Outbreaks of Enterovirus 71 Around the World


Department of Radiology
Wu-Chung Shen



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.

1969-1973 California

(Schmidt )(1) (Melnick ) (2, 3)

20 patients

Severe CNS disease (meningitis 10, encephalitis 7, meningoencephalitis 1, unknown 2, one fatal encephalitis)

1972~1973 Melbourne,


(Kennett ) (4)

49 patients

Aseptic meningitis (39), polyneuritis (1), and some had rash and respiratory infection

1973 Sweden

(Blomberg )(5)

195 patients

The majority was aseptic meningitis,

Hand-foot-mouth disease (HFMD)

1973 Japan

(Tagaya )(6)

335 patients

HFMD was predominant, CNS infections (aseptic meningitis, monoparesis) was also frequently observed.

1975 Bulgaria

(Shindarov ) (7)

(Chumakov ) (8)

705 patients

21% developed paralysis (149), and 44 patients died (30% of paralysis), one autopsy showed lesion in the anterior horn cell of spinal cord

Aseptic meningitis

Encephalitis, and some with myocarditis


1977 New York


29 patients


Aseptic meningitis



1978 Japan

Ishimaru Y(10)

692 patients


Aseptic meningitis


1978 Hungary

Nagy (11)

1550 patients


Aseptic meningitis (826)

Encephalitis (724) with 45 death, manifestated with cerebellar ataxia, and 13 with polio-like disease,

1979 France


5 cases

CNS signs

(EV71 was isolated in 1979 in Lyon, had the characteristics of influenza, although the most severely ill showed signs of CNS involvement.

1984 Scotland

(Grist ) (13)

Polio-like syndrome
1986 Hong Kong

Samuda (14)

HFMD with flaccid monoplegia (5 cases, completely recovered in 40 days)
1987 Philadelphia

Hayward (15)

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

1986 Australia,


(Gilbert) (16)

140 cases

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

(Alexander) (17)

1987 had a small peak (45 patients), with high rate of meningitis and paralysis
1997 Malaysia

(Lam SK)

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.


1. Schmidt NJ, Lennette EH, Ho HH. An apparently new enterovirus isolated from patients with disease of the central nervous system. J Infect Dis 1974;129:304-9.

2. Melnick JL. Enterovirus type 71 infections: a varied clinical pattern sometimes mimicking paralytic poliomyelitis. Rev Infect Disease 1984;6(suppl 2): S387-90.

3. Melnick J, Tagaya I, von Magnus H. Enteroviruses 69,70 and 71. Intervirology 1974;4:369-70.

4. Kennett ML, Birch CJ, Lewis FA, Yung AP, Locarnini SA, Gust ID. Enterovirus type 71 infection in Melbourne. Bull WHO 1974;51:609-615.

5. Blomberg J, Lycke E, Ahlfors K, Johnson T, Wolontis S, von Ziepel G. New enterovirus type associated with epidemic of aseptic meningitis and /or hand, foot, and mouth disease [letter]. Lancet 1974;2:112

6. Tagaya I, Tachibana K. Epidemic of hand, foot and mouth disease in Japan 1972-1973: difference in epidemiologic and virologic features from previous one. Jpn J Med Sci Biol 1975;28:231-234.

7.Shindarov L, Chumakov M, Voroshilov M et al: Epidemiological clinical and pathomorphological characteristics of epidemic poliomyelitis-like disease caused by Enterovirus 71. J Hyg Epidemiol Microbiol Immunol 1979;23:284-295.

8. Chumakov M, Voroshilova M, Shindarov L, Lavrova I, Gracheva L, Koroleva G et al. Enterovirus 71 isolated from cases of epidemic poliomyelitis-like disease in Bulgaria. Arch Virol 1979;60:329-340.

9. Chonmaitree T, Menegus MA et al. Enterovirus 71 infection: report of an outbreak with two cases paralysis and review of the literature. Pediatrics 1981;67:489-493.

10. Ishimaru Y, Nakano S, Yamaoka K, Takami S. Outbreaks of hand, foot, and mouth disease by enterovirus 71. Arch Dis Child 1980;55:583-588.

11. Nagy G, Takatsy S, Kukan E, Mihaly I, Domok I. Virological diagnosis of enterovirus type 71 infections: experiences gained during an epidemic of acute CNS diseases in Hungary in 1978. Arch Virol 1982;71:217-227.

12. World Health Organization: Enterovirus type 71 surveillance. Weekly Epidemiol Rec 1979;54:219.

13. Grist NR, Bell EJ: Paralytic poliomyelitis and nonpolio enteroviruses: studies in Scotland. Rev Infect Dis 1984;6:385-386.

14. Samuda GM, Chang WK, Yeung CY, Tang PS. Monoplegia caused by enterovirus 71: an outbreak in Hong Kong. Pediatr Infect Dis J 1987;6:206-208.

15. Hayward JC, Gillespie SM, Kaplan KM, Packer R, Pallansch M, Plotkin S, Schonberger LB. Outbreak of poliomyelitis-like paralysis associated with enterovirus 71. Pediatr Infect Dis J 1989;8:611-616.

16. Gilbert GL. Dickson KE, Waters MJ, Kennett ML, Land SA, Sneddon M: Outbreak of enterovirus 71 infection in Victoria, Australia, with a high incidence of neurologic involvement. Pediatr Infect Dis J 1988;7:484-488.

17.Alexander JP, Baden L, Pallansch MA, Anderson LJ. Enterovirus 71 infections and neurologic diseaseUnited States, 1977-1991. J Infect Dis 1994;169:905-908.

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