Enterovirus type 71: hand, foot, and mouth disease, encephalomyelitis, and acute pulmonary edema in children



Cite item

Full Text

Abstract

Enterovirus type 71 (EV71) (Picornaviridae family, Enterovirus genus, HEV-A species) belongs to the most neuropathogenic non-polio human enteroviruses. CNS damages caused by EV71 in children were very similar in their clinical and pathomorphological pattern and frequently indistinguishable from those induced by virulent strains of poliomyelitis virus. During the past 30-40 years, EV71 has caused large outbreaks of hand, foot, and mouth disease (HFMD) in the countries of Europe (Bulgaria, Hungary) and Southeastern Asia (Malaysia, Taiwan, Singapore, China and others). HFMD (rash on the hand and foot skin and oral mucosa) affects children aged 1 month to 12-14 years, mostly with favorable outcomes in 3-7 days. On 2-5 days of HFMD, ≈ 1% of less than 2-3-year-old children were found to have neurological syndromes, such serous meningitis, poliomyelitis-like signs (pareses and paralyses of the extremities), brainstem encephalitis (tremor, myoclonic jerks, lethargy, bulbar palsy, acute heart and pulmonary failure, neurogenic pulmonary edema, shock, coma, death). In severe cases, mortality rates were as high as 92-94%. Motor, respiratory, and psychoemotional disorders remained long in a small portion of the patients. Pathomorphologic studies revealed damages to the neurons located in the respiratory and cardiovascular centers of the reticular formation of the medulla oblongata, to the nuclei in the n. vagus, and to the anterior nuclei of the spinal cord. The changes in myocardial and lung tissues were minor or absent. The main causes of pulmonary edema were damages to the nerve centers of the brainstem brain and dysregulation of the autonomic nervous system. Drugs and vaccines against EV71 infection are currently unavailable. Immediate (during the first days of EV71 infection) hospitalization of children with the earliest prognostic signs (temperature 38.5-39°C within ≥ 3 days, lethargy) of CNS involvement, early intravenous administration of human immunoglobulin, and active cardiovascular therapy (administration of milrinone) are recommended to reduce the incidence of severe and fatal cases of EV71 infections.

About the authors

V A Lashkevich

Galina Aleksandrovna Koroleva

Aleksandr Nikolaevich Lukashev

Valentina Yakovlevna Karmysheva

Aida Nurislamovna Mustafina

Lyudmila Vasil'evna Khudyakova

E Yu Shumilina

V A Lashkevich

M. P. Chumakov Institute of Poliomyelitis and Viral Encephalidites, Russian Academy of Medical Sciences, Moscow

M. P. Chumakov Institute of Poliomyelitis and Viral Encephalidites, Russian Academy of Medical Sciences, Moscow

G A Koroleva

M. P. Chumakov Institute of Poliomyelitis and Viral Encephalidites, Russian Academy of Medical Sciences, Moscow

M. P. Chumakov Institute of Poliomyelitis and Viral Encephalidites, Russian Academy of Medical Sciences, Moscow

A N Lukashev

M. P. Chumakov Institute of Poliomyelitis and Viral Encephalidites, Russian Academy of Medical Sciences, Moscow

M. P. Chumakov Institute of Poliomyelitis and Viral Encephalidites, Russian Academy of Medical Sciences, Moscow

V Ya Karmysheva

M. P. Chumakov Institute of Poliomyelitis and Viral Encephalidites, Russian Academy of Medical Sciences, Moscow

M. P. Chumakov Institute of Poliomyelitis and Viral Encephalidites, Russian Academy of Medical Sciences, Moscow

A N Mustafina

M. P. Chumakov Institute of Poliomyelitis and Viral Encephalidites, Russian Academy of Medical Sciences, Moscow

M. P. Chumakov Institute of Poliomyelitis and Viral Encephalidites, Russian Academy of Medical Sciences, Moscow

L V Khudyakova

M. P. Chumakov Institute of Poliomyelitis and Viral Encephalidites, Russian Academy of Medical Sciences, Moscow

M. P. Chumakov Institute of Poliomyelitis and Viral Encephalidites, Russian Academy of Medical Sciences, Moscow

E Yu Shumilina

M. P. Chumakov Institute of Poliomyelitis and Viral Encephalidites, Russian Academy of Medical Sciences, Moscow

M. P. Chumakov Institute of Poliomyelitis and Viral Encephalidites, Russian Academy of Medical Sciences, Moscow

References

  1. Королева Г. А., Грачева Л. А., Ворошилова М. К. Выделение энтеровируса типа 71 от больных с полиомиелитоподобным заболеванием во время вспышки в Болгарии // Вопр. вирусол. - 1978. - № 5. - С. 611-618.
  2. Королева Г. А., Грачева Л. А. Патогенность энтеровируса типа 71 для лабораторных животных // Вопр. вирусол. - 1980. - № 2. - С. 185-190.
  3. Лукашев А. Н., Королева Г. А., Лашкевич В. А. и др. Энтеровирус 71: эпидемиология и диагностика // Журн. микробиол. - 2009. - № 3. - С. 110-116.
  4. Эпидемиологический надзор и профилактика энтеровирусной (неполио) инфекции: Метод. указания (МУ 3.1.1.2.2363-08). - М., 2008.
  5. AbuBakar S., Sam I. C., Yusof J. et al. Enterovirus 71 outbreak, Brunei // Emerg. Infect. Dis. - 2009. - Vol. 15. - P. 79-82.
  6. Alexander J. P., Baden L., Pallansch M. A. et al. Enterovirus 71 infections and neurologic disease - United States, 1977-1991 // J. Infect. Dis. - 1994. - Vol. 169. - P. 905-908.
  7. Ang L. W., Koh B. K., Chan K. P. et al. Epidemiology and control of hand, foot and mouth disease in Singapore, 2001-2007 // Ann. Acad. Med. Singapore. - 2009. - Vol. 38. - P. 106- 112.
  8. Baker A. B. Poliomyelitis. A study of pulmonary edema // Neurology. - 1957. - Vol. 7. - P. 743-751.
  9. Bible J. M., Iturriza-Gomara M., Megson B. et al. Molecular epidemiology of human enterovirus 71 in the United Kingdom from 1998 to 2006 // J. Clin. Microbiol. - 2008. - Vol. 46. - P. 3192-3200.
  10. Blomberg J., Lycke E., Ahlfors K. et al. Letter: New enterovirus type associated with epidemic of aseptic meningitis and-or hand, foot, and mouth disease // Lancet. - 1974. - Vol. 2. - P. 112.
  11. Bojinov S., Sivtchev S., Gentschev T. et al. A histopathological investigation of 35 children deceased during an epidemic of polioencephalomyelitis due to an enterovirus 71 (Bulgaria) // VII International Congress of Infectious and Paralytic Diseases. - Varna, 1978. - P. 402-405.
  12. Brown B. A., Kilpatrick D. R., Oberste M. S. et al. Serotype-specific identification of enterovirus 17 by PCR // J. Clin. Virol. - 2000. - Vol. 16. - P. 107-112.
  13. Cardosa M. J., Perrera D., Brown B. A. et al. Molecular epidemiology of human enterovirus 71 strains and recent outbreaks in the Asia-Pacific region: comparative analysis of the VP1 and VP4 genes // Emerg. Infect. Dis. - 2003. - Vol. 9. - P. 461- 468.
  14. Chakraborty R., Iturriza-Gomara M., Musoke R. et al. An epidemic of enterovirus 71 infection among HIV-1 infected orphans in Nairobi // AIDS. - 2004. - Vol. 18. - P. 1968- 1970.
  15. Chan K. P., Goh K. T., Chong C. Y. et al. Epidemic hand, foot and mouth disease caused by human enterovirus 71, Singapore // Emerg. Infect. Dis. - 2003. - Vol. 9. - P. 78-85.
  16. Chan L. G., Parashar U. D., Lye M. S. et al. Deaths of children during an outbreak of hand, foot, and mouth disease in Sarawak, Malaysia: clinical and pathological characteristics of the disease. For the outbreak study group // Clin. Infect. Dis. - 2000. - Vol. 31. - P. 678-683.
  17. Chan Y. F., Sam I. C., Abubakar S. Phylogenetic designation of enterovirus 71 genotypes and subgenotypes using complete genome sequences // Infect. Genet. Evol. - 2010. - Vol. 10. - P. 404-412.
  18. Chang L. Y., Huang Y. C., Lin T. Y. Fulminant neurogenic pulmonary oedema with hand, foot, and mouth disease // Lancet. - 1998. - Vol. 352. - P. 367-368.
  19. Chang L. Y., Lin T. Y., Hsu K. H. et al. Clinical features and risk factors of pulmonary oedema after enterovirus-71-related hand, foot, and mouth disease // Lancet. - 1999. - Vol. 354. - P. 1682-1686.
  20. Chang L. Y., Lin T. Y., Huang Y. C. et al. Comparison of enterovirus 71 and coxsackie-virus A16 clinical illnesses during the Taiwan enterovirus epidemic, 1998 // Pediatr. Infect. Dis. J. - 1999. - Vol. 18. - P. 1092-1096.
  21. Chang L. Y., King C. C., Hsu K. H. et al. Risk factors of enterovirus 71 infection and associated hand, foot, and mouth disease/herpangina in children during an epidemic in Taiwan // Pediatrics. - 2002. - Vol. 109. - P. e88.
  22. Chang L. Y., Hsia S. H., Wu C. T. et al. Outcome of enterovirus 71 infections with or without stage-based management: 1998 to 2002 // Pediatr. Infect. Dis. J. - 2004. - Vol. 23. - P. 327- 332.
  23. Chang L. Y., Tsao K. C., Hsia S. H. et al. Transmission and clinical features of enterovirus 71 infections in household contacts in Taiwan // J. A. M. A. - 2004. - Vol. 291. - P. 222- 227.
  24. Chang L. Y., Huang L. M., Gau S. S. et al. Neurodevelopment and cognition in children after enterovirus 71 infection // N. Engl. J. Med. - 2007. - Vol. 356. - P. 1226-1234.
  25. Chang L. Y. Clinical manifestations, diagnosis and long-term outcome of EV71 // APEC Conference for the Surveillance, Treatment, Laboratory Diagnostics and Vaccine Development of Enteroviruses. - Taipei, 2009. - III. - P. 2-17.
  26. Chatproedprai S., Theanboonlers A., Korkong S. et al. Clinical and molecular characterization of hand-foot-and-mouth disease in Thailand, 2008-2009 // Jpn J. Infect. Dis. - 2010. - Vol. 63. - P. 229-233.
  27. Chen S. C., Chang H. L., Yan T. R. et al. An eight-year study of epidemiologic features of enterovirus 71 infection in Taiwan // Am. J. Trop. Med. Hyg. - 2007. - Vol. 77. - P. 188-191.
  28. Chinese Center for Disease Control and Prevention. Report on the Hand, Foot and Mouth Disease Outbreak in Fuyang City, Anhui Province and the Prevention and Control in China. - Beijing, 2008. - P. 25.
  29. Chumakov M., Voroshilova M., Shindarov L. et al. Enterovirus 71 isolated from cases of epidemic poliomyelitis-like disease in Bulgaria // Arch. Virol. - 1979. - Vol. 60. - P. 329-340.
  30. Fujimoto T., Chikahira M., Yoshida S. et al. Outbreak of central nervous system disease associated with hand, foot, and mouth disease in Japan during the summer of 2000: detection and molecular epidemiology of enterovirus 71 // Microbiol. and Immunol. - 2002. - Vol. 46. - P. 621-627.
  31. Gau S. S., Chang L. Y., Huang L. M. et al. Attention-deficit/ hyperactivity-related symptoms among children with enterovirus 71 infection of the central nervous system // Pediatrics. - 2008. - Vol. 122. - P. 452-458.
  32. Gear J. H. S. Coxsackie virus infections of the newborn // Progr. Med. Virol. - 1958. - Vol. 1. - P. 106-121.
  33. Hamaguchi T., Fujisawa H., Sakai K. et al. Acute encephalitis caused by intrafamilial transmission of enterovirus 71 in adult // Emerg. Infect. Dis. - 2008. - Vol. 14. - P. 828-830.
  34. Ho M., Chen E. R., Hsu K. H. et al. An epidemic of enterovirus 71 infection in Taiwan. Taiwan Enterovirus Epidemic Working Group // N. Engl. J. Med. - 1999. - Vol. 341. - P. 929-935.
  35. Ho M. Enterovirus 71: the virus, its infections and outbreaks // J. Microbiol. Immunol. Infect. - 2000. - Vol. 33. - P. 205- 216.
  36. Hsia S. H., Wu C. T., Chang J. J. et al. Predictors of unfavorable outcomes in enterovirus 71-related cardiopulmonary failure in children // Pediatr. Infect. Dis. J. - 2005. - Vol. 24. - P. 331-334.
  37. Hsueh C., Jung S. M., Shih S. R. et al. Acute encephalomyelitis during an outbreak of enterovirus type 71 infection in Taiwan: report of an autopsy case with pathologic, immunofluorescence, and molecular studies // Mod. Pathol. - 2000. - Vol. 13. - P. 1200-1205.
  38. Huang C. C., Liu C. C., Chang Y. C. et al. Neurologic complications in children with enterovirus 71 infection // N. Engl. J. Med. - 1999. - Vol. 341. - P. 936-942.
  39. Huang M. C., Wang S. M., Hsu Y. W. et al. Long-term cognitive and motor deficits after enterovirus 71 brainstem encephalitis in children // Pediatrics. - 2006. - Vol. 118. - P. 1785-1788.
  40. Ishimaru Y., Nakano S., Yamaoka K. et al. Outbreaks of hand, foot, and mouth disease by enterovirus 71. High incidence of complication disorders of central nervous system // Arch. Dis. Child. - 1980. - Vol. 55. - P. 583-588.
  41. Jee Y. M., Cheon D. S., Kim K. et al. Genetic analysis of the VP1 region of human enterovirus 71 strains isolated in Korea during 2000 // Arch. Virol. - 2003. - Vol. 148. - P. 1735- 1746.
  42. Kapusinsky B., Szomor K. N., Farkas A. et al. Detection of non-polio enteroviruses in Hungary 2000-2008 and molecular epidemiology of enterovirus 71, coxsackievirus A16, and echovirus 30 // Virus Genes. - 2010. - Vol. 40. - P. 163-173.
  43. Kehle J., Roth B., Metzger C. et al. Molecular characterization of an enterovirus 71 causing neurological disease in Germany // J. Neurovirol. - 2003. - Vol. 9. - P. 125-128.
  44. Komatsu H., Shimizu Y., Takeuch Y. et al. Outbreak of severe neurologic involvement associated with enterovirus 71 infection // Pediatr. Neurol. - 1999. - Vol. 20. - P. 17-23.
  45. Lin T. Y., Chang L. Y., Huang Y. C. et al. Different proinflammatory reactions in fatal and non-fatal enterovirus 71 infections: implications for early recognition and therapy // Acta Paediatr. - 2002. - Vol. 91. - P. 605-632.
  46. Lin T. Y., Hsia S. H., Huang Y. C. et al. Proinflammatory cytokine reactions in enterovirus 71 infections of the central nervous system // Clin. Infect. Dis. - 2003. - Vol. 36. - P. 269- 274.
  47. Liu C. C., Tseng H. W., Wang S. M. et al. An outbreak of enterovirus 71 infection in Taiwan, 1998: epidemiologic and clinical manifestations // J. Clin. Virol. - 2000. - Vol. 17. - P. 23-30.
  48. Lu M., Meng G., He Y. X. et al. Pathology of enterovirus 71 infection: an autopsy study of 5 cases // Zhonghua Bing Li Xue Za Zhi. - 2009. - Vol. 38. - P. 81-85.
  49. Lum L. C., Wong K. T., Lam S. K. et al. Neurogenic pulmonary oedema and enterovirus 71 encephalomyelitis // Lancet. - 1998. - Vol. 352. - P. 1391.
  50. Lum L. C., Wong K. T., Lam S. K. et al. Fatal enterovirus 71 encephalomyelitis // J. Pediatr. - 1998. - Vol. 133. - P. 795-798.
  51. Melnick J. L., Tagaya I., von Magnus H. Enteroviruses 69, 70, and 71 // Intervirology. - 1974. - Vol. 4. - P. 369-370.
  52. Melnick J. L., Schmidt N. J., Mirkovic R. R. et al. Identification of Bulgarian strain 258 of enterovirus 71 // Intervirology. - 1980. - Vol. 12. - P. 297-302.
  53. Melnick J. L. Enterovirus type 71 infections: a varied clinical pattern sometimes mimicking paralytic poliomyelitis // Rev. Infect. Dis. - 1984. - Vol. 6, Suppl. 2. - P. S387-S390.
  54. Nagy G., Takatsy S., Kukan E. et al. Virological diagnosis of enterovirus type 71 infections: experiences gained during an epidemic of acute CNS diseases in Hungary in 1978 // Arch. Virol. - 1982. - Vol. 71. - P. 217-227.
  55. Nolan M. A., Craig M. E., Lahra M. M. et al. Survival after pulmonary edema due to enterovirus 71 encephalitis // Neurology. - 2003. - Vol. 60. - P. 1651-1656.
  56. Ooi M. H., Solomon T., Podin Y. et al. Evaluation of different clinical sample types in diagnosis of human enterovirus 71-associated hand-foot-and-mouth disease // J. Clin. Microbiol. - 2007. - Vol. 45. - P. 1858-1866.
  57. Ooi M. H., Wong S. C., Podin Y. et al. Human enterovirus 71 disease in Sarawak, Malaysia: a prospective clinical, virological, and molecular epidemiological study // Clin. Infect. Dis. - 2007. - Vol. 44. - P. 646-656.
  58. Ooi M. H., Wong S. C., Mohan A. et al. Identification and validation of clinical predictors for the risk of neurological involvement in children with hand, foot, and mouth disease in Sarawak // BMC Infect. Dis. - 2009. - Vol. 9. - P. 1-12.
  59. Ooi M. H., Wong S. C., Lewthwaite H. et al. Clinical features, diagnosis, and management of enterovirus 71 // Lancet Infect. Des. - 2010. - Vol. 9. - P. 1097-1105.
  60. Ortner B., Huang C. W., Schmid D. et al. Epidemiology of enterovirus causing neurological disease in Austria 1999-2007: detection of clusters of echovirus 30 and enterovirus 71 and analysis of prevalent genotypes // J. Med. Virol. - 2009. - Vol. 81. - P. 317-324.
  61. Perez-Velez C. M., Anderson M. S., Robinson C. C. et al. Outbreak of neurologic enterovirus 71 disease: a diagnostic challenge // Clin. Infect. Dis. - 2007. - Vol. 45. - P. 950-957.
  62. Prager P., Nolan M., Andrews I. P. et al. Neurogenic pulmonary edema in enterovirus 71 encephalitis is not uniformly fatal but causes severe morbidity in survivors // Pediatr. Crit. Care Med. - 2003. - Vol. 4. - P. 377-381.
  63. Richter J., Koptides D., Tryfonos C. et al. Molecular typing of enteroviruses associated with viral meningitis in Cyprus, 2000- 2002 // J. Med. Microbiol. - 2008. - Vol. 55. - P. 1035- 1041.
  64. Ryu W. S., Kang B., Hong J. et al. Interovirus 71 infection with central nervous system involvement, South Korea. N 75 // Emerg. Infect. Dis. - 2010. - Vol. 16. - P. 1764-1766.
  65. Sasidharan C. K., Sugathan P., Agarwal P. et al. Hand-foot-and-mouth disease in Calcut // Indian J. Pediatr. - 2005. - Vol. 72. - P. 17-21.
  66. Sato C., Syoji M., Ueki Y. et al. Isolation of enterovirus 71 from patients with hand, foot and mouth disease in a local epidemic on march 2006, in Miyagi prefecture, Japan // Jpn J. Infect. Dis. - 2006. - Vol. 59. - P. 348.
  67. Schmidt N. J., Lennette E. H., Ho H. H. An apparently new enterovirus isolated from patients with disease of the central nervous system // J. Infect. Dis. - 1974. - Vol. 129. - P. 304- 309.
  68. Schuffenecker I., Mirand A., Antona D. et al. Epidemiology of human enterovirus infections in France, 2000-2009 // J. Clin. Virol. - 2011. - Vol. 50. - P. 50-56.
  69. Shah V. A., Chong C. Y., Chan K. P. et al. Clinical characteristics of an outbreak of hand, foot and mouth disease in Singapore // Ann. Acad. Med. Singapore. - 2003. - Vol. 32. - P. 381-387.
  70. Shindarov L., Chumakov M., Voroshilova M. et al. A polio-like disease in Bulgaria associated with enterovirus 71 // VII International Congress of Infectious and Parasitic Diseases. - Varna, 1978. - P. 371-375.
  71. Shindarov L., Kamenov E., Staikov S. et al. Epidemiological study of a polio-like disease // VII International Congress of Infectious and Parasitic Diseases. - Varna, 1978. - P. 381- 384.
  72. Shindarov L., Chumakov M. P., Voroshilova M. et al. Epidemiological, clinical, and pathological characteristics of epidemic poliomyelitis-like disease caused by enterovirus 71 // J. Hyg. Epidemiol. Microbiol. Immunol. - 1979. - Vol. 23. - P. 284-295.
  73. Silva E. E., Winkler M., Pallansch M. Role of enterovirus 71 in acute flaccid paralysis aftere the eradication of poliovirus in Brasil // Emerg. Infect. Dis. - 1996. - Vol. 2. - P. 231-233.
  74. Singh S., Chow V. T., Phoon M. C. et al. Direct detection of enterovirus 71 (EV71) in clinical specimens from a hand, foot, and mouth disease outbreak in Singapore by reverse transcription-PCR with universal enterovirus and EV71-specific primers // J. Clin. Microbiol. - 2002. - Vol. 40. - P. 2823-2827.
  75. Solomon T., Willison H. Infectious causes of acute flaccid paralysis // Curr. Opin. Infect. Dis. - 2003. - Vol. 16. - P. 375-381.
  76. Solomon T., Lewthwaite P., Perrera D. et al. Virology, epidemiology, pathogeness, and control of enterovirus 71 // Lancet. Infect. Dis. - 2010. - Vol. 10. - P. 778-790.
  77. Spekhar K., Lye M. S., Norlijah O. et al. Death in children during outbreak of hand, foot and mouth disease in Peninsular Malaysia - clinical and pathological characteristics // Med. J. Malaysia. - 2005. - Vol. 60. - P. 297-304.
  78. Tagaya I., Takayama R., Nagivara A. A large scale epidemic of hand, foot and mouth disease associated with enterovirus infection in Japan in 1978 // Jpn J. Med. Sci. Biol. - 1981. - Vol. 34. - P. 191-196.
  79. Takimoto S., Waldman E. A., Moreira R. C. et al. Enterovirus 71 infection and acute neurological disease among children in Brazil (1988-1990) // Trans. Roy. Soc. Trop. Med. Hyg. - 1998. - Vol. 92. - P. 25-28.
  80. Tu P. V., Thao N. T., Perera D. et al. Epidemiologic and virologic investigation of hand, foot, and mouth disease, Southern Vietnam, 2005 // Emerg. Infect. Dis. - 2007. - Vol. 13. - P. 1733-1741.
  81. Vallet S., Legrand Q. M., Dailland T. et al. Fatal case of enterovirus 71 infection, France, 2007 // Emerg. Infect. Dis. - 2009. - Vol. 15. - P. 1837-1840.
  82. Van der Sanden S., Koopmans M., Uslu G. et al. Epidemiology of enterovirus 71 in the Netherlands, 1963 to 2008 // J. Clin. Microbiol. - 2009. - Vol. 47. - P. 2826-2830.
  83. Wang J. N., Yao C. T., Yeh C. N. et al. Clinical management in patients with severe enterovirus 71 infection // Pediatr. Int. - 2006. - Vol. 48. - P. 250-256.
  84. Wang J. R., Tsai H. P., Chen P. F. et al. An outbreak of enterovirus 71 infection in Taiwan, 1998. II. Laboratory diagnosis and genetic analysis // J. Clin. Virol. - 2000. - Vol. 17. - P. 91-99.
  85. Wang J. R., Tuan Y. C., Tsai H. P. et al. Change of major genotype of enterovirus 71 in outbreaks of hand-foot-and-mouth disease in Taiwan between 1998 and 2000 // J. Clin. Microbiol. - 2002. - Vol. 40. - P. 10-15.
  86. Wang S. M., Liu C. C., Tseng H. W. et al. Clinical spectrum of enterovirus 71 infection in children in Southern Taiwan, with an emphasis on neurological complications // Clin. Infect. Dis. - 1999. - Vol. 29. - P. 184-190.
  87. Wang S. M., Lei H. Y., Huang K. J. et al. Pathogenesis of enterovirus 71 brainstem encephalitis in pediatric patients: roles of cytokines and cellular immune activation in patients with pulmonary edema // J. Infect. Dis. - 2003. - Vol. 188. - P. 564-570.
  88. Wang S. M., Lei H. Y., Huang M. C. et al. Modulation of cytokine production by intravenous immunoglobulin in patients with enterovirus 71-qassociated brainstem encephalitis // J. Clin. Virol. - 2006. - Vol. 37. - P. 47-52.
  89. Wang S. M., Ho T. S., Shen C. F. et al. Enterovirus 71, one virus and many stories // Pediatr. Neonatol. - 2008. - Vol. 49. - P. 113-115.
  90. Welch J., Macklaran K., Jordan T. et al. Frequency, viral loads, and serotype identification of enterovirus infections in Scottish blood donors // Transfusion. - 2003. - Vol. 43. - P. 1060- 1066.
  91. WHO. Outbreak of hand, foot and mouth disease in Sarawak // Wkly Epidemiol. Rec. - 1997. - Vol. 28. - P. 211.
  92. Witso E., Palacios G., Ronningen K. S. et al. Asymptomatic circulation of HEV71 in Norway // Virus Res. - 2007. - Vol. 123. - P. 19-29.
  93. Xiao D. L. Strategy of prevention and control for HFMD in China // APEC Conference for the Surveillance, Treatment, Laboratory Diagnostics and Vaccine Development of Enteroviruses. - Taipei, 2009. - P. II-1-3.
  94. Yan J. J., Wang J. R., Liu C. C. et al. An outbreak of enterovirus 71 infection in Taiwan 1998: a comprehensive pathological, virological, and molecular study on a case of fulminant encephalitis // J. Clin. Virol. - 2000. - Vol. 17. - P. 13-22.
  95. Yang F., Ren L., Xiong Z. et al. Enterovirus 71 outbreak in the People Republic of China in 2008 // J. Clin. Microbiol. - 2009. - Vol. 47. - P. 2351-2352.
  96. Zhang Y., Tan X. J., Wang H. Y. et al. An outbreak of hand, foot, and mouth disease associated with subgenotype C4 of human enterovirus 71 in Shandong, China // J. Clin. Virol. - 2009. - Vol. 44. - P. 262-267.
  97. Zhu R. N., Qian Y., Deng J. et al. Study on the association of hand, foot and mouth disease and enterovirus 71/CA16 among children in Beijing, 2007 // Zhonghua Liu Xing Bing Xue Za Zhi. - 2007. - Vol. 28. - P. 1004-1008.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2011 Eco-vector


СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: № 014448 от 08.02.1996. 
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ЭЛ № ФС 77 - 80652 от 15.03.2021 .


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies