Enterovirus outbreak in Taiwan

June 8, 1998
Contact: CDC, Division of Media Relations
(404) 639­3286

CDC has been contacted by the Ministry of Health (MOH), Taiwan, Republic of China, concerning an outbreak of enterovirus among infants and young children. Since April 1998, a large number of children have contracted hand, foot, and mouth disease, and a increased number of children have been hospitalized with viral (aseptic) meningitis or encephalitis. Of those hospitalized, approximately 30 children < 3 years old have had a short febrile illness (2­4 days' duration), decompensated suddenly, and died within 12­24 hours. Some of the fatal cases had hand, foot and mouth symptoms. It is still unclear whether the three types of cases (hand, foot and mouth disease, meningitis-encephalitis, and fatal) are related. During this investigation, enteroviruses have been isolated from stool, cerebrospinal fluid, and other specimens. In particular, enterovirus 71 has been identified most often, but it is not yet confirmed as the cause of the outbreak.

Hand, foot, and mouth disease (HFMD) is usually a mild, self-limited illness that primarily affects infants and young children. The most common cause of HFMD is infection with coxsackievirus A16 (CA16), a member of the enterovirus group of viruses. Usually there are no complications of HFMD caused by CA16 infection, although aseptic or viral meningitis may occur occasionally. A second common cause of HFMD is enterovirus 71 (EV71). In addition to HFMD, EV71 may also cause aseptic or viral meningitis, encephalitis, or a polio-like paralysis. EV71 meningitis or encephalitis may, on rare occasions, be fatal.

Currently, there is no specific antiviral treatment licensed for CA16, EV71, or other enterovirus infections. Treatment of mild cases is symptomatic, directed at relieving fever, headache, and malaise. Children ill with meningitis or encephalitis are usually hospitalized.

Transmission of enteroviruses is usually from person-to-person; coming into contact with respiratory secretions (mucus, saliva) that contain the enterovirus. Enteroviruses are also excreted in stool, and can spread by direct contact with it. Therefore, good hygiene -- including frequent handwashing, appropriate cleanliness during diaper changes -- and not sharing items such as spoons and cups, etc. are simple actions that can be taken to reduce transmission.

The current HFMD outbreak among infants and children in Taiwan is not related to the foot-and-mouth disease outbreak that occurred among swine in Taiwan in 1997. Although the names of the two diseases are similar, they are not related and are caused by different viruses.

CDC is providing consultation to the Ministry of Health and is on-site in Taiwan to assist with the investigation and control of the outbreak.

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