Enteroviruses can cause outbreaks of hand-foot-and-mouth disease (characterized by
vesicular lesions on the hands, feet, and oral mucosa) or herpangina, usually without
life-threatening manifestations. In 1998 an epidemic of enterovirus 71 infection caused
hand-foot-and-mouth disease and herpangina in thousands of people in Taiwan, some
of whom died.
We assessed the epidemiologic aspects of this outbreak. Cases of hand-foot-and-mouth
disease or herpangina in ambulatory patients were reported to the Taiwan Department
of Health by a mean of 818 sentinel physicians. Severe cases in hospitalized patients
were reported by 40 medical centers and regional hospitals. Viruses were isolated
by 10 hospital laboratories and the department of health.
The sentinel physicians reported 129,106 cases of hand-foot-and-mouth disease or herpangina
in two waves of the epidemic, which probably represents less than 10 percent of the
estimated total number of cases. There were 405 patients with severe disease, most
of whom were five years old or younger; severe disease was seen in all regions of
the island. Complications included encephalitis, aseptic meningitis, pulmonary edema
or hemorrhage, acute flaccid paralysis, and myocarditis. Seventy-eight patients died,
71 of whom (91 percent) were five years of age or younger. Of the patients who died,
65 (83 percent) had pulmonary edema or pulmonary hemorrhage. Among patients from whom
a virus was isolated, enterovirus 71 was present in 48.7 percent of outpatients with
uncomplicated hand-foot-and-mouth disease or herpangina, 75 percent of hospitalized
patients who survived, and 92 percent of patients who died.
Although several enteroviruses were circulating in Taiwan during the 1998 epidemic,
enterovirus 71 infection was associated with most of the serious clinical manifestations
and with nearly all the deaths. Most of those who died were young, and the majority
died of pulmonary edema and pulmonary hemorrhage.