Nonpolio enterovirus (NPEV) infections in infants and children


Recent outbreaks

14 April - July 1997, Sarawak, Malaysia

April 1998 and continuing, Taiwan

May 1998 and continuing, Hong Kong


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Virology


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Epidemiology


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Clinical diseases


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Acute nonspecific febrile illness


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Exanthem and / or enanthem


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Conjunctivitis


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Epidemic myalgia / epidemic pleurodynia / Bornholm disease / Devil's grippe


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Pericarditis / Myocarditis / Myopericarditis


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Aseptic meningitis


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Encephalitis / Meningoencephalitis


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Myelitis / Encephalomyelitis


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Neonatal infections


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Miscellaneous diseases


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Diagnosis

Clinical


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Laboratory


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Treatment


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Prevention and control

Dr. Leung Chi Wai
Paediatric Infectious Disease Unit
Department of Paediatrics
Princess Margaret Hospital


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Key points Conditions for including enteroviruses in diagnostic workup
  • local epidemiology largely unknown
    - notification not required
    - surveillance system questionable
    - extent of asymptomatic or mildly symptomatic infections uncertain
  • underdiagnosed
    - majority asymptomatic or mildly symptomatic mimicking other common childhood infections
    - clinical manifestations are protean
    - gastrointestinal symptoms and / or skin rash absent in many
    - diagnosis often not suspected and clinicians are "caught by surprise"
    - limitations of laboratory diagnosis (availability, accessibility, late specimen collection, specimen quality, inadequate specimen storage or handling during transport, technology, cost, rapid diagnosis not readily available, viral isolation time-consuming, serological screening test not practical, cross-reactivity of antibody or heterotypic response, need for serological follow-up, etc.)
  • no specific therapy of proven effectiveness
  • no vaccines available for NPEV
  • efficacy of control measures undermined
    - background reservoir of asymptomatic excretors ("shedders" as opposed to "carriers")
    - prolonged faecal excretion with infectivity well beyond recovery
    - more than one route of transmission can exist
  • acute nonspecific febrile illness during epidemics of enterovirus infections
  • acute nonsuppurative or haemorrhagic conjunctivitis
  • herpangina or vesicular / aphthous pharyngitis
  • hand, foot and mouth disease
  • atypical exanthem and / or enanthem
  • erythema multiforme
  • febrile abdominal or chest pain
  • unexplained cardiac arrhythmia or heart failure
  • "atypical" or "epidemic" Kawasaki disease
  • pericarditis / myocarditis / myopericarditis
  • non-A, non-B hepatitis
  • pancreatitis
  • parotitis
  • orchitis
  • aseptic meningitis
  • encephalitis or meningoencephalitis
  • myelitis or encephalomyelitis
  • acute flaccid paralysis including "Bell's palsy" and "Guillain Barrk syndrome"
  • perinatal pneumonitis
  • neonatal hepatitis
  • perinatal / neonatal sepsis (<10 days old)
  • outbreak of nonbacterial neonatal infections in nursery and maternity units
  • nonbacterial sepsis or persistent CNS dysfunction in immunocompromised patients
  • unexplained sudden death or apparent life-threatening events (ALTE)
  • unexplained death from cardiac and / or neurological dysfunction
  • local epidemiology largely unknown


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