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In addition to highlighting the need to improve enterovirus surveillance, the observational study also helped identify what other medical providers should be looking for. Children with EV-A71 disease were best differentiated from children with other enteroviruses by the neurological findings of myoclonus (quick, involuntary muscle jerks), ataxia (dizziness), weakness and autonomic instability (dysregulation of heart rate, blood pressure and perfusion). Often times these symptoms can be misunderstood or misattributed to other diagnoses - especially among young children.
Finally, it's important to note that these viruses tend to appear in seasonal waves. If through additional surveillance efforts, the United States continues to see enteroviruses circulating that cause neurological illness, the development of antivirals and vaccines may need to become a priority.
"Were it not for Children's Hospital Colorado's ongoing interest and commitment to the study of enteroviruses, this outbreak would probably not have been detected," noted Drs. Carol Glaser and Mike Wilson in a commentary published alongside the Lancet study. "The USA has yet to have large-scale epidemics of enteroviruses as are seen in Asia and other countries, but it should take steps to become better prepared." Source:
Children's Hospital Colorado Journal reference:
Messacar, K., et al. (2019) Clinical characteristics of enterovirus A71 neurological disease during an outbreak in children in Colorado, USA, in 2018: an observational cohort study. The Lancet: Infectious Diseases . doi.org/10.1016/S1473-3099(19)30632-2 .
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