On June 19, 2018, the Taiwan Centers for Disease Control (Taiwan CDC) announced 1 new death associated echovirus 11 infection with severe complications in a newborn baby. As enterovirus season has arrived, Taiwan CDC once again urges childcare givers to practice hand hygiene (wash hands with soap and water frequently), avoid contact with infants and children when they develop symptoms, and ensure timely diagnosis and treatment of any infants and children with suspected symptoms at a healthcare facility.

The new death was confirmed in a newborn baby boy born in eastern Taiwan. He was hospitalized in the neonatal intensive care unit due to fever 9 days after birth. Subsequently, he experienced fast heartbeat, inactivity, and weakness in limbs. Although timely treatment was administered by the hospital, the case unfortunately passed away one week after developing symptoms due to multiple organ failure and neonatal sepsis. Infection with echovirus 11 and severe complications were laboratory confirmed in the case. According to the epidemiological investigation, the case had stayed in the hospital following his birth. No suspected cases of enterovirus infection had been reported in the hospital. In addition, his contacts, including his parents and healthcare personnel, had not developed suspected symptoms. Hence, it was determined that the case might have acquire his infection from an asymptomatic carrier.

According to the surveillance data compiled by Taiwan CDC, during June 17 and 23, 2018, the number of visits to outpatient services and ER for enterovirus infection in the nation was 11,510, which is 8.5% lower than that the week before. Nevertheless, the number of outpatient visits might have been underestimated due to the long weekend holiday when many clinics were close. Thus far this year, a cumulative total of 16 enterovirus cases with severe complications, including 3 deaths, have been confirmed. Among the 16 cases, 6 are caused by echovirus 11, 2 are caused by coxsackievirus A4, 2 are caused by coxsackievirus B1, 2 are caused by enterovirus 71, 1 is caused by coxsackievirus A9,1 is caused by coxsackievirus A16, 1 is caused by coxsackievirus B2, and 1 is caused by coxsakcievirus B3. During the recent 4 weeks, echovirus 11 is the dominant strain circulating in the community. Moreover, 29 sporadic cases of enterovirus 71 have been confirmed this year, indicating that enterovirus 71 continues to occur in the community.

Newborns can acquire enterovirus infection either during delivery from their mothers or contact with infected individuals after birth. Commonly, babies develop symptom some time between right after birth till 14 days after birth. Some experience mild symptoms like fever, inactivity, and loss of appetite. While others experience more severe symptoms of complications such as encephalitis, pneumonia, and even multiple organ failure. Expectant mothers are advised to pay attention to hand and respiratory hygiene during pregnancy. If symptoms pertaining to enterovirus infection such as fever, upper respiratory infection, diarrhea, and rib pain develop 14 days prior to and after delivery, please be sure to inform the physician to facilitate diagnosis and treatment. Adults in the household that come into frequent contact with children are urged to wash hands with soap and water frequently and avoid contact with newborns if they have symptoms in order to lower the risk of transmission.

Healthcare facilities and postpartum nursing care homes are urged to thoroughly implement infection control measures in order to reduce the risk of infection among newborn babies. In addition, operators running childcare facilities and public places frequented by children are also urged to maintain good indoor ventilation and conduct periodic disinfection of the places. For more information, please visit the Taiwan CDC website at https://www.cdc.gov.tw or call the toll-free Communicable Disease Reporting and Consultation Hotline, 1922 (or 0800-001922).