Virology, epidemiology, pathogenesis, and control of enterovirus 71

Abstract

First isolated in California, USA, in 1969, enterovirus 71 (EV71) is a major public health issue across the Asia-Pacifi c region and beyond. The virus, which is closely related to polioviruses, mostly aff ects children and causes hand, foot, and mouth disease with neurological and systemic complications. Specifi c receptors for this virus are found on white blood cells, cells in the respiratory and gastrointestinal tract, and dendritic cells. Being an RNA virus, EV71 lacks a proofreading mechanism and is evolving rapidly, with new outbreaks occurring across Asia in regular cycles, and virus gene subgroups seem to diff er in clinical epidemiological properties. The pathogenesis of the severe cardiopulmonary manifestations and the relative contributions of neurogenic pulmonary oedema, cardiac dysfunction, increased vascular permeability, and cytokine storm are controversial. Public health interventions to control outbreaks involve social distancing measures, but their eff ectiveness has not been fully assessed. Vaccines being developed include inactivated whole-virus, live attenuated, subviral particle, and DNA vaccines.

Disease burden of enterovirus 71 in rural central China: A community-based survey

“…[2][3][4][5][6] Besides, EV71 infection has been associated with an array of other clinical diseases, including aseptic meningitis, encephalitis, poliomyelitis-like paralysis, neurogenic pulmonary edema, and myocarditis. 7,8 Although most EV71-associated illness is mild and self-limiting, some cases lead to life-threatening illness or death. In the past decade, EV71 has accounted for more than 6 billion cases and more than 2000 deaths, affecting in particular infants and young children.…”

High prevalence of coxsackievirus A2 in children with herpangina in Thailand in 2015

“…Herpangina, a primarily pharyngeal infection in children caused by human enterovirus of the family Picornaviridae, is characterized by multiple oral ulcers predominantly on the soft palate and the posterior of the oral cavity. Although symptoms often spontaneously resolve within 1-2 weeks, infection contributes significantly to childhood morbidity in the Asia-Pacific region and elsewhere around the world [12].…”

First Case of Severe Enterovirus 71 Infection in Portugal

“…In the Laoprasopwattana study, the proportion of ciprofloxacin resistant Gram-negatives colonizing patients after 2 weeks of intervention was 95%, whereas it was 27% in those randomized to receive placebo. 1 To the contrary, in our institution where ciprofloxacin is not administered for prophylaxis, resistance to ciprofloxacin is 17% (25/145) of Gram-negative organisms causing bacteremia in children with cancer during an 8-year period (2004 to 2011). We consider this proportion as worrisome and worth strictly monitoring.…”

“…Cardiopulmonary compli cations, like neurogenic pulmonary edema, and cardiac collapse occur in a subset of children with rhombencephalitis, mostly in those younger than 5 years, associated with high mortality rate. 1 Among survivors, neurodevelopmental sequelae are frequent. Prognostic factors are progressively being found, including central nervous system involvement, leukocytosis, hypotension and hyperglycemia, all of which were found in our case.…”