During December 17 and 23, 2017, the Taiwan Centers for Disease Control (Taiwan CDC) confirmed 5 new cases of enterovirus infection with severe complications.　In light of the increasing number of cases of enterovirus infection with severe complications reported and the majority of these new cases are infected with enterovirus D68, Taiwan CDC invited the Pediatric Neurology professor from the Fu Jen Catholic University College of Medicine who is also Taiwan CDC’s Acute Flaccid Paralysis Surveillance Expert Northern Region Convener to discuss the symptoms induced by enterovirus D68, including acute flaccid paralysis and numbness, and urge parents to pay attention to the health of the children in their households and take the children to hospitals immediately when suspected symptoms develop.

Professor Hung Kun-long (洪焜隆) pointed out unlike the common symptoms of enterovirus infection such as hand, foot and mouth disease (HFMD) and herpangina, the primary symptoms of enterovirus D68 infection include the symptoms of the upper respiratory tract infection such as fever, runny nose, and cough. A few infected individuals may develop complications such as encephalitis and myelitis. However, once limb weakness or numbness develops, patients might develop permanent sequelae that will require extensive physical therapy. Professor Hung reminded the public that as there is no effective vaccine to prevent or drug to treat the infection, the most effective ways to prevent infection are to wash hands properly and frequently with soap and water and practice good personal hygiene. If a child in the household develops flaccid paralysis, he/she needs to be taken to a large hospital for treatment as soon as possible.

The 5 new cases of enterovirus infection with severe complications confirmed last week are respectively caused by enterovirus D68 (2 cases), CA9 (2 cases), and EV71 (1 case). 　　Among them, the 2 cases caused by enterovirus D68 respectively are a 4-year-old boy who resides in northern Taiwan and 5-year-old boy who resides in southern Taiwan. Both of them developed symptoms, including cough, runny nose, fever and sudden onset of limb weakness in early December. As of now, both of them are still hospitalized for treatment. The cases caused by CA9 respectively are a 5-year-old girl and a 3-year-old boy who reside in northern Taiwan. Both of them developed symptoms, including fever, vomiting, gait abnormality, limb weakness and encephalitis in early December and their infections were laboratory confirmed. As of now, both of them have recovered and been discharged from the hospital. The case caused by EV71 is a 13-year-old boy who resides in southern Taiwan. He developed symptoms, including fever, oral ulcer, sore throat, nausea, dizziness, general weakness and gait abnormality in early December and his infection was laboratory confirmed. As of now, the case’s conditions have been improved and he has been discharged from the hospital.

Thus far this year, 20 cases of enterovirus infection with severe complications, including 1 death, respectively caused by enterovirus D68 (8 cases), CA 6 (3 cases), CB3 (2 cases), CA9 (2cases), echovirus 5 (2 cases), enterovirus 71 (2 cases), and CA 2 (1 case) have been confirmed.

All enteroviruses are transmitted through the fecal-oral route, respiratory droplets and direct contact. The most effective ways to ward off enteroviruses are to practice good hand hygiene and cough etiquette, avoid visiting crowded public places, and rest at home when sick. When a child in a household develops symptoms of complications such as drowsiness, disturbed consciousness, inactivity, flaccid paralysis, myoclonic jerk, continuous vomiting, tachypnea, and tachycardia, please take the child to a large hospital for medical attention immediately in order to ensure prompt 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).