Enteroviruses: the Elephants in the Room.

Enteroviruses are extremely impactful pathogens in children, yet they remain neglected (with the exception of poliovirus) in terms of money spent on research, surveillance activities, pharmaceutical development, and prevention efforts. Enteroviruses were initially classified into four groups: polioviruses, coxsackie A viruses, coxsackie B viruses, and echoviruses, but it is now known that there is overlap between these groups, and newly identified enteroviruses are now named sequentially by species and serotype. Of the 12 enterovirus species, four (A, B, C, and D) cause disease in humans, including acute febrile respiratory and gastrointestinal illnesses, myocarditis, neonatal sepsis, and neurological illness. Neurological illnesses that are caused by enteroviruses include meningitis, cerebellar ataxia, meningoencephalitis, Guillain–Barré syndrome, and acute flaccid myelitis. Clinical characteristics of enterovirus A71 neurological disease during an outbreak in children in Colorado, USA, in 2018: an observational cohort studyThis outbreak of EV-A71 neurological disease, the largest reported in the Americas, was characterised by fever, myoclonus, ataxia, weakness, autonomic instability, and full recovery in most patients. Because EV-A71 epidemiology outside of Asia remains difficult to predict, identification of future outbreaks will be aided by prompt recognition of these distinct clinical findings, testing of non-sterile and sterile site specimens, and enhanced enterovirus surveillance. Full-Text PDF