Enterovirus 71 in Taiwan

The enterovirus 71 (EV71) outbreak in Taiwan in 1998 proved fatal in many children. A seroepidemiological study performed prior to the 1998 outbreak showed pre-epidemic (1997) EV71 seroprevalence rates to be about 60-70% in adults and children older than 6 years of age. A retrospective case review carried out from 1980-81 identified 16 cases of hand, foot and mouth disease associated with central nervous system involvement, two of whom died soon after hospitalization. There were 405 severe cases and 78 deaths reported in the 1998 epidemic, and dozens of fatal EV71 cases were still reported from 2000 to 2002. A stage-based management strategy was developed to reduce fatality, but most survivors of brainstem encephalitis with cardiopulmonary failure have neurologic sequelae and impaired cognition. Continuous clinical and laboratory surveillance of EV71 disease is required to enable earlier implementation of control and prevention measures. Development of EV71-specific antiviral therapy, a novel class of imidazolidinones, and development of a vaccine are ongoing.