The following pieces is posted by the Min Shing Daily (Taiwan) on 24 Feb.1999.

The Chief of the Communicable Disease Bureau, Dr. S.C. To, pointed out that based on investigations completed by the Ministry of Health on victims' clinical specimen from last year's enterovirus epidemic, the main culprit was EV71.

Chang Kung Children Hospital undertook a serological survey of residents of the Tow Yuen District (Central Taiwan) the percentage of people tested positive for antibodies  against EV71 were as follows:  

The percentage of positivity increased with the age group. The MOH concluded from this that EV71 virus had been infecting people in the community for some time.  Awareness of its presence was only uncovered when it caused numerous death last year. But because it has not reached the required 70-80% herd immunity required to stop transmission, there is still a possibility for its resurgence in the coming summer on a smaller scale. While the virus infect people indiscriminately, only those under 3 years of age are more vulnerable to its serious complications.

Taiwan University is also undertaking a similar survey for northern Taiwan. But the result will only be ready next month.

Taiwan Today News Network
Translated Friday 24/7/98

DOH officially declared that the EV outbreak is subsiding

With the concurrence of national and international infectious diseases experts, the DOH
today officially declared that the outbreak is definitely subsiding and that the people
can return to their normal ways of life. DOH however reiterated that the EV is still
present in the environment and the public must continue to observe personal and home
hygiene and public places must continue to maintain cleanliness. Only with continued
effort will the outbreak tail off till  complete disappearance.

DOH today invited experts from unversities, hospitals, research institutions, DOH and
CDC to a conference to examine the current outbreak situation and study case reports
tabled.

The acting Head of the Communicable Diseases Control Bureau made the afore-mentioned
statement after the conference. He pointed out that the conclusion is the consensus
opinion of the experts after repeated discussions. Although the people's life  can
return to normalcy, they must maintain the anti-infection mentality: e.g. have their
home well ventilated; deligence in hand washing; cover mouth / nose when sneezinf or
coughing and not directing the blast at someone nearby :-); food hygiene. These measures
will prevent spread of EV and other infections.

In total, EV has resulted in 309 suspected serious cases, among whom 55 died. There are
still 11 cases being hospitalised; their prognosis is poor and they are likely to remain
in vegetative state.

Taiwan U Hon Prof. Li expects the outbreak to peter out gradually, though occaional
sporadic cases would not be unexpected. He added that a recurrence of the outbreak is
unlikely in the next 2 to 3 years because of the increased herd immunity in the
population.

Central Medical Reaserch Institute's spokes-person said the fatal and serious cases have
been grouped into 3 categories:
1. EV 71 fatal and serious cases
2. Fatal and serious cases of undertemined aetiology
3. Other fatal and serious cases of determined causes.

Analysis showed that 60 - 70 % showed brain stem / brain involvement and clinical
features included twitching, vomiting, drowsiness and confusional state. They mostly had
2 -  3 consultations during this period. In addition, some had tachycardia which led to
the diagnosis of myocarditis, hitherto unconfirmed.

Excerpts and translation from Min Sheng World Health Daily http://ww10.sinanet.com/msb/health/ Dated 19/6/98

Headlines:

"Suspected deaths now number 43. More older children fell victims" Amongst the seven latest victims, one was aged 12 yers and one 9 years.

"Autopsy findings, 2 contardictory verdicts"

6 autopsies done so far. 4 reports available:One 8 year old was earlier confirmed to be EV71 with predominant brain stem and spinal cord pathology; One had atypical clinical picture and negative findings, thus excluded as case fatality for the outbreak.

Two other case, 6 month old boy and 8 month old girl. DOH confirmed that the autopsies were negative for EV. However, the relevant hospitals stated that they have found viral agent very similar but not identical to the usual EV71.

"Preliminary consensus of expert panel"

A panel of experts, including 3 CDC experts, has held a preliminary review.  The  findings were that most of those with "myocarditis" presentation also CNS signs. Review of several of these cases noted that though they had obvious heart failure, shock and pulmonary oedema, their cardiac enzymes were normal, and they exhibited confusional state, drowsiness consistent with brain stem involvement.CDC experts also noted that the Malaysian experience last year was similar.

The current consensus is that the primarily brain stem involvement results in the cardiovascular events.DOH is planning to conduct detail questionaire interviews of the families of all the suspected case fatalities.


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Comments:
The picture gets clearer as more information becomes available, even though, not
unexpectedly, some results are contradictory.

CHH

I attach a translated exerpt from Min Sheng Daily News of 18/6/98

"EV71 might not be the only culprit"

Many paediatricians caution that finding from one autopsy may not be applicable to all cases.

Taichong Yungmin General Hospital paediatrician said that in his hospital, children whose illness rapidly led to death had this similar finding: echocardiography showed heart failure and death followed within 1 to 2 days. However pathological (? autopsy) findings were negative for myocarditis.

Taipei Yungchong Hospital also reported an autopsy of a 18 days old baby whose heart was enlarged but showed no myocarditis.

Taiwan University Professor said some of the autopsies showed obvious cardiac enlargement, the cause of which has yet to be established.There is still the possiblity of other viral agent(s) or other mechanisms that may result in hear failure and death.

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Comments:

The above sounds a cautionary note in the wake of euphoria after the very significant autopsy findings.

It points to the need to have more