Outbreaks of Enterovirus 71 Around the World
Enterovirus 71 was first recognized in 1969 in California, USA, when it was isolated from the feces of an infant suffering from encephalitis. Till 1998, there were many reports of outbreak of enterovirus 71 around the world.
(Schmidt )(1) (Melnick ) (2, 3)
Severe CNS disease (meningitis 10, encephalitis 7, meningoencephalitis 1, unknown 2, one fatal encephalitis)
(Kennett ) (4)
Aseptic meningitis (39), polyneuritis (1), and some had rash and respiratory infection
The majority was aseptic meningitis,
Hand-foot-mouth disease (HFMD)
HFMD was predominant, CNS infections (aseptic meningitis, monoparesis) was also frequently observed.
(Shindarov ) (7)
(Chumakov ) (8)
21% developed paralysis (149), and 44 patients died (30% of paralysis), one autopsy showed lesion in the anterior horn cell of spinal cord
Encephalitis, and some with myocarditis
1977 New York
Aseptic meningitis (826)
Encephalitis (724) with 45 death, manifestated with cerebellar ataxia, and 13 with polio-like disease,
(EV71 was isolated in 1979 in Lyon, had the characteristics of influenza, although the most severely ill showed signs of CNS involvement.
(Grist ) (13)
Polio-like syndrome 1986 Hong Kong
HFMD with flaccid monoplegia (5 cases, completely recovered in 40 days) 1987 Philadelphia
5 cases of EV71 with polio like disease
1 had transient brainstem encephalitis.
CT & MRI of brain: negative
One MRI: hypointensity in the anterior portion of spinal cord (T1WI)
Patient got complete recover from 60 days to 1 year
Meningitis & Encephalitis: 34 cases
(diagnosed by CSF, Sx: drowsiness, irritability, focal twitching, convulsion)
Rash (HFMD): 61 cases
Respiratory disease: 35, 7 of them had pneumonia
1977-1991 Enterovirus Surveillance system at CDC, USA
1987 had a small peak (45 patients), with high rate of meningitis and paralysis 1997 Malaysia
2140 patients, 31 patients died
Report 4 cases of autopsy of enterovirus encephalitis:
Autopsy: the pathology findings showed predominant lesions of the brain stem and mild inflammation of the overlying meninges.
1998 Taiwan Estimate 300,000 got HFMD or herpangina, 386 were very sick admitted into ICU due to encephalitis, 56 patients died. Several autopsy proved the brain stem was invaded by enterovirus. MRI proved inflammation in the brain stem.
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