On October 21, 2014, the Taiwan Centers for Disease Control (Taiwan CDC) announced a new case of coxsackie B5 infection with severe complications in a newborn. The case is a newborn boy who resides in northern Taiwan. On October 2, which was 7 days after he was born, he developed fever, thrombocytopenia, blood coagulation disorder, hepatitis, and myocarditis. After being treated in the intensive care unit for five days, the case became stable and has been discharged from the hospital. Hence, Taiwan CDC advises expectant mothers and households with infants and children to take measures to ward off infection, including washing hands thoroughly with soap and maintaining personal hygiene.

Since 2003, coxsackie B virus is the most common cause of enterovirus infection with severe complications in newborns, followed by echovirus. Coxsackie B3 virus is the most common strain among cases of coxsackie B virus infection, making up 85% of the cases, while only one case was infected with coxsackie B5 virus. Most people who become infected coxsackie B virus experience mild symptoms and they can recover on their own without treatment. However, when newborns become infected with coxsackie B virus, they might develop myocarditis, hepatitis, encephalitis, disseminated intravascular coagulation, and multiorgan dysfunction, which may lead to death.

According to Taiwan CDC’s surveillance data, coxsackie A virus is currently the dominant virus strain circulating in the community. In the past, enterovirus 71 used to be the primary virus causing severe complications and deaths associated with enterovirus infection. Thus far this year, enterovirus 71 is comparatively less active. As of October 15, a cumulative total of 6 cases of enterovirus infection with severe complications have been confirmed, including 1 case of CA2, 1 case of CA5, 1 case of CA16 and 1 case of CB5, 1 case of EV71 and 1 case of Echo 11 in a newborn that died. Although the enterovirus season has passed, Taiwan CDC continues to closely monitor the activity of various enteroviruses to prevent the occurrence of an outbreak.

Taiwan CDC reminds that eneterovirus can be transmitted to the newborn during delivery via infected maternal secretions. Hence, expectant mothers are urged to pay attention to their health and the health of other children residing in the same household 14 days prior to delivery. If symptoms such as fever, upper respiratory infection, diarrhea, and pleurodynia develop, please inform the doctor. Appropriate isolation measures must be implemented accordingly to keep the newborn from becoming infected. On the other hand, physicians are urged to pay attention to the health of newborns and enhance the implementation of infection control and prevention in the newborn baby nursery. Taiwan CDC once again urges both adults and children to develop good personal hygiene habits such as washing hands properly, seeking medical attention immediately when sick, and resting at home when sick in order to reduce the risk of disease transmission.

Taiwan CDC once again stresses that infants and children aged below 5 are at increased risk of developing enterovirus infection with severe complications. Taiwan CDC also warns 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 pay close attention to the symptoms of the sick child. Once the sick child develops suspected symptoms such as persistent fever, drowsiness, disturbed consciousness, inactivity, flaccid paralysis, myoclonic jerk, continuous vomiting, tachypnea, and tachycardia, please take the child to a large hospital immediately in order to ensure prompt treatment. For more information on enterovirus, please visit the Taiwan CDC’s website at http://www.cdc.gov.tw or call the toll-free Communicable Disease Reporting and Care Hotline, 1922, or 0800-001922 if calling from a cell phone.