The findings of an investigator study conducted by Children’s Hospital Colorado Infectious Disease, together with collaborators at the Centers for Disease Control and also at the Colorado Department of Public Health and the Environment, have recently been published by Lancet Infectious Diseases.
“We need to watch this very closely.” — Kevin Messacar, MD
EV-A71 has contributed to major and sometimes deadly epidemics in the Asia-Pacific region since the 1990s, every 1 to 3 years, which have led to the development of EV-A71 vaccines. Detections of this virus were low and sporadic in the United States. Nevertheless, there was an epidemic with uncommon symptoms, unusually high numbers of cases and regional clusters of children observed.
“We need to watch this very closely,” stated Kevin Messacar, MD, pediatric infectious disease physician as well as researcher at Children’s Hospital Colorado and also working at the University of Colorado Anschutz Medical Campus. “Enhanced surveillance is needed to determine whether this outbreak was an isolated event, or a warning of impending cyclic outbreaks of EV-A71 neurological disease in the U.S.”
The observational study has also helped to classify what other doctors should look for in addition to stressing a need to improve the monitoring of enterovirus. Infants with EV-A71, ataxias (dizziness), weakness as well as autonomic instability (heart rate dysregulation), or blood pressure (sweat and infusion) have been best differentiated from children with other enteroviruses by neurological findings of myoclonus (fast, involuntary muscle jerks). Those signs can often be confused or misrepresented for different diagnoses, especially in young children.
It is important to note, however, that these viruses occur in waves of the season. When, by further surveillance efforts, enteroviruses that because neurological disease continues to spread in the United States, it may be important to promote the production of antivirals and vaccinations.
“Were it not for Children’s Hospital Colorado’s ongoing interest and commitment to the study of enteroviruses, this outbreak would probably not have been detected,” told Drs. Carol Glaser as well as Mike Wilson in a commentary published alongside the Lancet study. “The USA has yet to have large-scale epidemics of enteroviruses as are seen in Asia and other countries, but it should take steps to become better prepared.”