Transmission and clinical features of enterovirus 71 infections in household contacts in Taiwan
Transmission and clinical features of enterovirus 71 infections in household contacts in Taiwan
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DOI：
10.1001/jama.291.2.222
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发表时间：
2004-01-14
影响因子：
120.7
通讯作者：
Lin, TY
中科院分区：
文献类型：
--
作者：
Chang, LY;Tsao, KC;Lin, TY
背景虽然肠道病毒71型已经引起了流行病，发病率和死亡率都很高，但它的传播还没有被彻底调查。和参与者前瞻性家庭队列研究，调查台湾儿童医院的患者和这些患者的家庭成员，这些患者的体征和症状提示肠病毒71型。患者和家庭成员进行了临床评估，病毒学研究，基于问卷调查的访谈，并随访了6 months.Main结果测量肠道病毒71型感染，定义为阳性病毒培养从喉咙或直肠拭子，或IgM或中和抗体的血清中的4倍增加的存在;和临床综合征，定义为无症状;结果94个家庭（433名家庭成员）中至少有1名家庭成员存在肠道病毒71型感染。整体肠病毒71型传染给家居接触者的比率为52%（176/339名家居接触者）。兄弟姐妹的传播率为84%（70/83）;堂兄弟姐妹的传播率为83%（19/23）;父母的传播率为41%（72/175）;祖父母的传播率为28%（10/36）;叔叔和阿姨的传播率为26%（5/19）。在183名受感染儿童中，11名（6%）无症状，133名（73%）无并发症（手足口病、疱疹性咽峡炎、非特异性发热性疾病、上呼吸道感染、肠炎或病毒性腹泻）。21%（39/183）的患者出现了复杂的综合征，包括中枢神经系统或心肺功能衰竭。在6个月的随访中，10例死亡，13例有长期后遗症，包括吞咽功能障碍、颅神经麻痹、中枢性通气不足或肢体无力和萎缩。年龄小于3岁是与儿童不良结局相关的最重要因素（P=.004）。在87名受感染的成年人中，46人（53%）无症状，34人（39%）有发热、咽喉痛或胃肠道不适等非特异性疾病，7人（8%）有手足口病。结论台湾地区儿童肠道病毒71型家庭传播率高，严重并发症、后遗症和死亡的严重疾病频繁发生。相比之下，成年人的感染率要低得多，不良后遗症也少得多。
Context Although enterovirus 71 has caused epidemics associated with significant morbidity and mortality, its transmission has not been thoroughly investigated.Objectives To investigate enterovirus 71 transmission and determine clinical outcomes within households.Design, Setting, and Participants Prospective family cohort study to investigate patients at a children's hospital in Taiwan and family members of these patients who had signs and symptoms suggestive of enterovirus 71 between February 2001 and August 2002. Patients and household members underwent clinical evaluations, virological studies, questionnaire-based interviews, and were followed up for 6 months.Main Outcome Measures Enterovirus 71 infection, defined as a positive viral culture from a throat or rectal swab, or the presence of IgM or a 4-fold increase in neutralizing antibody in serum; and clinical syndromes, defined as asymptomatic; uncomplicated symptomatic; and complicated; with unfavorable outcomes of sequelae or death.Results Ninety-four families (433 family members) had at least 1 family member with evidence of enterovirus 71 infection. The overall enterovirus 71 transmission rate to household contacts was 52% (176/339 household contacts). Transmission rates were 84% for siblings (70/83); 83%, cousins (19/23); 41%, parents (72/175); 28%, grandparents (10/36); and 26%, uncles and aunts (5/19). Of 183 infected children, 11 (6%) were asymptomatic and 133 (73%) had uncomplicated illnesses (hand, foot, and mouth disease, herpangina, nonspecific febrile illness, upper respiratory tract infection, enteritis, or viral exanthema). Twenty-one percent (39/183) experienced complicated syndromes including the central nervous system or cardiopulmonary failure. During the 6-month follow-up, 10 died and 13 had long-term sequelae consisting of dysfunction in swallowing, cranial nerve palsies, central hypoventilation, or limb weakness and atrophy. Age younger than 3 years was the most significant factor associated with an unfavorable outcome in children (P=.004). Among 87 infected adults, 46 (53%) were asymptomatic, 34 (39%) had nonspecific illnesses of fever, sore throat, or gastrointestinal discomfort, and 7 (8%) had hand, foot, and mouth disease. There were no complicated cases in adults.Conclusions Enterovirus 71 household transmission rates were high for children in Taiwan and severe disease with serious complications, sequelae, and death occurred frequently. in contrast, adults had a much lower rate of acquisition of the infection and much less adverse sequelae.