Comparison of enterovirus 71 and coxsackievirus A16 clinical illnesses during the Taiwan enterovirus epidemic, 1998

Objectives. To compare enterovirus 71 (EV 71) with coxsackievirus A16 (Cox Ale) clinical illness in patients at Chang Gung Children's Hospital during Taiwan's enterovirus epidemic of 1998, Methods. With the use of the immunofluorescence assay and neutralization te st, 177 cases of EV 71 and 64 cases of Cox A16 illness were confirmed from April to September, 1998, The clinical signs and symptoms, complications an d case fatality rates were compared. Results. Three-fourths of the cases were younger than 3 years of age, and t he ratio of males to females was 1.3 in the EV 71 group and 1.2 in the Cox Ale group. In the EV 71 group 120 (68%) cases were uncomplicated, including 94 cases of hand, foot and mouth disease and 15 cases of herpangina, and 5 7 (32%) cases had complications, including 13 (7.3%) cases of aseptic menin gitis, 18 (10%) cases of encephalitis, 4 (2.3%) cases of polio-like syndrom e, 8 (4.5%) cases of encephalomyelitis and 12 (6.8%) cases of fatal pulmona ry edema. Fourteen (7.9%) patients died, including 12 cases of pulmonary ed ema and 2 cases of encephalitis; seven (4%) patients had sequelae, By contr ast, 60 (94%) of the 64 cases of Cox Ale infection were uncomplicated and o nly 4 (6.3%) cases were complicated by aseptic meningitis; no fatalities or sequelae were observed. By multivariate analysis vomiting (P = 0.01) and f ever higher than 39 degrees C plus lasting longer than 3 days (P = 0.02) we re significantly more frequent in the EV 71 group. Conclusion. EV 71 illness is more severe with significantly greater frequen cy of serious complications and fatality than is illness caused by Cox A16.