Reemerging of enterovirus 71 in Taiwan: the age impact on disease severity

Eur J Clin Microbiol Infect Dis. 2012 Jun;31(6):1219-24. doi: 10.1007/s10096-011-1432-6. Epub 2011 Oct 9.


Enterovirus 71 (EV71) infection commonly strike children under the age of 3 years, with an occasionally unfavorable outcome in children. This study was designed to explore the relationship between age and the severity of complications, which may associate with antibody-dependent enhancement (ADE) in EV71. All EV71-infected patients during the outbreak of 2008 were recruited. In total, 134 patients were enrolled and categorized into two age groups, 0-12 months (n = 18) and >12 months (n = 116). Pulmonary edema/hemorrhage more commonly occur in patients younger than 12 months. No difference in the occurrence of herpangina/hand-foot-and-mouth disease (HFMD), uncomplicated brainstem encephalitis (BE), or autonomic nervous system (ANS) dysregulation was noted between the two age groups. Patients with pulmonary edema/hemorrhage (11.9 ± 14.7 months) were younger than patients with herpangina/HFMD (35.8 ± 26.4 months) or ANS dysregulation (33.9 ± 20.9 months). Our findings are in agreement with the data regarding the outbreak in Taiwan, in which a decrease in age corresponded to an increase in disease severity with regard to central nervous system complications. A reduction of maternal antibodies to the subneutralizing level within 1 year of age may be associated with the ADE of the infection. This study could provide possible clinical significance with regard to ADE phenomena in young infants infected by EV71.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Antibodies, Viral / blood
  • Child
  • Child, Preschool
  • Communicable Diseases, Emerging / complications
  • Communicable Diseases, Emerging / epidemiology*
  • Communicable Diseases, Emerging / pathology*
  • Encephalitis, Viral / epidemiology
  • Encephalitis, Viral / pathology
  • Enterovirus A, Human / isolation & purification*
  • Enterovirus Infections / complications
  • Enterovirus Infections / epidemiology*
  • Enterovirus Infections / pathology*
  • Female
  • Humans
  • Infant
  • Male
  • Severity of Illness Index*
  • Taiwan / epidemiology


  • Antibodies, Viral