Although enterovirus 71 has caused epidemics associated with significant
morbidity and mortality, its transmission has not been thoroughly investigated.
To investigate enterovirus 71 transmission and determine clinical outcomes
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.
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.
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.