Lu Chun-Yi, Lee Chin-Yun, Kao Chuan-Liang, Shao Wen-Yi, Lee Ping-Ing, Twu Shiing-Jer, Yeh Chin-Chuan, Lin Shang-Ching, Shih Wen-Yi, Wu Shiow-Ing, Huang Li-Min
Department of Pediatrics, National Taiwan University Hospital, Taiwan.
J Med Virol. 2002 Jun;67(2):217-23. doi: 10.1002/jmv.2210.
In 1998, an epidemic of hand-foot-and-mouth disease and herpangina caused by enterovirus 71 occurred in Taiwan, leaving many fatalities and severely handicapped survivors in its wake. The reasons this rather common pathogen would cause such a large-scale epidemic remain unknown. A seroepidemiological survey to elucidate the epidemiological characteristics of this outbreak, including its incidence and case-fatality rates was undertaken. Microneutralization tests for antibodies against enterovirus 71 were used to screen four collections of serum samples: 1) 202 specimens taken from individuals > or = 4 years old in 1994; 2) 245 specimens collected from individuals of all ages in 1997; 3) 1,258 specimens collected from individuals of all ages in 1999; and 4) sera samples from a birth cohort of 81 children who had yearly blood samples taken from 1988-98. After the maternal antibody had declined, the seropositive rates began to increase with age. Approximately half of all children aged 6 years or older were enterovirus 71 seropositive. Significantly higher seropositive rates were noted in 1999 than in 1997, in children aged 0.5-3 years. The incidence of enterovirus 71 infection during the epidemic was estimated to be 13-22%, with the higher rates in younger children. The case-fatality rate was highest (96.96 per 100,000) in infants aged 6-11 months, and declined in older children. The results showed that enterovirus 71 is endemic in Taiwan. The apparent lack of large-scale enterovirus 71 activity in the 3 years before 1998 might have been the prelude to the epidemic's appearance in 1998, and might suggest that enterovirus 71 infection will reappear every few years. The lack of a protective antibody in younger children may account for the high incidence and case-fatality rate in this age group.
1998年，台湾地区发生了由肠道病毒71型引起的手足口病和疱疹性咽峡炎疫情，导致许多人死亡，并留下了许多严重残疾的幸存者。这种相当常见的病原体引发如此大规模疫情的原因仍然不明。为此开展了一项血清流行病学调查，以阐明此次疫情的流行病学特征，包括发病率和病死率。采用针对肠道病毒71型抗体的微量中和试验，对四组血清样本进行了筛查：1）1994年从4岁及以上个体采集的202份标本；2）1997年从各年龄段个体采集的245份标本；3）1999年从各年龄段个体采集的1258份标本；4）1988 - 1998年每年采集血样的81名儿童出生队列的血清样本。母体抗体下降后，血清阳性率开始随年龄增长而上升。6岁及以上儿童中约有一半肠道病毒71血清呈阳性。在0.5 - 3岁儿童中，1999年的血清阳性率显著高于1997年。据估计，疫情期间肠道病毒71型感染的发病率为13% - 22%，年龄较小的儿童发病率较高。6 - 11个月龄婴儿的病死率最高（每10万人中96.96例），且随年龄增长而下降。结果表明肠道病毒71型在台湾地区呈地方性流行。1998年前3年明显缺乏大规模的肠道病毒71型活动，可能是1998年疫情出现的前奏，这可能表明肠道病毒71型感染每隔几年就会再次出现。幼儿缺乏保护性抗体可能是该年龄组发病率和病死率高的原因。
