Fatal Enterovirus71 Encephalitis among Children in Lopburi Province, Thailand, August – September 2011
Keywords:
EV71, Encephalitis, serosurvey, ThailandAbstract
Background: In July 2011, fatal EV71 encephalitis cases were reported in concurrent with increased incidence of HFMD in Lopburi Province. An investigation was conducted to identify the source of EV71 infection and assess immune status and risk factor for EV71 infection.
Methods: We reviewed treatment records and conducted active case finding. An EV71 suspected case was defined as a child aged 10 years or less who lived in Village A or B and developed or died with one of the following symptoms; rash on palms or soles, painful oral ulcers, fever, seizure, dyspnea during May 1st-August 11th, 2011. A probable case was defined as a suspected case who had epidemiological linkage with confirmed cases. A laboratory confirmed case was identified by EV71 isolation. A cross-sectional seroprevalence study was carried out to assess immune status and risk factors among children in both villages. The EV71 seropositivity was defined as IgG titer of 1:8 or more by micro-neutralizing test.
Results: Two fatal rhombencephalitis cases including a lab confirmed genogroup C4 EV71 case and a probable case. Of 52 houses and 2 schools surveyed, 10 cases (11.6%) including 2 probable and 8 suspected cases were found. Among 10 confirmed EV71 infection in school of Village B, 90% had asymptomatic infection. Proportion of seropositivity among 17 children from the school in Village A (97 %) was significantly higher than 27 children from the school in Village B (19%). Drinking boiled water was a significant protective factor for EV71 infection (Adjusted OR=0.11, 95% CI=0.01-0.82). Poor sanitation and environment was observed in both villages.
Conclusion: The source of EV71 infection was possibly attributable to contaminated water and environment. Majority of children in the Village A have been infected by EV71. Drinking boiled water should be promoted in the epidemic area.
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