Melnick J L
Rev Infect Dis. 1984 May-Jun;6 Suppl 2:S387-90. doi: 10.1093/clinids/6.supplement_2.s387.
Not all poliomyelitis-like paralytic illnesses can be attributed to polioviruses. Among the most recently recognized agents able to cause severe central nervous system disease with persistent flaccid paralysis is enterovirus type 71. In the 1969-1973 California outbreaks during which strains of this type were first reported, meningitis predominated, but cases of encephalitis were also seen. Outbreaks in different regions of the world followed. In some, hand-foot-and-mouth syndrome predominated; in others, meningitis; and in some, the clinical patterns were mixed. In the 1975 Bulgarian outbreak of greater than 705 cases, 149 patients developed paralysis and 44 others died. Enterovirus 71 was incriminated as the cause of the epidemic, in which infants and young children were the chief victims. The 1978 Hungarian epidemic of central nervous system disease was mixed, involving a tick-borne encephalitis virus among adults and enterovirus 71 among children. This newly recognized enterovirus is also significant in relation to polio vaccines. At some time, vaccine inevitably will be given to persons already incubating enterovirus 71 infection, who then may present with the paralytic syndrome due to the wild enterovirus. Such cases could be mistakenly designated as related to polio vaccine, particularly since many enterovirus 71 strains are difficult to isolate under conditions that would readily yield poliovirus isolates from the vaccine.
并非所有脊髓灰质炎样麻痹性疾病都可归因于脊髓灰质炎病毒。能够导致严重中枢神经系统疾病并伴有持续性弛缓性麻痹的最新确认病原体之一是71型肠道病毒。在1969 - 1973年加利福尼亚州的疫情爆发期间首次报告了该病毒株，当时脑膜炎占主导，但也出现了脑炎病例。随后世界不同地区都有疫情爆发。在一些地区，手足口综合征占主导；在另一些地区，脑膜炎占主导；还有一些地区，临床症状呈混合性。在1975年保加利亚爆发的超过705例病例中，149名患者出现麻痹，另有44人死亡。71型肠道病毒被认定为此次疫情的病因，婴幼儿是主要受害者。1978年匈牙利中枢神经系统疾病疫情呈混合性，成人中涉及一种蜱传脑炎病毒，儿童中涉及71型肠道病毒。这种新确认的肠道病毒在脊髓灰质炎疫苗方面也具有重要意义。有时，疫苗不可避免地会接种给已经感染71型肠道病毒且处于潜伏期的人，这些人随后可能会因野生肠道病毒而出现麻痹综合征。此类病例可能会被错误地认定与脊髓灰质炎疫苗有关，特别是因为许多71型肠道病毒株在能轻易从疫苗中分离出脊髓灰质炎病毒的条件下很难分离出来。
