Enterovirus 71: emergence of the new poliomyelitis

Large regional epidemics of enterovirus 71 disease have occurred in Asia and other parts of the world since the late 1990s, primarily affecting young children. Manifestations range from benign hand-foot-disease and herpangina to neurological disease that includes meningitis, brainstem encephalitis, and acute faccid paralysis. Cardiopulmonary complications, including pulmonary oedema, pulmonary haemorrhage, interstitial pneumonitis, and cardiopulmonary collapse, occur in a subset of children with brainstem encephalitis, associated with rapid clinical decompensation and high mortality rates, and, among survivors, frequent neurological and neurodevelopmental sequelae. Virological diagnosis is primarily based on nucleic acid amplifcation or viral culture of peripheral specimens such as throat and rectal swabs and vesicular fuid, rather than of cerebrospinal fuid, which has a relatively low yield. Treatment is primarily supportive. Development of candidate antiviral compounds and vaccines is being actively pursued.