News Release 

Children's Hospital Colorado uncovers largest US outbreak of neurologic disease to date

Comprehensive clinical testing led researchers to connect enterovirus A71, which causes Hand, Foot and Mouth Disease, to outbreak of neurological illness

Children's Hospital Colorado

Aurora, Colo. (Jan. 8, 2020) - The Lancet Infectious Diseases recently published the results of an observational study led by researchers on Children's Hospital Colorado Infectious Disease and Neurology teams, along with counterparts at the Centers for Disease Control and Colorado Department of Public Health and Environment. The study was conducted from March 1 to November 30, 2018, and led to a discovery of the largest outbreak of enterovirus A71 (EV-A71) in the United States.

Since the 1990s, every 1 to 3 years, EV-A71 has caused large-scale, and sometimes deadly epidemics in the Asia-Pacific region, which has prompted the development of EV-A71 vaccines. In the United States, detections of this virus have been small-scale and sporadic. However, the unique symptoms, unusually high number of cases, and the geographic clustering of children who were observed during this study, indicated an outbreak.

"We need to watch this very closely," said Kevin Messacar, MD, pediatric infectious disease physician and researcher at Children's Hospital Colorado and University of Colorado Anschutz Medical Campus . "Enhanced surveillance is needed in order to determine whether this outbreak was an isolated event, or a warning of impending cyclic outbreaks of EV-A71 neurological disease in the U.S."

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."

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Click here to read the full study in The Lancet, Infectious Diseases.

Click here to read the full commentary in The Lancet, Infectious Diseases.

About Children's Hospital Colorado

Children's Hospital Colorado is one of the nation's leading and most expansive pediatric healthcare systems with a mission to improve the health of children through patient care, education, research and advocacy. Founded in 1908 and recognized as a top ten children's hospital by U.S. News & World Report, Children's Colorado has established itself as a pioneer in the discovery of innovative and groundbreaking treatments that are shaping the future of pediatric healthcare worldwide. Children's Colorado offers a full spectrum of family-centered care at its urgent, emergency and specialty care locations throughout Colorado, including its location on the Anschutz Medical Campus, and across the region. The newly-opened Children's Hospital Colorado, Colorado Springs, is now the first pediatric-only hospital in southern Colorado. For more information, visit http://www.childrenscolorado.org, or connect with us on Facebook and Twitter.

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