Enteroviruses are a common cause of human disease, especially in children. There are a number of members of this family of viruses. As the name enteric implies, the primary site of infection and transmission is usually the gastrointestinal tract. There are over 70 enteroviruses, but only 10-15 cause most human disease. No single type causes only a specific disease, but certain types are more common in certain diseases. The best known enterovirus is the polio virus, which before the vaccine became available caused epidemics of infection and paralysis every summer across the United States. The most well-known enteroviral infection now is probably hand-foot-and-mouth disease, which is very common in young children. Enteroviral infections occur year-round, but are more common in the summer and early fall in North America.
Enterovirus infections are extremely common in children. Fortunately, most infections are benign and self-limited. Sometimes a person has no symptoms at all. However, enteroviruses can cause serious disease including encephalitis and paralysis or other neurologic effects, heart disease, and death. Rarely, a child may suffer a serious complication from one of the common childhood infections. Unfortunately, no specific treatment is available for enterovirus infections.
Groups
- Polioviruses
- Coxsackie A and B viruses
- Echoviruses
- Other numbered enteroviruses, e.g. enterovirus 71
Diseases
Common
- Hand-foot-and-mouth disease
- Herpangina
- Febrile illness (nonspecific)
- Viral meningitis (about ½ of infants with an enteroviral infection actually have viral meningitis, though this may not have symptoms)
- Upper respiratory infection (runny nose)
- Gastroenteritis (vomiting and/or diarrhea)
- Polio (common before the vaccine)
Less common
- Acute hemorrhagic conjunctivitis
- Pleurodynia
- Myocarditis and/or pericarditis
- Encephalitis
- Other neurologic diseases
- Paralysis (polio-like complications)
- Neonatal infections (can be serious)
Symptoms
Symptoms vary depending on the specific virus and the illness caused. Common symptoms include:
- Fever, which may be as high as 105-106 F
- Sore throat
- Mouth ulcers
- Vomiting
- Diarrhea
- Rash
- Runny nose
- Headache
Clinical course
The course depends on the specific virus and illness and on the child. Symptoms usually start 3-5 days after exposure, though many infections are asymptomatic and cause no signs of illness at all. Fever usually lasts 3-5 days, and complete recovery occurs in 7-10 days.
Treatment
Treatment is usually supportive care, such as adequate fluids and comfort measures. In most cases, the infection resolves without any serious complications. Antibiotics do not treat viral infections, including enteroviruses.
Prevention
Enteroviral infections are very contagious. They are usually spread from the fecal-oral route; therefore hand washing and disinfecting of surfaces is very important after changing diapers. It can also be spread through respiratory secretions like a runny nose or saliva. The person is usually contagious 1-2 days before having any signs of illness, so it is difficult to prevent the spread of illness in daycare and school settings. The child is definitely contagious during the period of fever and oral ulcers or rash. Unfortunately, in many cases the virus is still present in stool for up to 8 weeks after infection and in the respiratory tract for 1-3 weeks after infection, again making it difficult to prevent the spread of the infection. Handwashing and good hygiene remain the single best way to prevent infection.
Polio virus infections are, of course, preventable with the polio vaccine. A vaccine is being investigated for enterovirus 71, because infections with this virus can be serious and can lead to paralysis like polio viruses.
Return to school or daycare
This is somewhat debated, since the virus is shed for so long after the symptoms go away. Since it is also contagious before symptoms develop, it is difficult to prevent the spread of the virus and good hygiene and handwashing are the main way to reduce transmission. Most agree that the child can return to school or daycare when the fever, ulcers and rash are gone and the child is not too fussy and is drinking well. If the child has diarrhea, it needs to not be leaking out of the child’s diaper.
