On June 12, 2015, the Taiwan Centers for Disease Control (Taiwan CDC) announced the second death from severe enterovirus infection in a newborn boy who resided in northern Taiwan. Infection with Coxsackie A16 virus was confirmed in the case. As the enterovirus activity has peaked, Taiwan CDC stresses that infants and children aged below 5 are at increased risk of developing enterovirus infection with severe complications. Taiwan CDC also urges expectant mothers to pay attention to their health and the health of their babies, wash hands frequently and wear a facemask when necessary to ward off infection. In addition, 14 days before and after delivery, if symptoms such as fever, upper respiratory tract infection, diarrhea, and pleurodynia develop, please be sure to inform the physician and refrain from contact with infants and children to prevent passing on the infection to them.

The case developed diffuse intravascular coagulation (DIC), pulmonary edema, pulmonary hemorrhage, multi-organ failure, and low platelet count right after birth. Despite administering emergency treatment, the case died two hours later. Infection with Coxsackie A16 virus was confirmed in the case. According to the epidemiological investigation, the case’s mother sought medical attention when she experienced cough and phlegm prior to childbirth. Taiwan CDC reminds the public that the majority of infected adults become a potential source of infection when they experience no or influenza-like symptoms that are not easily discernible from common cold and further transmission is thus not prevented. Hence, besides maintaining hand hygiene and wearing a mask when symptoms developed, the public is also urged to clean and disinfect the environment and toys and objects children play with regularly and educate children the importance of cleanliness in maintaining health in order to prevent disease transmission.

According to surveillance data collected by Taiwan CDC, the ER consultation rate for enterovirus infection during Week 22 (7.73‰) is 29.5% higher than that during the previous week (5.97‰). At the moment, the ER consultation rate for enterovirus infection is higher than the epidemic threshold (4.35‰). During Week 20, Coxsackie A virus is the dominant strain circulating in the community. As of June 12, a cumulative total of 3 severe cases of enterovirus infection were confirmed, including two caused by CB 5 virus (one recovered and one died) and one caused by CA 16 virus (died). During the same period in 2010 and 2014, the cumulative numbers of enterovirus infection cases respectively are 13, 0, 78, 4 and 4. During the same period in the same years, the numbers of deaths are 0, 0, 1, 0 and 0.

Physicians are urged to watch for the development of suspected symptoms in patients, including drowsiness, disturbed consciousness, inactivity, flaccid paralysis, myoclonic jerk, continuous vomiting, tachypnea, and tachycardia. Once such symptoms develop, the patient needs to be immediately sent to a large hospital 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 Care Hotline, 1922 (or 0800-001922).