. According to one report22), which compared the viral pathogens and clinical features of HFMD between 2008 and 2009 in Korea using data from a nationwide surveillance system, the main causative viruses were coxsackievirus A10 and echovirus 30 in 2008, whereas the chief pathogen in 2009 was EV71. During this period, the prevalence of accompanying meningoencephalitis increased considerably, from 4.0% to 15.2%.…”

Comparative proteome analyses of host protein expression in response to Enterovirus 71 and Coxsackievirus A16 infections

“…Hand, Foot and Mouth Disease (HFMD) is a common disease among children and had caused several large epidemics in the Asian-Pacific region [1][2][3][4][5][6]. The disease is characterized by prolonged fever, poor appetite, vomiting and lethargy, accompanied by development of vesicular exanthem in the mouth, as well as papulovesicular exanthem on the hands, feet and buttocks [7].…”