On June 19, 2018, the Taiwan Centers for Disease Control (Taiwan CDC) announced 3 new cases of enterovirus infection with severe complications in a 5-year-old boy and a 4-year-old girl who reside in northern Taiwan, and a 3-year-old boy who resides in central Taiwan. Among them, the 2 cases residing in northern Taiwan are currently in stable condition. One of them is still hospitalized for observation, while the other case has been discharged. In addition, the case residing in central Taiwan has been discharged from the hospital after receiving treatment and recovery.

According to the epidemiological investigation, the 5-year-old boy who resides in northern Taiwan sought medical attention in early June after developing fever and headache. Subsequently, he sought further medical attention and was hospitalized after developing weakness in lower limbs. Infection with coxsackievirus A9 and severe complications were laboratory confirmed in the case. The 4-year-old girl who resides in northern Taiwan sought medical attention and was hospitalized after subsequently developing upper respiratory infection symptoms, including fever and cough with mucus, in early May. Afterwards, she began to develop vomiting, lethargy, and weakness in lower limbs in late May. Infection with echovirus 11 and severe complications were laboratory confirmed in the case. The 3-year-old boy who resides in central Taiwan sought medical attention in end of May and early June after developing muscle ache in lower limbs and unsteady gait, and he was then hospitalized for treatment, Infection with coxsackievirus A4 and severe complications were laboratory confirmed in the case. Based on the epidemiological investigation, it was speculated that both the 5-year-old boy who resides in northern Taiwan and the 3-year-old boy who resides in central Taiwan acquired their infection through contact with an asymptomatic carrier. As of now, none of their family members residing in the same household and their kindergarten teachers and fellow schoolmates has developed suspected symptoms. On the other hand, none of the family members residing in the same household with the 4-year-old girl who resides in northern Taiwan has developed suspected symptoms. However, there is an ongoing echovirus outbreak in the community where the girl resides. Hence, it is speculated that the girl acquired infection from the community.

According to the surveillance data compiled by Taiwan CDC, during June 10 and 16, 2018, the number of visits to outpatient services and ER for enterovirus infection in the nation was 12,553, which is 4.6% higher than that the week before. Thus far this year, a cumulative total of 15 enterovirus cases with severe complications, including 2 deaths, have been confirmed. Among the 15 cases, 5 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, coxsackievirus A is the dominant strain circulating in the community. However, the number of specimens tested positive for echovirus 11 has been recently on the rise. In addition, 25 sporadic cases of enterovirus 71 have been confirmed this year, indicating that enterovirus 71 continues to occur in the community. Taiwan CDC will continue to monitor the ongoing outbreak and enterovirus activity.

Taiwan CDC once again reminds that enterovirus is highly contagious and washing hands with soap and water frequently is the most effective way to ward off infection. Children below the age of 5 are at increased risk of developing severe infection. If a child develops prodromal symptoms of complications such as flaccid paralysis, limb weakness, drowsiness, disturbed consciousness, inactivity, myoclonic jerk, continuous vomiting, tachypnea, and tachycardia, please ensure the child receive medical assistance at a large hospital as soon as possible. Infected adults often do not develop obvious symptoms and are likely to pass on the infection to the children residing in the same household. Hence, adults are advised to change clothes and wash hands with soap and water after returning home and before hugging and feeding infants and children. 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).