Outbreaks & Surveillance
In the United States, people can get infected with non-polio enteroviruses at any time of the year. However, it is more common in the summer and fall. There is no predictable pattern for when these viruses circulate and cause infections and outbreaks.
Outbreaks of Various Non-Polio Enteroviruses
- Coxsackievirus A16 is the most common cause of hand, foot, and mouth disease (HFMD) in the United States. However, in 2011 and 2012, coxsackievirus A6 was a common cause of HFMD in this country; some of the infected people became severely ill.
- Coxsackievirus A24 and enterovirus 70 have been associated with outbreaks of conjunctivitis.
- Echoviruses 13, 18, and 30 have caused outbreaks of viral meningitis in the United States.
- Enterovirus 71 has caused large outbreaks of HFMD worldwide, especially in children in Asia. Some infections from this virus have been associated with severe neurologic disease, such as brainstem encephalitis.
- In late summer and fall 2014, enterovirus D68 has caused an increase (relative to the same period in previous years) in people in several states examined and hospitalized with severe respiratory illness.
Information on cases and outbreaks of enterovirus infection is collected in the United States using two surveillance systems:
- National Respiratory and Enteric Virus Surveillance System (NREVSS) is a voluntary, laboratory-based surveillance system that has included enterovirus reporting since July 2007. This system is used to track the number of enterovirus tests that are done and the proportion that are positive, by specimen type, location, and when they were collected. Serotyping, demographic data, and clinical data are not reported.
- National Enterovirus Surveillance System (NESS) is a passive, voluntary, laboratory-based system that collects basic data on specimens that are positive for enterovirus, including serotype.
- Midgley CM, Jackson MA, Selvarangan R, Turabelidze G, Obringer E, Johnson D, et al. Severe respiratory illness associated with enterovirus D68 — Missouri and Illinois, 2014. MMWR. 2014:63(36)798-9.
- Centers for Disease Control and Prevention. Notes from the field: Severe hand, foot, and mouth disease associated with coxsackievirus a6—Alabama, Connecticut, California, and Nevada, November 2011-February 2012. MMWR 2012;61:213-4.
- American Academy of Pediatrics. Section 3: Enterovirus (nonpoliovirus) and parechovirus infections (group A and B coxsackieviruses, echoviruses, numbered enteroviruses, and human parechoviruses) – clinical manifestations. In Red Book: 2012 Report of the Committee on Infectious Diseases. Pickering LK, ed. 29th ed. Elk Grove Village, IL: American Academy of Pediatrics; 2012.
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