Non-Polio Enterovirus Infections: DVRD


Article title: Non-Polio Enterovirus Infections: DVRD
Conditions: Enteroviruses
Source: DVRD

Global Laboratory Network for Measles Surveillance
Non-Polio Enterovirus
Viral Meningitis
Hand Foot and Mouth Disease
Parvovirus B19 (Fifth Disease)
B19 and Pregnancy
Viral Gastroenteritis
Norwalk-Like Virus
Human Parainfluenza
Respiratory Syncytial Virus
Non-Polio Enterovirus Infections
What are enteroviruses?

Enteroviruses are small viruses that are made of ribonucleic acid (RNA) and protein. This group includes the polioviruses, coxsackieviruses, and echoviruses. In addition to the three different polioviruses, there are 61 non-polio enteroviruses that can cause disease in humans: 23 Coxsackie A viruses, 6 Coxsackie B viruses, 28 echoviruses, and 4 other enteroviruses.

How common are infections with these viruses?

Non-polio enteroviruses are second only to the "common cold" viruses, the rhinoviruses, as the most common viral infectious agents in humans. The enteroviruses cause an estimated 10-15 million or more symptomatic infections a year in the United States. All three types of polioviruses have been eliminated from the Western Hemisphere by the widespread use of vaccines.

Who is at risk of infection and illness from these viruses?

Everyone is at risk. Infants, children, and adolescents are more likely to be susceptible to infection and illness from these viruses, but adults can also become infected and ill if they do not have immunity to a specific enterovirus.

How does someone become infected with one of these viruses?

Enteroviruses can be found in the respiratory secretions (e.g., saliva, sputum, or nasal mucus) and stool of an infected person. Other persons may become infected by direct contact with secretions from an infected person or by contact with contaminated surfaces or objects, such as a drinking glass or telephone. Parents, teachers, and child care center workers may also become infected by contamination of the hands with stool from an infected infant or toddler during diaper changes.

What time of year is someone at risk for infection / illness?

In the United States, infections caused by the enteroviruses are most likely to occur during the summer and fall.

What illnesses do these viruses cause?

Most people who are infected with an enterovirus have no disease at all. Infected persons who become ill usually develop either mild upper respiratory symptoms (a "cold"), a flu-like illness with fever and muscle aches, or an illness with rash. Less commonly, some persons have aseptic or viral meningitis. Rarely, a person may develop an illness that affects the heart (myocarditis) or the brain (encephalitis) or causes paralysis. Enterovirus infections are suspected to play a role in the development of juvenile-onset diabetes mellitus (sugar diabetes). Newborns who become infected with an enterovirus may rarely develop an overwhelming infection of many organs, including liver and heart, and die from the infection.

Are there any long-term complications from these illnesses?

Usually, there are no long-term complications from the mild illnesses or from aseptic meningitis. Some patients who have paralysis or encephalitis, however, do not fully recover. Persons who develop heart failure (dilated cardiomyopathy) from myocarditis require long-term care for their conditions.

What are the health care costs of these infections?

The health care costs from enterovirus infections are unknown, but a large portion of the costs may come from use of over-the-counter medications to treat symptoms for millions of cases of "summer colds and flu". There are also significant costs associated with the 30,000 to 50,000 hospitalizations for aseptic meningitis each year in the United States.

Are these infections more severe in some years than in others?

There are no predictable patterns of circulation of these viruses or of diseases such as aseptic meningitis. There are occasional national or regional outbreaks of aseptic meningitis, such as the echovirus 30 outbreaks in the United States between 1989 and 1992. However, there is significant yearly variation, and no long-term trends have been identified.

Can these infections be prevented?

No vaccine is currently available for the non-polio enteroviruses. General cleanliness and frequent handwashing are probably effective in reducing the spread of these viruses.

Do CDC and state health departments keep track of these viruses?

State health department laboratories report to CDC the enteroviruses they identify by testing specimens from patients. Aseptic meningitis is no longer a nationally notifiable disease in the United States. Other forms of meningitis and poliomyelitis are notifiable, which means that any doctor or laboratory that diagnoses a case must report it to the public health department.

For further information, please contact the Respiratory and Enteric Viruses Branch, National Center for Infectious Diseases, at 404-639-3607 (telephone) or 404-639-4960 (facsimile).

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