Kim Kyung Hyo
Department of Pediatrics, School of Medicine, Ewha Womans University, Seoul, Korea.
Korean J Pediatr. 2010 May;53(5):616-22. doi: 10.3345/kjp.2010.53.5.616. Epub 2010 May 31.
Enterovirus 71 (EV71) has been recognized as a frequent cause of epidemics of hand-foot-and-mouth disease (HFMD) associated with severe neurological symptoms. In the spring of 2009, HFMD was epidemic in Korea. Severe cases with complication, including death, have been reported and it has become a public health issue. Most symptomatic EV71 infections commonly result in HFMD or herpangina. These clinical manifestations can be associated with neurologic syndromes frequently. Neurologic syndromes observed in EV71 include meningitis, meningoencephalomyelitis, poliomyelitis-like paralytic disease, Guillain-Barré syndrome, transverse myelitis, cerebellar ataxia, opsoclonus-myoclonus syndrome, benign intracranial hypertension, and brainstem encephalitis. Examinations for EV 71 were performed from the stools, respiratory secretion or CSF of the children by realtime PCR. Gene analysis showed that most of them were caused by EV71 subgenotype C4a which was prevalent in China, 2008. Public health measures including personal and environmental hygiene, must to target daycare centers, kindergartens, and schools where highly susceptible children congregate. To prevent the spread of infection, preschools where transmission persists for more than 2 incubation periods, have been recommended for closure, and trigger criteria for voluntary closure was instituted. During closure, operators are to thoroughly clean the centers before they are allowed to reopen. In addition, parents are advised to ensure that their children adopt a high standard of personal hygiene and to keep the infected child at home until full recovery. Because the outbreaks occur in a cyclical pattern, surveillance system to predict next outbreaks and adequate public health measures to control need to be planned for future. Control of EV71 epidemics through surveillance and public health intervention needs to be maintained in Korea. Future research should focus on understanding of EV71 virulence, identification of the receptor(s) for EV71, development of antiviral agents and development of vaccine.
肠道病毒71型（EV71）已被确认为是引发手足口病（HFMD）流行并伴有严重神经症状的常见病因。2009年春季，手足口病在韩国流行。已报告出现包括死亡在内的伴有并发症的重症病例，它已成为一个公共卫生问题。大多数有症状的EV71感染通常会导致手足口病或疱疹性咽峡炎。这些临床表现常常会伴有神经综合征。在EV71感染中观察到的神经综合征包括脑膜炎、脑膜脑脊髓炎、脊髓灰质炎样麻痹性疾病、格林-巴利综合征、横贯性脊髓炎、小脑共济失调、眼阵挛-肌阵挛综合征、良性颅内高压和脑干脑炎。通过实时聚合酶链反应（PCR）对儿童的粪便、呼吸道分泌物或脑脊液进行EV71检测。基因分析表明，其中大多数是由2008年在中国流行的EV71 C4a亚型引起的。包括个人和环境卫生在内的公共卫生措施必须以日托中心、幼儿园和学校为目标，这些地方是高度易感儿童聚集的场所。为防止感染传播，对于传播持续超过2个潜伏期的学前班，建议予以关闭，并制定了自愿关闭的触发标准。在关闭期间，经营者在获准重新开放之前要对场所进行彻底清洁。此外，建议家长确保其子女保持高标准的个人卫生，并让感染的孩子居家直至完全康复。由于疫情呈周期性发生，需要规划未来预测下一次疫情的监测系统以及控制疫情的适当公共卫生措施。韩国需要通过监测和公共卫生干预来维持对EV71疫情的控制。未来的研究应侧重于了解EV71的毒力、鉴定EV71的受体、开发抗病毒药物以及研发疫苗。
