On May 16, 2017, the Taiwan Centers for Disease Control (Taiwan CDC) announced one new case of enterovirus infection with severe complications in a 5-year-old boy who resides in northern Taiwan. On April 23, the case sought medical attention after developing fever. On April 25, when his symptoms persisted, he sought further medical attention and was hospitalized. Subsequently, when he developed frequent muscle twitching, blisters on the bottom of his feet, rashes on limbs, inactivity, loss of appetite, and rapid heartbeat, he was transferred to another hospital for further medical attention. After the hospital collected specimens from the case for laboratory testing and reported the case to the health authority as a suspected case, infection with CA 6 was confirmed in the case. After treatment, the case has recovered and been discharged from the hospital. Currently, the case is in good health.

According to the epidemiological investigation, among the contacts who reside in the same household with the case, only his 9-year-old sister was hospitalized after developing fever and cough and was diagnosed with pneumonia in late April. As of now, the sister has recovered. None of the other contacts have developed suspected symptoms.　 Hence, it was determined that he might have become infected through contact with an asymptomatic carrier. The local health authority has provided the case’s family members with relevant health education and taught them methods to disinfect the environment.

According to the surveillance data compiled by Taiwan CDC, during May 7 and 13, 2017, the number of visits to outpatient services and ER for enterovirus infection in the nation was 3,822, which is still low. As of May 15, 2017, thus far this year, a total of 17 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, 2 cases of enterovirus infection with severe complications respectively caused by CA 2 and CA 6 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.

Recently, China has reported an increasing level of hand, foot and mouth disease (HFMD) activity though the numbers of cases, severe cases and deaths are lowered by 40% compared to the same period last year. Enterovirus 71 is the dominant strain circulating in China. Further, HFMD activity has reached a peak in Beijing City. Among neighboring countries, HFMD activity in Singapore remains at a plateau, while HFMD activities in Japan, Korea, Hong Kong and Thailand remains at a relatively low level. Only Thailand has reported a higher cumulative number of cases this year compared to the same period last year.

Taiwan CDC once again reminds that enterovirus found in the gastrointestinal tract and the respiratory tract is highly contagious, especially in crowded places such as households and child care facilities. Infection can occur through contact with blisters on the skin of and discharges from infected individuals. In addition, children below the age of 5 are at increased risk of developing severe infection. Some patients develop merely mild cold-like symptoms after becoming infected, which are indiscernible and could become potential sources of infection. Hence, adults returning home from work are advised to change clothes and wash hands with soap and water before coming into contact with children. Additionally, please make sure children wash their hands with soap and water thoroughly when returning home and before having their meals in order to prevent infection.

Taiwan CDC stresses that as enterovirus infection progresses fast, 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).