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Epidemiology

Clinical and Etiological Characteristics of Enterovirus 71-Related Diseases during a Recent 2-Year Period in Korea

Wi-Sun Ryu, Byounghak Kang, Jiyoung Hong, Seoyeon Hwang, Jonghyun Kim, Doo-Sung Cheon
Wi-Sun Ryu
1Division of Enteric and Hepatitis Viruses, National Institute of Health, Korea Center for Disease Control and Prevention
2Department of Neurology, Seoul National University Hospital, Seoul
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Byounghak Kang
1Division of Enteric and Hepatitis Viruses, National Institute of Health, Korea Center for Disease Control and Prevention
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Jiyoung Hong
1Division of Enteric and Hepatitis Viruses, National Institute of Health, Korea Center for Disease Control and Prevention
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Seoyeon Hwang
1Division of Enteric and Hepatitis Viruses, National Institute of Health, Korea Center for Disease Control and Prevention
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Jonghyun Kim
3Department of Pediatrics, Catholic University College of Medicine, Suwon, Republic of Korea
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Doo-Sung Cheon
1Division of Enteric and Hepatitis Viruses, National Institute of Health, Korea Center for Disease Control and Prevention
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  • For correspondence: cheonds@hanmail.net
DOI: 10.1128/JCM.02369-09
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    FIG. 1.

    Distribution of the patients in a nationwide surveillance system.

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  • TABLE 1.

    Prevalences of enterovirus genotypes identified in patients with hand-foot-mouth disease or herpangina in South Korea

    SerotypeaNo. (%) of cases
    20082009
    CA2013 (7.9)
    CA32 (3.8)0
    CA44 (7.5)0
    CA5017 (10.3)
    CA6014 (8.5)
    CA1018 (34.0)0
    CA1202 (1.2)
    CA162 (3.8)15 (9.1)
    CB14 (7.5)4 (2.4)
    CB34 (7.5)0
    E304 (2.4)
    E66 (11.3)1 (0.6)
    E902 (1.2)
    E1104 (2.4)
    E141 (1.9)0
    E3012 (22.6)1 (0.6)
    E3301 (0.6)
    EV71091 (55.2)
    Total53165
    • ↵ a CA, coxsackie virus A; CB, coxsackie virus B; E, echovirus; EV, enterovirus.

  • TABLE 2.

    Demographic and clinical comparisons of patients suspected of enterovirus infection between 2008 and 2009

    CharacteristicaValue P
    2008 (n = 200)2009 (n = 519)
    Age (mo) (mean ± SD)†35.0 ± 46.541.9 ± 73.50.22
    Male gender113 (56.5)304 (58.6)0.61
    Time interval (days) (mean ± SD)†2.6 ± 1.82.7 ± 4.50.82
    Clinical category
        HFMD42 (21.0)371 (71.5)<0.01
        Herpangina162 (81.0)157 (30.3)<0.01
        Meningoencephalitis8 (4.0%)79 (15.2)<0.01
    Presenting symptoms
        Fever (>37°C)37 (18.5)203 (39.1)<0.01
        Headache11 (5.5)53 (10.2)0.04
        Vomiting32 (16.0)39 (7.5)<0.01
        Neck stiffness*4 (2.0)12 (2.3)0.80
        Sore throat59 (29.5)70 (13.5)<0.01
        Abdominal pain*3 (1.5)10 (1.9)0.70
        Diarrhea9 (4.5)15 (2.9)0.28
        Decreased mental status*1 (0.5)12 (2.3)0.08
        Seizure6 (3.0)14 (2.7)0.83
    Sample type
        Stool94 (47.0)239 (46.1)0.82
        Respiratory122 (61.0)330 (63.6)0.52
        CSF1 (0.5)61 (11.8)<0.01
    • ↵ a Except where otherwise indicated, values are the number (percentage) of patients with the characteristic. Symbols indicate that either the Fisher exact test (*) or the Student t test (†) was used to determine significance.

  • TABLE 3.

    Clinical characteristics of patients suspected of enterovirus infection according to the presence of the enterovirus genome by real-time RT-PCR

    CharacteristicaValue for patients: P
    Negative by PCR (n = 272)Positive by PCR (n = 447)
    Age (mo) (mean ± SD)†48.8 ± 93.334.5 ± 35.90.06
    Male gender152 (55.9)265 (59.3)0.37
    Time interval (days) (mean ± SD)†2.7 ± 4.52.6 ± 3.80.71
    Clinical category
        HFMD152 (55.9)261 (58.4)0.51
        Herpangina125 (46.0)194 (43.4)0.50
        Meningoencephalitis11 (4.0)67 (15.0)<0.01
    Presenting symptoms
        Fever (>37°C)93 (35.7)143 (32.0)0.31
        Headache20 (7.4)44 (9.8)0.26
        Vomiting23 (8.5)48 (10.7)0.32
        Neck stiffness*3 (1.1)13 (2.9)0.05
        Sore throat47 (17.3)82 (18.3)0.72
        Abdominal pain*6 (2.2)7 (1.6)0.53
        Diarrhea13 (4.8)11 (2.5)0.09
        Decreased mental status*1 (0.4)12 (2.7)0.02
        Seizure7 (2.6)13 (2.9)0.79
    • ↵ a Except where otherwise indicated, values are the number (percentage) of patients with the characteristic. Symbols indicate that either the Fisher exact test (*) or the Student t test (†) was used to determine significance.

  • TABLE 4.

    Clinical characteristics of 218 patients according to EV 71 or non-EV 71 genotype

    CharacteristicaValue for patients with the following genotype: P
    Non-EV 71 (n = 127)EV 71 (n = 91)
    Age (mo) (mean ± SD)†44.0 ± 42.329.9 ± 27.9<0.01
    Male gender68 (53.5)54 (59.3)0.40
    Time interval (days) (mean ± SD)†2.9 ± 1.73.1 ± 4.00.57
    Clinical category
        HFMD55 (43.3)87 (95.6)<0.01
        Herpangina74 (58.3)7 (7.7)<0.01
        Meningoencephalitis6 (4.7)35 (38.5)<0.01
    Presenting symptoms
        Fever (>37°C)20 (15.7)33 (36.3)<0.01
        Headache*5 (3.9)16 (17.6)<0.01
        Vomiting13 (10.2)13 (14.3)0.36
        Neck stiffness*1 (0.8)6 (6.6)0.02
        Sore throat*23 (18.1)4 (4.4)<0.01
        Diarrhea5 (3.9)0 (0)0.07
        Decreased mental status*0 (0)3 (3.3)0.07
    Sample type
        Stool68 (53.5)55 (60.4)0.31
        Respiratory80 (63.0)62 (28.1)0.43
        CSF*3 (2.4)15 (16.5)<0.01
    • ↵ a Except where otherwise indicated, values are the number (percentage) of patients with the characteristic. Symbols indicate that either the Fisher exact test (*) or the Student t test (†) was used to determine significance.

  • TABLE 5.

    Univariate and multivariable analyses of predictors for EV 71 infection

    PredictorUnivariate analysis Multivariate analysisa
    Unadjusted OR (95% CI)PAdjusted OR (95% CI)P
    Age, per yr0.98 (0.97-1.00)0.006NA
    Presenting with HFMD28.47 (9.85-82.34)<0.00131.86 (10.04-101.09)<0.001
    Presenting with herpangina0.06 (0.03-0.14)<0.001NA
    Fever (>37°C)3.04 (1.60-5.78)0.0014.76 (1.71-13.25)0.003
    Headache5.21 (1.83-14.79)0.0026.51 (0.77-55.13)0.086
    Neck stiffness8.89 (1.05-72.20)0.045NA
    Sore throat0.21 (0.07-0.62)0.0050.18 (0.04-0.77)0.020
    • ↵ a Stepwise backward regression. The variables entered were presenting with HFMD, presenting with herpangina, fever, headache, neck stiffness, and sore throat. NA, not available.

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Clinical and Etiological Characteristics of Enterovirus 71-Related Diseases during a Recent 2-Year Period in Korea
Wi-Sun Ryu, Byounghak Kang, Jiyoung Hong, Seoyeon Hwang, Jonghyun Kim, Doo-Sung Cheon
Journal of Clinical Microbiology Jun 2010, 48 (7) 2490-2494; DOI: 10.1128/JCM.02369-09

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Clinical and Etiological Characteristics of Enterovirus 71-Related Diseases during a Recent 2-Year Period in Korea
Wi-Sun Ryu, Byounghak Kang, Jiyoung Hong, Seoyeon Hwang, Jonghyun Kim, Doo-Sung Cheon
Journal of Clinical Microbiology Jun 2010, 48 (7) 2490-2494; DOI: 10.1128/JCM.02369-09
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KEYWORDS

Coxsackievirus Infections
Enterovirus A, Human

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