The Enterovirus threat

RECENTLY the Philippine health care system was shaken by news that a boy from Mindanao was found positive for the much feared Enterovirus 71(EV-71) -- the same disease that claimed the lives of at least 64 children in Cambodia for the past few weeks.

According to the Center of Disease Control and Prevention (CDC) in the US, enterovirus is a group of viruses that include polioviruses, which causes polio; coxsackieviruses, which causes fever, rash and manifestations similar to polio but with the absence of paralysis; and echoviruses, a disease that affects the digestive system but may involve the respiratory system.

The CDC also claims that aside from the three major types of enteroviruses, which they classified as having polio-like characteristics, there are over 60 types of other enteroviruses that include Coxsackievirus A16-that causes hand, foot and mouth diseases and the dreaded EV-71.

According to Health Secretary Enrique Ona, EV-71 causes diarrhea, rashes and hand, foot and mouth disease.

He stresses that it is sometimes associated with severe central neurological disease.

A medical encyclopedia explains that central neurological diseases are those conditions that affect the nervous system, including the anatomy and accessory structures of the brain, spinal cord and the peripheral nerves.

The CDC also maintains that enteroviruses have been generally eradicated in the US as well as in some European regions due to massive vaccinations.

However, in some parts of the world especially those that are poverty-laden, enteroviruses continue to infest.

The CDC emphasizes that everyone is at risk at being infected with enteroviruses but they also highlight that children, infants and adolescents are the most susceptible population because they may not have the necessary antibodies yet from previous exposure.

The antibodies make a person immune against certain diseases as in this case, the enteroviruses. Adults can be infected if they are not vaccinated the CDC points out.

Communicable disease experts claim that enteroviruses are spread from person to person by direct contact with the infectious viruses that cause this disease. They believe that these viruses are found in the nose and throat secretions like the saliva, sputum or nasal mucus.

Furthermore, they support that the fluid in blisters of the skin rashes and stool of the infected persons may contain the viruses in abundance.

These experts explain that the viruses may be spread when infected persons touch objects and surfaces that are then touched by others.

Pathologists explain that infected persons are most contagious during the first week of the illness. They believe that several weeks after a person is infected or has recuperated, he or she may still potentially infect others even if they no longer show any manifestations.

Historically speaking, EV-71 is not a new disease. In 1997, EV-71 emerged in Kuala Lampur, Malaysia, claiming the lives of four children.

The said victims suffered inflammation in their brainstem and pulmonary edema that led to cardiopulmonary arrest.

By 1998, EV-71 outbreak occurred in Taiwan that resulted in 408 severe cases in children and causing 78 deaths -- 71 of which were children aged below five years.

For Dr. Ona, the boy from Mindanao who had been infected with enterovirus had the similar strain of virus found in Cambodia but he assured that it was a milder form with manifestations limited to fever, rashes to his hands and soles of the feet, mouth and buttocks.

Infection control nurses emphasize the importance of handwashing in preventing the spread of EV-71, especially among the vulnerable population groups.

Preschool and elementary school teachers should also instruct their pupils to make the act of handwashing a regular habit especially when using public toilet since EV-71 is transmitted via body secretions that may contain the enterovirus.

In the absence of soap and water, parents may wish to include in their children’s hygiene kit a small-sized alcohol or hand sanitizer.
School facilities including day care centers must also develop a stringent system of disinfecting communal surfaces that may harbor the enterovirus.

The CDC recommends that communal surfaces like those in toilets, classrooms, canteens and other public places should be cleaned first with soap and water and then followed a dilute solution of chlorine-containing bleach or a mixture of one-fourth cup of bleach to a gallon of water.

Experts support that foot and mouth diseases (FMD) are not similar to hand, foot and mouth diseases. For them, the FMD is a disease of cattle, sheep and swine while the hand, foot and mouth disease is not transmitted to or from pets or other animals.

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