Enterovirus 71 in Malaysia: A decade later

In the last decade, Malaysia has experienced several hand, foot and mouth disease (HFMD) epidemics, complicated by fatalities due to severe neurological involvement. Enterovirus 71 (EV-71) has been implicated as the major causative agent for these epidemics. EV-71 infection is a global public health problem with pandemic potential. In many parts of Asia-Pacifi c, the virus has emerged as one of the most deadly virus infections amongst young children. The virus is highly transmissible through faecaloral route and respiratory droplets. A recent rise in neurological complications and deaths suggests that the viruses currently circulating may be more virulent. The major risk factor associated with more severe EV-71 infection is young age and poor cellular immunity. Rapid laboratory diagnosis and molecular surveillance is important to closely monitor the emergence of new EV-71 subgenotypes. Since vaccine and anti-virals for EV-71 are not available, control and prevention strategies remain the only ways to combat the infection. Neurology Asia 2011; 16(1) : 1 – 15 Address correspondence to: Yoke-Fun Chan, Department of Medical Microbiology, Faculty of Medicine, University Malaya, 50603 Kuala Lumpur, Malaysia. Tel: 60379676677, Fax: 60379675752, Email: [email protected]; [email protected] INTRODUCTION Since its fi rst isolation in California in 1969, enterovirus 71 (EV-71) has caused sporadic outbreaks of hand, foot and mouth disease (HFMD), as well as serious neurological diseases such as meningitis, encephalitis, and acute fl accid paralysis (AFP). In the last 15 years, these epidemics have increased in number and involved large numbers of children in Asia, including Malaysia. In this review, we will discuss the epidemiology, clinical manifestations, risk factors, diagnosis, and management of EV-71 infection, with particular reference to work in Malaysia, and our diagnostic virology laboratory in University Malaya Medical Centre (UMMC), in Kuala Lumpur, Malaysia.