Enterovirus 71 (EV71) commonly causes hand-foot-and-mouth disease, but infection can be complicated occasionally by devastating brain-stem encephalitis presenting with myoclonic jerks in sleep, tachypnoea and collapse due to neurogenic pulmonary oedema. Other complications include acute flaccid paralysis resembling poliomyelitis. Outbreaks of EV71 infection have affected children across Asia and, more recently, Australia. In 2010, there were 1.8 million cases in China and 908 deaths. A Chinese randomised controlled trial in over 10 000 children aged 6–35 months found that two IM doses of an inactivated EV71 vaccine was 90% effective (95% CI 67.1–96.9) against hand-foot-and-mouth disease and 80.4% effective (95% CI 58.2–90.8) against EV71-asociated disease 2–14 months later. There were no serious adverse events. Use of the vaccine will depend on evidence of protection against severe disease and of cost-effectiveness.
Reviewer: David Isaacs, firstname.lastname@example.org