On September 20, 2016, the Taiwan Centers for Disease Control (Taiwan CDC) announced this year’s first death from severe enterovirus infection in a two-year-old girl who resided in northern Taiwan. The case has been re-evaluated by external pediatricians and the cause of death has been confirmed to be associated with severe enterovirus infection. An expert meeting will be recently convened to discuss the case’s cause of death and future outbreak preparedness and response efforts. In view of the fact that the overall enterovirus activity remains at a plateau and there are no signs of large-scale EV71 outbreaks, there is currently no need for upscaling the existing prevention and control efforts. Nonetheless, Taiwan CDC will remain vigilant for enterovirus and continue to closely monitor enterovirus activity.

The case had incomplete brain development and a medical history of right-sided hemiparesis and development delay. Since the end of August, the case subsequently developed symptoms, including upper respiratory tract infection and middle ear infection in both ears. In the night of September 6, she developed high fever and blisters on the soft palate. After seeking medical attention, she was diagnosed with herpangina. On September 9, when she developed spasm, unconsciousness, and foaming at the mouth, she was hospitalized for treatment in the intensive care unit. Infection with EV 71 was laboratory confirmed in the case after the hospital reported the case to the health authority. However, the case’s conditions did not improve and she remained in shock, experiencing low body temperature, low blood pressure and multiple organ dysfunction. Unfortunately, on September 12, she died of heart and lung failure and sepsis.

According to the surveillance data compiled by Taiwan CDC, enterovirus activity in Taiwan has recently increased and coxsackie A virus is currently the dominant strains circulating in the community. During Week 37 (September 11 and 17, 2016), the number of visits to outpatient services and ER for enterovirus infection in the nation was 7,295, which is 4.6% up from 6,977 reported during the previous week. As of September 20, a total of 21 severe cases of enterovirus infection have been confirmed, including 20 caused by EV 71 and 1 caused by CA 5. During the same period in 2011 and 2015, a cumulative total of 11, 146, 8, 5, and 4 severe cases of enterovirus infection were respectively confirmed and a cumulative total of 3, 2, 1, 1, and 2 deaths were respectively confirmed.

Taiwan CDC reminds that although fall is upon us, enterovirus remains highly contagious, especially in crowded places such as households and child care facilities. Therefore, childcare center personnel and parents are advised to pay attention to their health and the health of infants and children they care for. 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 severe enterovirus infection in the sick child such as drowsiness, disturbed consciousness, inactivity, flaccid paralysis, myoclonic jerk, continuous vomiting, tachypnea, and tachycardia to ensure timely treatment. On the other hand, local governments are urged to reinforce the surveillance of enterovirus outbreaks in the child care facilities in their jurisdiction and promptly provide appropriate guidance to prevent further transmission. 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).