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Enterovirus 71 (EV71) infection - including symptoms, treatment and prevention

Enterovirus 71 (EV71) is one of a large family of viruses which multiply in the human gastrointestinal tract (gut). EV71 infection can cause illness ranging from mild through to serious with life threatening complications. Reports of EV71 infection occur from time to time in Australia. Outbreaks have been reported in Asia over many years, and occasionally in Australia (for example in NSW in 2012 and 2013).

How enterovirus 71 is spread

Spread is from person to person through contamination of hands or objects (for example, toys) with infected faeces. The virus is then taken in by the mouth. Spread also occurs by contact with the saliva, nasal mucus or sputum (phlegm) of an infected person. In people with hand, foot and mouth disease, direct contact with fluid from blisters on the infected person can also spread the virus.

Signs and symptoms

EV71 is one of many possible viruses that cause hand, foot and mouth disease. Not all children with EV71 infections will have HFMD. In South Australia most cases of hand, foot and mouth disease are caused by other viruses.

The symptoms of hand, foot and mouth disease are:

  • fever
  • rash
  • tiredness
  • loss of appetite
  • ulcers or blisters in the mouth, and on the hands and feet. Often there is a sore mouth for a few days before the ulcers or blisters appear and affected young children may refuse to eat or drink.

EV71 infection usually causes only a mild illness in adults and children. However children under 5 years old, especially those under 2 years, are at higher risk of developing a severe EV71 infection.

Serious infection may involve the brain (encephalitis) and the meninges (the lining of the brain and spinal cord, causing meningitis). Signs may include: 

  • fever
  • stiff neck
  • vomiting
  • rash
  • cough
  • irritability
  • seizures (fits)
  • unsteadiness
  • weakness
  • paralysis. 

The infection can also involve the heart, causing fast or slow heart rate, high blood pressure, or breathing difficulties.

Most cases recover completely but some require a short stay in hospital, and a very small number may have long-term consequences.

Diagnosis

Hand, foot and mouth disease is diagnosed on the presenting signs and symptoms. Unless laboratory tests are done, it is not possible to determine what virus is causing the hand, foot and mouth disease.

To make a definite diagnosis of EV71 infection, laboratory testing such as PCR (polymerase chain reaction) testing or culture for the virus from samples of throat secretions, faeces or CSF (cerebrospinal fluid: the fluid surrounding the brain and spinal cord) is needed.

Incubation period

(time between becoming infected and developing symptoms)

3 to 5 days.

Infectious period

(time during which an infected person can infect others)

People with hand, foot and mouth disease are infectious as long as there is fluid in the blisters. The faeces can remain infectious for several weeks.

Treatment

There is no specific treatment for EV71 infection. With severe infection, hospital admission is required to monitor for any complications involving the brain and heart.

Prevention

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