Human Enterovirus 71 Disease in Sarawak, Malaysia: A Prospective Clinical, Virological, and Molecular Epidemiological Study
Background. Human enterovirus (HEV)–71 causes large outbreaks of hand-foot-and-mouth disease with central nervous system (CNS) complications, but the role of HEV-71 genogroups or dual infection with other viruses in causing severe disease is unclear. Methods. We prospectively studied children wit...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Infectious Diseases Society of America
2007
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| Subjects: | |
| Online Access: | http://ir.unimas.my/id/eprint/13614/ http://ir.unimas.my/id/eprint/13614/1/Human%20Enterovirus%2071%20Disease%20In%20Sarawak%20%28abstract%29.pdf |
| Summary: | Background. Human enterovirus (HEV)–71 causes large outbreaks of hand-foot-and-mouth disease with central
nervous system (CNS) complications, but the role of HEV-71 genogroups or dual infection with other viruses
in causing severe disease is unclear.
Methods. We prospectively studied children with suspected HEV-71 (i.e., hand-foot-and-mouth disease, CNS
disease, or both) over 3.5 years, using detailed virological investigation and genogroup analysis of all isolates.
Results. Seven hundred seventy-three children were recruited, 277 of whom were infected with HEV-71,
including 28 who were coinfected with other viruses. Risk factors for CNS disease in HEV-71 included young age,
fever, vomiting, mouth ulcers, breathlessness, cold limbs, and poor urine output. Genogroup analysis for the HEV-
71–infected patients revealed that 168 were infected with genogroup B4, 68 with C1, and 41 with a newly emerged
genogroup, B5. Children with HEV-71 genogroup B4 were less likely to have CNS complications than those with
other genogroups (26 [15%] of 168 vs. 30 [28%] of 109; odds ratio [OR], 0.48; 95% confidence interval [CI],
0.26–0.91; ) and less Pp.0223 likely to be part of a family cluster (12 [7%] of 168 vs. 29 [27%] of 109; OR, 0.21;
95% CI, 0.10–0.46; P ! .0001); children with HEV-71 genogroup B5 were more likely to be part of a family cluster
(OR, 6.26; 95% CI, 2.77–14.18; P ! .0001). Children with HEV-71 and coinfected with another enterovirus or
adenovirus were no more likely to have CNS disease.
Conclusions. Genogroups of HEV-71 may differ with regard to the risk of causing CNS disease and the
association with family clusters. Dual infections are common, and all possible causes should be excluded before
accepting that the first virus identified is the causal agent. |
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