Transmission and Clinical Features of Enterovirus 71 Infections in Household Contacts in Taiwan

Luan Yin Chang, Kou Chien Tsao, Shao Hsuan Hsia, Shin Ru Shih, Chung Guei Huang, Wing Kai Chan, Kuang Hung Hsu, Tsui Yen Fang, Yhu Chering Huang, Tzou Yien Lin

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Abstract

Context: Although enterovirus 71 has caused epidemics associated with significant morbidity and mortality, its transmission has not been thoroughly investigated. Objectives: To investigate enterovirus 71 transmission and determine clinical outcomes within households. Design, Setting, and Participants: Prospective family cohort study to investigate patients at a children's hospital in Taiwan and family members of these patients who had signs and symptoms suggestive of enterovirus 71 between February 2001 and August 2002. Patients and household members underwent clinical evaluations, virological studies, questionnaire-based interviews, and were followed up for 6 months. Main Outcome Measures Enterovirus 71 infection, defined as a positive viral culture from a throat or rectal swab, or the presence of IgM or a 4-fold increase in neutralizing antibody in serum; and clinical syndromes, defined as asymptomatic; uncomplicated symptomatic; and complicated; with unfavorable outcomes of sequelae or death. Results: Ninety-four families (433 family members) had at least 1 family member with evidence of enterovirus 71 infection. The overall enterovirus 71 transmission rate to household contacts was 52% (176/339 household contacts). Transmission rates were 84% for siblings (70/83); 83%, cousins (19/23); 41%, parents (72/175); 28%, grandparents (10/36); and 26%, uncles and aunts (5/19). Of 183 infected children, 11 (6%) were asymptomatic and 133 (73%) had uncomplicated illnesses (hand, foot, and mouth disease, herpangina, nonspecific febrile illness, upper respiratory tract infection, enteritis, or viral exanthema). Twenty-one percent (39/183) experienced complicated syndromes including the central nervous system or cardiopulmonary failure. During the 6-month follow-up, 10 died and 13 had long-term sequelae consisting of dysfunction in swallowing, cranial nerve palsies, central hypoventilation, or limb weakness and atrophy. Age younger than 3 years was the most significant factor associated with an unfavorable outcome in children (P=.004). Among 87 infected adults, 46 (53%) were asymptomatic, 34 (39%) had nonspecific illnesses of fever, sore throat, or gastrointestinal discomfort, and 7 (8%) had hand, foot, and mouth disease. There were no complicated cases in adults. Conclusions: Enterovirus 71 household transmission rates were high for children in Taiwan and severe disease with serious complications, sequelae, and death occurred frequently. In contrast, adults had a much lower rate of acquisition of the infection and much less adverse sequelae.

Original languageEnglish
Pages (from-to)222-227
Number of pages6
JournalJournal of the American Medical Association
Volume291
Issue number2
DOIs
Publication statusPublished - Jan 14 2004
Externally publishedYes

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Enterovirus Infections
Enterovirus
Taiwan
Hand, Foot and Mouth Disease
Herpangina
Fever
Cranial Nerve Diseases
Hypoventilation
Enteritis
Pharyngitis
Deglutition
Pharynx
Exanthema
Neutralizing Antibodies
Respiratory Tract Infections
Signs and Symptoms
Atrophy
Immunoglobulin M
Siblings
Cohort Studies

ASJC Scopus subject areas

  • Medicine(all)

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Transmission and Clinical Features of Enterovirus 71 Infections in Household Contacts in Taiwan. / Chang, Luan Yin; Tsao, Kou Chien; Hsia, Shao Hsuan; Shih, Shin Ru; Huang, Chung Guei; Chan, Wing Kai; Hsu, Kuang Hung; Fang, Tsui Yen; Huang, Yhu Chering; Lin, Tzou Yien.

In: Journal of the American Medical Association, Vol. 291, No. 2, 14.01.2004, p. 222-227.

Research output: Contribution to journalArticle

Chang, LY, Tsao, KC, Hsia, SH, Shih, SR, Huang, CG, Chan, WK, Hsu, KH, Fang, TY, Huang, YC & Lin, TY 2004, 'Transmission and Clinical Features of Enterovirus 71 Infections in Household Contacts in Taiwan', Journal of the American Medical Association, vol. 291, no. 2, pp. 222-227. https://doi.org/10.1001/jama.291.2.222
Chang, Luan Yin ; Tsao, Kou Chien ; Hsia, Shao Hsuan ; Shih, Shin Ru ; Huang, Chung Guei ; Chan, Wing Kai ; Hsu, Kuang Hung ; Fang, Tsui Yen ; Huang, Yhu Chering ; Lin, Tzou Yien. / Transmission and Clinical Features of Enterovirus 71 Infections in Household Contacts in Taiwan. In: Journal of the American Medical Association. 2004 ; Vol. 291, No. 2. pp. 222-227.
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abstract = "Context: Although enterovirus 71 has caused epidemics associated with significant morbidity and mortality, its transmission has not been thoroughly investigated. Objectives: To investigate enterovirus 71 transmission and determine clinical outcomes within households. Design, Setting, and Participants: Prospective family cohort study to investigate patients at a children's hospital in Taiwan and family members of these patients who had signs and symptoms suggestive of enterovirus 71 between February 2001 and August 2002. Patients and household members underwent clinical evaluations, virological studies, questionnaire-based interviews, and were followed up for 6 months. Main Outcome Measures Enterovirus 71 infection, defined as a positive viral culture from a throat or rectal swab, or the presence of IgM or a 4-fold increase in neutralizing antibody in serum; and clinical syndromes, defined as asymptomatic; uncomplicated symptomatic; and complicated; with unfavorable outcomes of sequelae or death. Results: Ninety-four families (433 family members) had at least 1 family member with evidence of enterovirus 71 infection. The overall enterovirus 71 transmission rate to household contacts was 52{\%} (176/339 household contacts). Transmission rates were 84{\%} for siblings (70/83); 83{\%}, cousins (19/23); 41{\%}, parents (72/175); 28{\%}, grandparents (10/36); and 26{\%}, uncles and aunts (5/19). Of 183 infected children, 11 (6{\%}) were asymptomatic and 133 (73{\%}) had uncomplicated illnesses (hand, foot, and mouth disease, herpangina, nonspecific febrile illness, upper respiratory tract infection, enteritis, or viral exanthema). Twenty-one percent (39/183) experienced complicated syndromes including the central nervous system or cardiopulmonary failure. During the 6-month follow-up, 10 died and 13 had long-term sequelae consisting of dysfunction in swallowing, cranial nerve palsies, central hypoventilation, or limb weakness and atrophy. Age younger than 3 years was the most significant factor associated with an unfavorable outcome in children (P=.004). Among 87 infected adults, 46 (53{\%}) were asymptomatic, 34 (39{\%}) had nonspecific illnesses of fever, sore throat, or gastrointestinal discomfort, and 7 (8{\%}) had hand, foot, and mouth disease. There were no complicated cases in adults. Conclusions: Enterovirus 71 household transmission rates were high for children in Taiwan and severe disease with serious complications, sequelae, and death occurred frequently. In contrast, adults had a much lower rate of acquisition of the infection and much less adverse sequelae.",
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AU - Tsao, Kou Chien

AU - Hsia, Shao Hsuan

AU - Shih, Shin Ru

AU - Huang, Chung Guei

AU - Chan, Wing Kai

AU - Hsu, Kuang Hung

AU - Fang, Tsui Yen

AU - Huang, Yhu Chering

AU - Lin, Tzou Yien

PY - 2004/1/14

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N2 - Context: Although enterovirus 71 has caused epidemics associated with significant morbidity and mortality, its transmission has not been thoroughly investigated. Objectives: To investigate enterovirus 71 transmission and determine clinical outcomes within households. Design, Setting, and Participants: Prospective family cohort study to investigate patients at a children's hospital in Taiwan and family members of these patients who had signs and symptoms suggestive of enterovirus 71 between February 2001 and August 2002. Patients and household members underwent clinical evaluations, virological studies, questionnaire-based interviews, and were followed up for 6 months. Main Outcome Measures Enterovirus 71 infection, defined as a positive viral culture from a throat or rectal swab, or the presence of IgM or a 4-fold increase in neutralizing antibody in serum; and clinical syndromes, defined as asymptomatic; uncomplicated symptomatic; and complicated; with unfavorable outcomes of sequelae or death. Results: Ninety-four families (433 family members) had at least 1 family member with evidence of enterovirus 71 infection. The overall enterovirus 71 transmission rate to household contacts was 52% (176/339 household contacts). Transmission rates were 84% for siblings (70/83); 83%, cousins (19/23); 41%, parents (72/175); 28%, grandparents (10/36); and 26%, uncles and aunts (5/19). Of 183 infected children, 11 (6%) were asymptomatic and 133 (73%) had uncomplicated illnesses (hand, foot, and mouth disease, herpangina, nonspecific febrile illness, upper respiratory tract infection, enteritis, or viral exanthema). Twenty-one percent (39/183) experienced complicated syndromes including the central nervous system or cardiopulmonary failure. During the 6-month follow-up, 10 died and 13 had long-term sequelae consisting of dysfunction in swallowing, cranial nerve palsies, central hypoventilation, or limb weakness and atrophy. Age younger than 3 years was the most significant factor associated with an unfavorable outcome in children (P=.004). Among 87 infected adults, 46 (53%) were asymptomatic, 34 (39%) had nonspecific illnesses of fever, sore throat, or gastrointestinal discomfort, and 7 (8%) had hand, foot, and mouth disease. There were no complicated cases in adults. Conclusions: Enterovirus 71 household transmission rates were high for children in Taiwan and severe disease with serious complications, sequelae, and death occurred frequently. In contrast, adults had a much lower rate of acquisition of the infection and much less adverse sequelae.

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