Epidemiology of Enterovirus 71 Infections in Taiwan

Chia, Min‐Yuan; Chiang, Pai-Shan; Chung, Wan-Yu; Luo, Shu-Ting; Lee, Min-Shi

doi:10.1016/j.pedneo.2013.07.007

Cited by 56 publications

(40 citation statements)

References 44 publications

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“…Either the different virulence of different genotypes, host factors and other socioeconomic factors [13, 19–22] may contribute to the severe complication and sequelae of EV71 infection as well.…”

Section: Discussionmentioning

confidence: 99%

The correlation between the presence of viremia and clinical severity in patients with enterovirus 71 infection: a multi-center cohort study

et al. 2014

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BackgroundEnterovirus 71 (EV71) is a great disease burden across the whole world, particularly in Southeast Asia. However, in recent decades, the pathogenesis of severe EV71 infection was not well understood. This study was aimed to investigate the correlation between the presence of viremia and the clinical severity of EV71 infection.MethodsWe organized a prospective cohort study and enrolled laboratory-confirmed EV71 cases in six tertiary care hospitals in Taiwan during the EV71 epidemic from 2011 to 2012. Blood samples were collected once in the acute stage, on the first day of admission. We used real-time RT-PCR to detect EV71 viremia. Demographical and clinical data were collected and the clinical severity was categorized into four grades. Data analysis was performed to identify the risk factors of viremia and the correlation between viremia and clinical severity of EV71 infection.ResultsOf the total 224 enrolled patients, 59 (26%) patients were confirmed to have viremia. Two-thirds (68%) of viremic cases were detected within the first three days of infection. Viremia occurred more frequently in children under the age of one year old (odds ratios [OR] 4.82, p < 0.001) but the association between the presence of viremia and complicated EV71 infection was not found (OR 1.02, p = 0.96). In the viremia group, patients had significantly more severe complications if viremia was detected after the third day of disease onset (26% vs. 5%, p = 0.03).ConclusionsViremia occurred more frequently in children under the age of one year and viremia detected beyond three days after the onset of disease correlated with more severe disease in EV71 patients.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2334-14-417) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

The correlation between the presence of viremia and clinical severity in patients with enterovirus 71 infection: a multi-center cohort study

et al. 2014

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“…50 Subgenogroups C2, C4 and B5 with genomic variations have repeatedly appeared during outbreaks in Japan between 1990 and 2013. 120 EV-A71 has caused nationwide epidemics in Taiwan 121 The C4 subgenotype emerged in 1998 in China with a predominance of the C4b lineage until 2009 followed by the exclusive occurrence of the C4a lineage until now. Between 2008 and 2014, C4 epidemics have been responsible for more than 10 million HFMD cases with a case-severity and case-fatality rates per year of 1.1% and 0.03-0.04%, respectively.…”

Section: Molecular Epidemiologymentioning

confidence: 99%

“…Sequential inter-genotype shifts from C2 to B4 and subsequently from C4 to B5 were observed in Taiwan. 7,121,126 The co-circulation of several EV-A71 genotypes and CV-A16 during HFMD epidemics has been responsible for intra-typic genetic recombination between EV-A71 B and C genotypes in Taiwan and inter-typic recombination between EV-A71 and CV-A16 in China. 5,7,14,19,126,129 Another inter-serotypic recombination happened between EV-A71 genotype C2 and CV-A8 to create genotype B4, responsible for outbreaks in Japan and Taiwan in 1998.…”

Section: Molecular Epidemiologymentioning

confidence: 99%

Is a multivalent hand, foot, and mouth disease vaccine feasible?

Klein¹,

Chong

2015

Human Vaccines & Immunotherapeutics

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Keywords: bivalent and multivalent vaccines, coxsackievirus A16, coxsackieviruses B3 and B5, echovirus 30, epidemiology, enterovirus A (EV-A), enterovirus A71, hand, foot and mouth diseases, inactivated whole virion vaccines, monovalent, EV-A71 vaccine Enterovirus A infections are the primary cause of hand, foot and mouth disease (HFMD) in infants and young children. Although enterovirus 71 (EV-A71) and coxsackievirus A16 (CV-A16) are the predominant causes of HFMD epidemics worldwide, EV-A71 has emerged as a major neurovirulent virus responsible for severe neurological complications and fatal outcomes. HFMD is a serious health threat and economic burden across the Asia-Pacific region. Inactivated EV-A71 vaccines have elicited protection against EV-A71 but not against CV-A16 infections in large efficacy trials. The current development of a bivalent inactivated EV-A71/CV-A16 vaccine is the next step toward that of multivalent HFMD vaccines. These vaccines should ultimately include other prevalent pathogenic coxsackieviruses A (CV-A6 and CV-A10), coxsackieviruses B (B3 and B5) and echovirus 30 that often co-circulate during HFMD epidemics and can cause severe HFMD, aseptic meningitis and acute viral myocarditis. The prospect and challenges for the development of such multivalent vaccines are discussed.

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“…[3][4][5][6][7] In 1998, EV71 caused a large-scale epidemic in Taiwan, which led to 405 severe cases and 78 deaths due to the development of neurologic complications such as meningitis and encephalitis. [8][9][10] Despite the fact that EV71 causes fatal diseases, it has also been reported that it has diverse manifestations, ranging from asymptomatic, mild disease, to extremely severe disease to fatal deaths. 6 Genetic factors are believed to cause the differences in physical responses to the same virulence of pathogens, such as tumor necrosis factor, a promoter type II.…”

mentioning

confidence: 99%