Enterovirus / Enterovirus Infection with Severe Complications in Taiwan

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Data from Division of Acute Infectious Diseases, CDC, Taiwan

Background

Enterovirus belongs to a group of small RNA viruses, including polioviruses, Coxsackie A viruses, Coxsackie B viruses, echoviruses, and other enteroviruses (EVD68~). EVA71 has a significantly higher pathogenicity compared to other known enteroviruses, especially regarding neurological complications. Enteroviruses are found in the gastrointestinal tract (the stool of infected persons, mouth) and respiratory tract (such as saliva, sputum, or nasal mucus). Infections can be produced by direct contact with the secretions of infected persons or with contaminated surfaces or objects. Humans appear to be the only known host and source for enteroviruses transmission. The patient is contagious before their onset, and the infectivity will last for weeks after the patient is recovered. There are currently no preventive vaccines for non-polio enteroviruses in Taiwan and no known highly efficacious medicine to eliminate the virus once it is inside the human body. Therefore, enteroviruses will continue to pose a threat to human health for the foreseeable future.

Epidemiology           

According to survey data gathered over a period of several years by Taiwan CDC and the National Health Insurance (NHI) Administration, the number of weekly outpatient and emergency visits, as shown by the data transferred from the database of NHI, increases in late March and peaks around mid-June. It decreases after mid-June. There is usually another smaller outbreak when schools reopen in September (see Figure1).

Those survey data also indicate that children under the age of 5 are more prone to critical complications and death. In Taiwan, the case-fatality rate of enterovirus infection with severe complications (EVSC) are ranged from 1.3% to 33.3%. The major symptoms of enterovirus infection are herpangina and hand-foot-and-mouth disease (HFMD). EVA71 is the most commonly seen serotype of cases of EVSC in Taiwan.

EV/EVSC Surveillance in Taiwan 

  1. Taiwan National Infectious Disease Statistics SystemEnterovirus infection with severe complications
  2. School-Based Surveillance System

Prevention and Control

  1. Established multiple and real-time surveillance systems for enterovirus infections, covering HFMD and herpangina, severe cases, clustering, virus isolation and typing.
  2. Constructed a medical service network, including six regional chiefs, 76 responsible hospitals and eight contract laboratories.
  3. Health Education

(1)   Local organizations work with the community to promote enterovirus education and prevention.

(2)   Restaurants, schools, hospitals, clinics and other public gathering places must conduct regular inspections for environmental sanitation and provide hand-washing facilities.

  1. Establishment of consultation channels staffed by clinical professionals. The professionals provide clinical health care consultation and guidelines for treating enterovirus complications. Primary care for patients with complications can effectively lower the mortality rate.
  2. “The Manual for Enterovirus Prevention” and “The Handbook for Enterovirus Prevention for Child Care Workers” list all necessary precautions. These materials are provided on the Taiwan CDC website and updated annually.
  3. Workshops are held on the clinical treatment of critical enterovirus complications to enhance doctors’ skills in treating the disease, raise treatment quality and reduce mortality rates and sequelae.

Last modified at 2017-06-07