An investigation of epidemic enterovirus 71 infection in Taiwan, 2008: Clinical, virologic, and serologic features

Min Shi Lee, Tzou Yien Lin, Pai Shan Chiang, Wen Chen Li, Shu Ting Luo, Kuo Chien Tsao, Guan Yuan Liou, Mei Liang Huang, Shao Hsuan Hsia, Yhu Chering Huang, Shih Cheng Chang

Research output: Contribution to journalArticle

50 Citations (Scopus)

Abstract

Background: Enterovirus 71 (EV71) is causing life-threatening hand-foot-mouth disease in Asia. In Taiwan, EV71 epidemics with different predominant genotypes occurred in 1998 (C2), 2000-2001 (B4), and 2004-2005 (C4). This genotype replacement may have important implications for vaccine development and prediction of epidemics. A nationwide EV71 outbreak occurred again in 2008, which provided a unique opportunity to characterize clinical, virologic, and serologic features of this epidemic. Methods: We analyzed clinical and virologic data of 111 EV71 patients hospitalized in 2008 and prospectively conducted follow-ups of healthy children from June 2006 to December 2008. Results: Among the 111 EV71 inpatients, 21 (19%) developed complications. Among the 21 complicated cases, 15 had central nervous system complication only, 2 had acute heart failure, and 4 had central nervous system and pulmonary complications. In the prospective study, 11 symptomatic infections and 4 asymptomatic infections were detected. Twenty-two EV71 isolates were genotyped, and 21 of them belong to genotype B5, which is phylogenetically close to B5 viruses circulating in Southeast Asia. Serologic tests show that children infected with B5 viruses have lower geometric mean titers of neutralizing antibody against genotype C4 than those against genotype B5 (P = 0.004, t test). Conclusions: The 2008 nationwide EV71 epidemic was caused by genotype B5 that was likely introduced to Taiwan from Southeast Asia. Clinical features of the 2008 epidemic were not different from those observed before in Taiwan. Potential antigenic variations between genotype C4 and B5 viruses could be detected and its long-term epidemiologic significance needs further investigation to clarify.

Original languageEnglish
Pages (from-to)1030-1034
Number of pages5
JournalPediatric Infectious Disease Journal
Volume29
Issue number11
DOIs
Publication statusPublished - Nov 2010
Externally publishedYes

Fingerprint

Enterovirus Infections
Enterovirus
Taiwan
Genotype
Southeastern Asia
Viruses
Central Nervous System
Hand, Foot and Mouth Disease
Antigenic Variation
Asymptomatic Infections
Serologic Tests
Neutralizing Antibodies
Disease Outbreaks
Inpatients
Vaccines
Heart Failure
Prospective Studies
Lung
Infection

Keywords

  • cohort study
  • Enterovirus 71
  • molecular epidemiology
  • seroepidemiology

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Microbiology (medical)
  • Infectious Diseases

Cite this

An investigation of epidemic enterovirus 71 infection in Taiwan, 2008 : Clinical, virologic, and serologic features. / Lee, Min Shi; Lin, Tzou Yien; Chiang, Pai Shan; Li, Wen Chen; Luo, Shu Ting; Tsao, Kuo Chien; Liou, Guan Yuan; Huang, Mei Liang; Hsia, Shao Hsuan; Huang, Yhu Chering; Chang, Shih Cheng.

In: Pediatric Infectious Disease Journal, Vol. 29, No. 11, 11.2010, p. 1030-1034.

Research output: Contribution to journalArticle

Lee, MS, Lin, TY, Chiang, PS, Li, WC, Luo, ST, Tsao, KC, Liou, GY, Huang, ML, Hsia, SH, Huang, YC & Chang, SC 2010, 'An investigation of epidemic enterovirus 71 infection in Taiwan, 2008: Clinical, virologic, and serologic features', Pediatric Infectious Disease Journal, vol. 29, no. 11, pp. 1030-1034. https://doi.org/10.1097/INF.0b013e3181e52945
Lee, Min Shi ; Lin, Tzou Yien ; Chiang, Pai Shan ; Li, Wen Chen ; Luo, Shu Ting ; Tsao, Kuo Chien ; Liou, Guan Yuan ; Huang, Mei Liang ; Hsia, Shao Hsuan ; Huang, Yhu Chering ; Chang, Shih Cheng. / An investigation of epidemic enterovirus 71 infection in Taiwan, 2008 : Clinical, virologic, and serologic features. In: Pediatric Infectious Disease Journal. 2010 ; Vol. 29, No. 11. pp. 1030-1034.
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T1 - An investigation of epidemic enterovirus 71 infection in Taiwan, 2008

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AU - Lin, Tzou Yien

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AU - Li, Wen Chen

AU - Luo, Shu Ting

AU - Tsao, Kuo Chien

AU - Liou, Guan Yuan

AU - Huang, Mei Liang

AU - Hsia, Shao Hsuan

AU - Huang, Yhu Chering

AU - Chang, Shih Cheng

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N2 - Background: Enterovirus 71 (EV71) is causing life-threatening hand-foot-mouth disease in Asia. In Taiwan, EV71 epidemics with different predominant genotypes occurred in 1998 (C2), 2000-2001 (B4), and 2004-2005 (C4). This genotype replacement may have important implications for vaccine development and prediction of epidemics. A nationwide EV71 outbreak occurred again in 2008, which provided a unique opportunity to characterize clinical, virologic, and serologic features of this epidemic. Methods: We analyzed clinical and virologic data of 111 EV71 patients hospitalized in 2008 and prospectively conducted follow-ups of healthy children from June 2006 to December 2008. Results: Among the 111 EV71 inpatients, 21 (19%) developed complications. Among the 21 complicated cases, 15 had central nervous system complication only, 2 had acute heart failure, and 4 had central nervous system and pulmonary complications. In the prospective study, 11 symptomatic infections and 4 asymptomatic infections were detected. Twenty-two EV71 isolates were genotyped, and 21 of them belong to genotype B5, which is phylogenetically close to B5 viruses circulating in Southeast Asia. Serologic tests show that children infected with B5 viruses have lower geometric mean titers of neutralizing antibody against genotype C4 than those against genotype B5 (P = 0.004, t test). Conclusions: The 2008 nationwide EV71 epidemic was caused by genotype B5 that was likely introduced to Taiwan from Southeast Asia. Clinical features of the 2008 epidemic were not different from those observed before in Taiwan. Potential antigenic variations between genotype C4 and B5 viruses could be detected and its long-term epidemiologic significance needs further investigation to clarify.

AB - Background: Enterovirus 71 (EV71) is causing life-threatening hand-foot-mouth disease in Asia. In Taiwan, EV71 epidemics with different predominant genotypes occurred in 1998 (C2), 2000-2001 (B4), and 2004-2005 (C4). This genotype replacement may have important implications for vaccine development and prediction of epidemics. A nationwide EV71 outbreak occurred again in 2008, which provided a unique opportunity to characterize clinical, virologic, and serologic features of this epidemic. Methods: We analyzed clinical and virologic data of 111 EV71 patients hospitalized in 2008 and prospectively conducted follow-ups of healthy children from June 2006 to December 2008. Results: Among the 111 EV71 inpatients, 21 (19%) developed complications. Among the 21 complicated cases, 15 had central nervous system complication only, 2 had acute heart failure, and 4 had central nervous system and pulmonary complications. In the prospective study, 11 symptomatic infections and 4 asymptomatic infections were detected. Twenty-two EV71 isolates were genotyped, and 21 of them belong to genotype B5, which is phylogenetically close to B5 viruses circulating in Southeast Asia. Serologic tests show that children infected with B5 viruses have lower geometric mean titers of neutralizing antibody against genotype C4 than those against genotype B5 (P = 0.004, t test). Conclusions: The 2008 nationwide EV71 epidemic was caused by genotype B5 that was likely introduced to Taiwan from Southeast Asia. Clinical features of the 2008 epidemic were not different from those observed before in Taiwan. Potential antigenic variations between genotype C4 and B5 viruses could be detected and its long-term epidemiologic significance needs further investigation to clarify.

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