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Enteroviruses: Enterovirus 71

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Viral Infections of Humans

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Abstract

Although poliomyelitis has been eradicated from much of the globe, during the past 20 years countries in the Asia Pacific region have been afflicted by large outbreaks of infection with the related human enterovirus A71 (EV-A71). This infection affects mostly children, causing hand foot and mouth disease, aseptic meningitis, poliomyelitis-like acute flaccid paralysis, brainstem encephalitis, and other severe systemic manifestations, particularly pulmonary edema and cardio-respiratory collapse. Being an RNA virus, EV-A71 lacks a proofreading mechanism and is evolving rapidly, with large outbreaks occurring mostly in Asia but also occasionally elsewhere. The subgenogroups of virus appear to differ in their clinical epidemiological properties, with some of the more recently evolved subgenogroups having potential to cause explosive outbreaks. There is controversy over the pathogenesis of the severe cardio-pulmonary manifestations, and the relative contributions of neurogenic pulmonary edema, cardiac dysfunction, increased vascular permeability, and “cytokine storm.” Clinical predictors of the development of severe disease include high temperature and lethargy, and a lumbar puncture may reveal pleocytosis. Of the many alternative biological samples and laboratory tests with diagnostic utility, PCR applied to swabs from the throat or vesicle fluid, if available, is one of the most efficient. Magnetic resonance imaging reveals features of inflammation, particularly in the anterior horns of the spinal cord, the dorsal pons, and the medulla. There is no established antiviral treatment. Although untested in formal trials, intravenous immunoglobulin appears to be beneficial in severe disease, perhaps through nonspecific anti-inflammatory mechanisms. Milrinone appears helpful in treatment of cardiac dysfunction. To control outbreaks, social distancing (e.g., closing nurseries) has been attempted as a public health measure, but its effectiveness has not been fully examined. An inactivated whole virus vaccine has been found to be safe and effective in a phase 3 randomized double-blind placebo-controlled trial and has been licensed for clinical use in China.

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Acknowledgment

The authors are grateful to Associate Prof. David Perera, Institute of Health and Community Medicine, University Malaysia Sarawak (UNIMAS) for his help in generating phylogenetic tree of EV71 VP1 gene sequences (Fig. 1). TS is supported by the National Institute for Health Research (NIHR) Health Protection Research Unit in Emerging and Zoonotic Infections (Grant No. IS-HPU-1112-10117), NIHR Programme Grant for Applied Research (No. RP-PG-0108-10,048), NIHR Global Health Research Group on Brain Infections (No. 17/63/110), and the European Union’s Horizon 2020 research and innovation program ZikaPLAN (Preparedness Latin America Network), grant agreement No. 734584.

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Authors and Affiliations

  1. Institute of Health and Community Medicine, Universiti Malaysia Sarawak, Kota Samarahan, Malaysia

    Mong How Ooi

  2. Brain Infections Group, Institute of Infection and Global Health, University of Liverpool, Liverpool, UK

    Tom Solomon

  3. Department of Neurological Science, Walton Centre NHS Foundation Trust, Liverpool, UK

    Tom Solomon

  4. NIHR Health Protection Research Unit in Emerging and Zoonotic Infection, Liverpool, UK

    Tom Solomon

  5. University College of London, London, UK

    Heli Harvala

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  1. Mong How Ooi
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Correspondence to Tom Solomon .

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Editors and Affiliations

  1. School of Public Health, Yale University, Washington, DC, USA

    Richard A. Kaslow

  2. Vagelos College of Physicians & Surgeons, Columbia University, New York, NY, USA

    Lawrence R. Stanberry

  3. Cters for Disease Control and Prevention, National Center for Emerging and Zoonoti, Fort Collins, CO, USA

    Ann M. Powers

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  1. Departmant of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York, USA

    Lawrence R. Stanberry

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Ooi, M.H., Solomon, T., Harvala, H. (2022). Enteroviruses: Enterovirus 71. In: Kaslow, R.A., Stanberry, L.R., Powers, A.M. (eds) Viral Infections of Humans. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-9544-8_12-1

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