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Volume 341:929-935 September 23, 1999 Number 13 Next

	Full Text PDF Editorial by Dolin, R. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Enteroviruses can cause outbreaks of hand-foot-and-mouth disease (characterized by vesicular lesions on the hands, feet, and oral mucosa) or herpangina, usually without life-threatening manifestations. In 1998 an epidemic of enterovirus 71 infection caused hand-foot-and-mouth disease and herpangina in thousands of people in Taiwan, some of whom died.

Methods We assessed the epidemiologic aspects of this outbreak. Cases of hand-foot-and-mouth disease or herpangina in ambulatory patients were reported to the Taiwan Department of Health by a mean of 818 sentinel physicians. Severe cases in hospitalized patients were reported by 40 medical centers and regional hospitals. Viruses were isolated by 10 hospital laboratories and the department of health.

Results The sentinel physicians reported 129,106 cases of hand-foot-and-mouth disease or herpangina in two waves of the epidemic, which probably represents less than 10 percent of the estimated total number of cases. There were 405 patients with severe disease, most of whom were five years old or younger; severe disease was seen in all regions of the island. Complications included encephalitis, aseptic meningitis, pulmonary edema or hemorrhage, acute flaccid paralysis, and myocarditis. Seventy-eight patients died, 71 of whom (91 percent) were five years of age or younger. Of the patients who died, 65 (83 percent) had pulmonary edema or pulmonary hemorrhage. Among patients from whom a virus was isolated, enterovirus 71 was present in 48.7 percent of outpatients with uncomplicated hand-foot-and-mouth disease or herpangina, 75 percent of hospitalized patients who survived, and 92 percent of patients who died.

Conclusions Although several enteroviruses were circulating in Taiwan during the 1998 epidemic, enterovirus 71 infection was associated with most of the serious clinical manifestations and with nearly all the deaths. Most of those who died were young, and the majority died of pulmonary edema and pulmonary hemorrhage.

Source Information

From the National Health Research Institutes, Taipei (M.H.); the National Department of Health, Taipei (E.-R.C., K.-H.H., S.-J.T., K.-T.C., S.-F.T.); the National Cheng Kung University Medical Center Virus Laboratory, Tainan (J.-R.W.); and the Chang Gung Medical Center Virus Laboratory, Lin Ko (S.-R.S.) — all in Taiwan.

Address reprint requests to Dr. Ho at the Division of Clinical Research, National Health Research Institutes, 128 Yen-Chiu-Yuan Rd., Section 2, Taipei 115, Taiwan, or at monto{at}mail.nhri.org.tw.

Full Text of this Article

Related Letters:

Outbreaks of Enterovirus 71 Infection
AbuBakar S., Chan Y.-F., Lam S. K., Ho M., Wang J.-R., Shih S.-R.
Extract | Full Text  
N Engl J Med 2000; 342:355-356, Feb 3, 2000. Correspondence

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