Incidence and case-fatality rates resulting from the 1998 enterovirus 71 outbreak in 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.

MeSH terms

  • Adolescent
  • Adult
  • Antibodies, Viral / blood*
  • Child
  • Child, Preschool
  • Disease Outbreaks*
  • Enterovirus / immunology*
  • Enterovirus Infections / epidemiology*
  • Enterovirus Infections / mortality
  • Enterovirus Infections / virology
  • Hand, Foot and Mouth Disease / epidemiology*
  • Hand, Foot and Mouth Disease / mortality
  • Hand, Foot and Mouth Disease / virology
  • Herpangina / epidemiology*
  • Herpangina / mortality
  • Herpangina / virology
  • Humans
  • Incidence
  • Infant
  • Middle Aged
  • Neutralization Tests
  • Seroepidemiologic Studies
  • Taiwan / epidemiology


  • Antibodies, Viral