McMinn Peter C
Division of Virology, TVW Telethon Institute for Child Health Research, 100 Roberts Road, Subiaco, WA 6008, Australia.
FEMS Microbiol Rev. 2002 Mar;26(1):91-107. doi: 10.1111/j.1574-6976.2002.tb00601.x.
Since its discovery in 1969, enterovirus 71 (EV71) has been recognised as a frequent cause of epidemics of hand-foot-and-mouth disease (HFMD) associated with severe neurological sequelae in a small proportion of cases. There has been a significant increase in EV71 epidemic activity throughout the Asia-Pacific region since 1997. Recent HFMD epidemics in this region have been associated with a severe form of brainstem encephalitis associated with pulmonary oedema and high case-fatality rates. The emergence of large-scale epidemic activity in the Asia-Pacific region has been associated with the circulation of three genetic lineages that appear to be undergoing rapid evolutionary change. Two of these lineages (B3 and B4) have not been described previously and appear to have arisen from an endemic focus in equatorial Asia, which has served as a source of virus for HFMD epidemics in Malaysia, Singapore and Australia. The third lineage (C2) has previously been identified [Brown, B.A. et al. (1999) J. Virol. 73, 9969-9975] and was primarily responsible for the large HFMD epidemic in Taiwan during 1998. As EV71 appears not to be susceptible to newly developed antiviral agents and a vaccine is not currently available, control of EV71 epidemics through high-level surveillance and public health intervention needs to be maintained and extended throughout the Asia-Pacific region. Future research should focus on (1) understanding the molecular genetics of EV71 virulence, (2) identification of the receptor(s) for EV71, (3) development of antiviral agents to ameliorate the severity of neurological disease and (4) vaccine development to control epidemics. Following the successful experience of the poliomyelitis control programme, it may be possible to control EV71 epidemics if an effective live-attenuated vaccine is developed.
自1969年发现肠道病毒71型（EV71）以来，它一直被认为是手足口病（HFMD）流行的常见病因，在少数病例中会伴有严重的神经后遗症。自1997年以来，整个亚太地区EV71的流行活动显著增加。该地区最近的手足口病疫情与一种严重的脑干脑炎形式有关，伴有肺水肿和高病死率。亚太地区大规模流行活动的出现与三个似乎正在经历快速进化变化的基因谱系的传播有关。其中两个谱系（B3和B4）以前未被描述过，似乎起源于亚洲赤道地区的一个地方病疫源地，该疫源地一直是马来西亚、新加坡和澳大利亚手足口病疫情的病毒来源。第三个谱系（C2）先前已被鉴定[Brown, B.A.等人（1999年）《病毒学杂志》73卷，9969 - 9975页]，主要导致了1998年台湾地区大规模的手足口病疫情。由于EV71似乎对新开发的抗病毒药物不敏感，且目前尚无疫苗可用，因此需要在整个亚太地区维持并扩大通过高水平监测和公共卫生干预来控制EV71疫情的措施。未来的研究应集中在：（1）了解EV71毒力的分子遗传学；（2）鉴定EV71的受体；（3）开发抗病毒药物以减轻神经疾病的严重程度；（4）开发疫苗以控制疫情。借鉴脊髓灰质炎控制项目的成功经验，如果能开发出有效的减毒活疫苗，就有可能控制EV71疫情。
