For health professionals: non-polio enterovirus infections

Find detailed information on non-polio enterovirus infections, their clinical manifestations, diagnoses and treatments.

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What health professionals need to know about non-polio enterovirus

Non-polio enteroviruses are common ribonucleic acid (RNA) viruses that are found worldwide.

Infection is usually asymptomatic or associated with a mild non-specific illness. More severe presentations do occur, particularly in children.

Hand, foot and mouth disease (HFMD), or vesicular stomatitis with exanthema, is a common childhood condition. It results from infection with non-polio enteroviruses, such as:

  • coxsackie viruses A16 (CV-16), CV-A4, CV-A5, CV-A9, CV-A10, CV-B2 and CV-B5
  • enterovirus 71 (EV-A71)

HFMD is most commonly caused by CV-A16 and EV-A71.

Large outbreaks of HFMD related to CV-A16 and EV-A71 have both been documented. Outbreaks of HFMD due to CV-A16 have not been associated with significant complications or mortality.

Certain outbreaks of HFMD due to EV-A71 have been associated with:

  • severe neurological complications
  • significant mortality

Other outbreaks have been associated with:

  • relatively fewer complications
  • little mortality

Clinical manifestations

Non-polio enterovirus presentations include:

  • exanthems
  • herpangina
  • conjunctivitis
  • encephalitis
  • aseptic meningitis
  • acute flaccid paralysis
  • acute respiratory problem
  • myopericarditis

Infection with EV-A71 may result in complications without producing clinically-evident HFMD.

HFMD generally affects children 11 years-old and younger.

HFMD characteristically presents with:

  • fever
  • oral lesions, which consist of rapidly-ulcerating vesicles on the:
    • buccal mucosa
    • tongue
    • palate
    • gums
  • rash on the hands, feet and buttocks, which consists of:
    • papulovesicular lesions on the palms, fingers and soles (these generally persist for 7 to 10 days)
  • maculopapular lesions on the buttocks
  • malaise
  • sore throat
  • vomiting
  • diarrhea

The disease is considered benign and self-limited.

However, complications may arise, particularly when the illness results from infection with EV-A71.

Complications include:

  • encephalitis
  • aseptic meningitis
  • acute flaccid paralysis
  • pulmonary edema
  • hemorrhage
  • myocarditis

Most deaths in HFMD occur as a result of:

  • pulmonary edema
  • hemorrhage


Laboratory diagnosis is generally not required for uncomplicated cases.

In complicated cases, diagnosis can be made by isolating the virus:

  • by culture of upper respiratory tract or fecal specimens
  • from specimens of cerebrospinal fluid, biopsy material or skin lesions

Viral culture and molecular techniques can both be used, such as:

  • polymerase chain reaction (PCR)
  • sequencing

However, culture to obtain a viral isolate is preferred for accurate typing of the virus strain.

A 4-fold rise in the level of neutralizing antibody in blood specimens collected during the acute and convalescent phases of illness can provide evidence of recent infection.

However, this is often difficult in practice since patients may have already started to seroconvert upon presentation of symptoms.


No specific antiviral agent is available for therapy or prophylaxis enterovirus infection.

Treatment is supportive and focuses on management of complications.

Intravenous administration of immune globulin may have a use in preventing severe disease in:

  • immunocompromised patients
  • those with life-threatening disease

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