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Enteroviruses: Enterovirus 71

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Viral Infections of Humans

Abstract

Although poliomyelitis has been eradicated from much of the globe, during the past 15 years countries in the Asia-Pacific region have been afflicted by large outbreaks of infection with the related human enterovirus A71 (EV71). 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 cardiorespiratory collapse. Being an RNA virus, EV71 lacks a proofreading mechanism and is evolving rapidly, with new outbreaks occurring across Asia in regular cycles. The subgenogroups 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 cardiopulmonary 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.

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Acknowledgment

The authors are grateful to Associate Prof. David Perera, Institute of Health and Community Medicine, Universiti Malaysia Sarawak (UNIMAS), for his help in generating the phylogenetic tree of EV71 VP1 gene sequences (Fig. 12.1).

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Authors and Affiliations

  1. Institute of Health and Community Medicine, Universiti Malaysia Sarawak, Kota Samarahan, Sarawak, 94300, Malaysia

    Mong How Ooi MD

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

    Tom Solomon BA, BM, BCh

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

    Tom Solomon BA, BM, BCh

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

    Tom Solomon BA, BM, BCh

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  1. Mong How Ooi MD
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Correspondence to Mong How Ooi MD .

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Editors and Affiliations

  1. Department of Epidemiology, University of Alabama, Birmingham School of Public Health, Birmingham, Alabama, USA

    Richard A. Kaslow

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

    Lawrence R. Stanberry

  3. Department of Microbiology and Immunology, University of Texas Medical Branch, Galveston, Texas, USA

    James W. Le Duc

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Ooi, M.H., Solomon, T. (2014). Enteroviruses: Enterovirus 71. In: Kaslow, R., Stanberry, L., Le Duc, J. (eds) Viral Infections of Humans. Springer, Boston, MA. https://doi.org/10.1007/978-1-4899-7448-8_12

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