On June 27, 2017, the Taiwan Centers for Disease Control (Taiwan CDC) announced two new cases of enterovirus infection with severe complications in one baby girl who resides in southern Taiwan and one baby boy who resides in northern Taiwan. Both of them are below the age of 2 and they respectively developed symptoms on June 6 and 11.　 They sought medical attention after developing fever and myoclonic jerks. After the hospital collected specimens from the cases for laboratory testing and reported the cases to the health authority as suspected cases, infection with echovirus 5 with severe complications was confirmed in the baby girl and infection with CA 6 with severe complications was confirmed in the baby boy. Fortunately, both cases have recovered after receiving treatment. As of now, they are in good health.

According to the epidemiological investigation, the baby girl is care for by her family. Among the family members who reside in the same household with the case, her 6-year-old sister developed fever on the same day as the case. The sister has recovered after seeking medical attention. None of the students attending the same kindergarten as the case’s sister has developed suspected symptoms. On the other hand, the baby boy’s primary areas of daily activity include his house and the day care center. Prior to the case’s disease onset, his mother developed cold symptoms. Hence, it cannot be determined whether the baby boy acquired infection at home or at the day care center. During June 12 and 13, the day care center reported 3 confirmed enterovirus cases, including the baby boy. In addition, during June 13 and 20, the day care center suspended classes. The local health authority has provided the cases’ family members with relevant health education and taught them methods to disinfect the environment.

According to the surveillance data compiled by Taiwan CDC, during June 18 and 24, 2017, the number of visits to outpatient services and ER for enterovirus infection in the nation was 9,045, which is close to the epidemic threshold (11,000). As of June 27, 2017, thus far this year, a total of 20 sporadic cases of EV71 infection have been confirmed in Taiwan, indicating that EV71 is currently circulating in the community. Nevertheless, all the cases are mild cases. Coxsackie A virus is currently the dominant strain circulating in the community. So far this year, 4 cases of enterovirus infection with severe complications respectively caused by CA 6 (2 cases), CA 2 (1 case), and echovirus 5 (1 case) have been confirmed. Last year, a cumulative total of 33 cases of enterovirus infection with severe complications were confirmed, including 23 caused by EV 71 (1 died), 2 caused by CA 4, 2 caused by CA 6, 2 caused by CB 3, 1 caused by CA 2, 1 caused by CA 5, 1 caused by CB 4 and 1 caused by echovirus 18. An increasing level of hand, foot and mouth disease (HFMD) activity has been observed in the adjacent countries, including China, Korea, Japan, Thailand, Hong Kong and Vietnam. Among them, Japan and Vietnam have both reported a higher number of cases this year compared to the same period last year. Enterovirus 71 is the dominant strain circulating in China, accounting for approximately 50% of the reported enterovirus cases in the country.

Taiwan CDC once again reminds that enterovirus found in the gastrointestinal tract and the respiratory tract is highly contagious. Infection can occur through contact with blisters on the skin of and discharges from infected individuals. Hence, frequent handwashing with soap and water is the most effective way to ward off infection. Adults returning home from work are advised to change clothes and wash hands with soap and water before coming into contact with children. Additionally, as the summer vacation is fast approaching, please make sure children wash their hands with soap and water thoroughly when returning home from visiting crowded places and before having their meals in order to prevent infection.

In addition, Taiwan CDC stresses that as enterovirus infection progresses fast, children below the age of 5 are at increased risk of developing severe infection. When a child in a household is diagnosed with enterovirus infection, parents and child caregivers are urged to refrain the sick child from close contact with other children to prevent further spread of the disease and watch for the development of prodromal symptoms of complications in the sick child such as drowsiness, disturbed consciousness, inactivity, flaccid paralysis, myoclonic jerk, continuous vomiting, tachypnea, and tachycardia to ensure timely treatment. For more information, please visit the Taiwan CDC website at http://www.cdc.gov.tw or call the toll-free Communicable Disease Reporting and Consultation Hotline, 1922 (or 0800-001922).