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Volume 44, Number 4, August 2011

Epidemiologic and clinical features of non-polio enteroviral infections in northern Taiwan in 2008


Chien-Hui Hsu, Chun-Yi Lu, Pei-Lan Shao, Ping-Ing Lee, Chuan-Liang Kao, Ming-Yi Chung, Luan-Yin Chang, Li-Min Huang


Received: July 16, 2009    Revised: April 20, 2010    Accepted: August 12, 2010   

 

Corresponding author:

Division of Infectious Diseases, Department of Pediatrics, National Taiwan University Hospital, 8 Chung-Shan South Road, Taipei 100, Taiwan. E-mail addresses: lychang@ntu.edu.tw, ly7077@tpts6.seed.net.tw (L.-Y. Chang)



 

Background and purpose: 

Non-polio enteroviruses may cause different diseases, including herpangina, hand–foot–mouth disease (HFMD), meningitis, and nonspecific febrile illness; and cause epidemic outbreak annually. This study delineates the diversity of clinical presentations based on different serotypes and different groups [human enterovirus (HEV)-A and HEV-B] of enteroviruses (EVs) during the 2008 epidemic in National Taiwan University Hospital (NTUH).



 

Methods:

We retrospectively identified patients younger than 18 years who had positive isolates of non-polio EV in throat swabs, rectal swabs, or cerebrospinal fluid, in NTUH from January 1 to December 31, 2008. For serotyping, immunofluorescence assay and polymerase chain reaction followed by viral structure protein-1 sequencing were applied. We analyzed and compared their clinical features among different serotypes and different groups of EVs.



 

Results:

Among 172 patients who were enrolled, 16 serotypes were identified. The major serotype in NTUH was EV71 (25.6%) followed by coxsackievirus A (CA)16 and coxsackievirus B (CB)4. EV71 manifested mostly as HFMD (89%) and was complicated with encephalomyelitis in three patients. Serotypes of HFMD included EV71 (70%), CA16 (27%), CA4, and CA6. Serotypes of herpangina were heterogeneous, and the major serotype was CA2 (35.7%) followed by CB4 (23.8%). Aseptic meningitis was entirely caused by HEV-B and mostly infected by echovirus 30 (50%). Among children with EV-related respiratory tract infection, CB4 (32%) was dominant in upper respiratory tract infection, whereas echovirus 4 (71%) was the major cause of lower respiratory tract infection. Cases of HEV-A were significantly younger than the cases of HEV-B (p=0.04). Multivariate analysis revealed that the most significant factor associated with hospitalization is HEV-B (odds ratio, 2.2; 95% confidence interval, 1.1–4.2; p=0.02).



 

Conclusion:

At least 16 serotypes circulated in northern Taiwan in 2008. EV71 is the predominant strain in this outbreak. All patients with HFMD were infected by HEV-A, but HEV-B was associated with a higher rate of hospitalization and aseptic meningitis, which should be a cause of alert regarding public health.



 

Key words:

Children, Epidemiology, Non-polio enterovirus;, Taiwan