Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Enterovirus and parechovirus infections: Clinical features, laboratory diagnosis, treatment, and prevention

John F Modlin, MD
Section Editors
Martin S Hirsch, MD
Morven S Edwards, MD
Deputy Editor
Allyson Bloom, MD


The human enteroviruses and parechoviruses are ubiquitous viruses found throughout the world and are transmitted from person to person chiefly through fecal-oral contact [1].

Polioviruses, the prototypic enteroviruses, are the cause of paralytic poliomyelitis, a disease that has been eradicated in the United States and other resource-rich countries (except for very rare cases that are attributable to live, attenuated polio vaccine viruses) and that has been targeted for worldwide eradication. The non-polio enteroviruses (group A and B coxsackieviruses, echoviruses, and enteroviruses) and parechoviruses are responsible for a wide spectrum of disease in persons of all ages, although infection and illness disproportionately affect infants and young children.

The clinical manifestations, laboratory diagnosis, treatment, and prevention of non-polio enterovirus and parechovirus infections are reviewed in this topic. The microbiology, epidemiology, and pathogenesis of these infections are discussed separately. (See "Enterovirus and parechovirus infections: Epidemiology and pathogenesis".)

Poliovirus infection and prevention are discussed in detail elsewhere. (See "Polio and infectious diseases of the anterior horn" and "Post-polio syndrome" and "Poliovirus vaccination".)


Changes in enterovirus taxonomy based on RNA sequence now specify that the serotypes designated as "enteroviruses" under the original classification scheme include the letter (A, B, C, or D) that identifies the species to which the serotype belongs (eg, enterovirus D68). (See "Enterovirus and parechovirus infections: Epidemiology and pathogenesis", section on 'Classification'.)

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Jul 10, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Messacar K, Modlin JF, Abzug MJ. Enteroviruses and Parechoviruses. In: Principles and Practice of Pediatric Infectious Diseases, Long S, Prober C, Fischer M (Eds), Elsevier Saunders, Philadelphia 2017.
  2. Kogon A, Spigland I, Frothingham TE, et al. The virus watch program: a continuing surveillance of viral infections in metropolitan New York families. VII. Observations on viral excretion, seroimmunity, intrafamilial spread and illness association in coxsackie and echovirus infections. Am J Epidemiol 1969; 89:51.
  3. Rotbart HA, McCracken GH Jr, Whitley RJ, et al. Clinical significance of enteroviruses in serious summer febrile illnesses of children. Pediatr Infect Dis J 1999; 18:869.
  4. HORSTMANN DM. Clinical aspects of acute poliomyelitis. Am J Med 1949; 6:592.
  5. Richardson M, Elliman D, Maguire H, et al. Evidence base of incubation periods, periods of infectiousness and exclusion policies for the control of communicable diseases in schools and preschools. Pediatr Infect Dis J 2001; 20:380.
  6. Adler JL, Mostow SR, Mellin H, et al. Epidemiologic investigation of hand, foot, and mouth disease. Infection caused by coxsackievirus A 16 in Baltimore, June through September 1968. Am J Dis Child 1970; 120:309.
  7. Alexander JP Jr, Baden L, Pallansch MA, Anderson LJ. Enterovirus 71 infections and neurologic disease--United States, 1977-1991. J Infect Dis 1994; 169:905.
  8. Lum LC, Wong KT, Lam SK, et al. Fatal enterovirus 71 encephalomyelitis. J Pediatr 1998; 133:795.
  9. Huang CC, Liu CC, Chang YC, et al. Neurologic complications in children with enterovirus 71 infection. N Engl J Med 1999; 341:936.
  10. Chan KP, Goh KT, Chong CY, et al. Epidemic hand, foot and mouth disease caused by human enterovirus 71, Singapore. Emerg Infect Dis 2003; 9:78.
  11. Jiang M, Wei D, Ou WL, et al. Autopsy findings in children with hand, foot, and mouth disease. N Engl J Med 2012; 367:91.
  12. Flett K, Youngster I, Huang J, et al. Hand, foot, and mouth disease caused by coxsackievirus a6. Emerg Infect Dis 2012; 18:1702.
  13. Stewart CL, Chu EY, Introcaso CE, et al. Coxsackievirus A6-induced hand-foot-mouth disease. JAMA Dermatol 2013; 149:1419.
  14. Chung WH, Shih SR, Chang CF, et al. Clinicopathologic analysis of coxsackievirus a6 new variant induced widespread mucocutaneous bullous reactions mimicking severe cutaneous adverse reactions. J Infect Dis 2013; 208:1968.
  15. Cherry JD, Jahn CL. Herpangina: the etiologic spectrum. Pediatrics 1965; 36:632.
  16. Bell EJ, Ross CA, Grist NR. ECHO 9 infection in pregnant women with suspected rubella. J Clin Pathol 1975; 28:267.
  17. LERNER AM, KLEIN JO, LEVIN HS, FINLAND M. Infections due to Coxsackie virus group A, type 9, in Boston, 1959, with special reference to exanthems and pneumonia. N Engl J Med 1960; 263:1265.
  18. SABIN AB, KRUMBIEGEL ER, WIGAND R. ECHO type 9 virus disease. AMA J Dis Child 1958; 96:197.
  19. NEVA FA. A second outbreak of Boston exanthem disease in Pittsburgh during 1954. N Engl J Med 1956; 254:838.
  20. NEVA FA, FEEMSTER RF, GORBACH IJ. Clinical and epidemiological features of an usual epidemic exanthem. J Am Med Assoc 1954; 155:544.
  21. FROTHINGHAM TE. ECHO virus type 9 associated with three cases simulating meningococcemia. N Engl J Med 1958; 259:484.
  22. CHERRY JD, LERNER AM, KLEIN JO, FINLAND M. Coxsackie A9 infections with exanthems, with particular reference to urticaria. Pediatrics 1963; 31:819.
  23. Marier R, Rodriguez W, Chloupek RJ, et al. Coxsackievirus B5 infection and aseptic meningitis in neonates and children. Am J Dis Child 1975; 129:321.
  24. Wilfert CM, Lauer BA, Cohen M, et al. An epidemic of echovirus 18 meningitis. J Infect Dis 1975; 131:75.
  25. Berlin LE, Rorabaugh ML, Heldrich F, et al. Aseptic meningitis in infants < 2 years of age: diagnosis and etiology. J Infect Dis 1993; 168:888.
  26. Huang C, Morse D, Slater B, et al. Multiple-year experience in the diagnosis of viral central nervous system infections with a panel of polymerase chain reaction assays for detection of 11 viruses. Clin Infect Dis 2004; 39:630.
  27. Rorabaugh ML, Berlin LE, Heldrich F, et al. Aseptic meningitis in infants younger than 2 years of age: acute illness and neurologic complications. Pediatrics 1993; 92:206.
  28. Rotbart HA, Brennan PJ, Fife KH, et al. Enterovirus meningitis in adults. Clin Infect Dis 1998; 27:896.
  29. Fowlkes AL, Honarmand S, Glaser C, et al. Enterovirus-associated encephalitis in the California encephalitis project, 1998-2005. J Infect Dis 2008; 198:1685.
  30. Solomon T, Lewthwaite P, Perera D, et al. Virology, epidemiology, pathogenesis, and control of enterovirus 71. Lancet Infect Dis 2010; 10:778.
  31. Nagy G, Takátsy S, Kukán E, et al. Virological diagnosis of enterovirus type 71 infections: experiences gained during an epidemic of acute CNS diseases in Hungary in 1978. Arch Virol 1982; 71:217.
  32. Shindarov LM, Chumakov MP, Voroshilova MK, et al. Epidemiological, clinical, and pathomorphological characteristics of epidemic poliomyelitis-like disease caused by enterovirus 71. J Hyg Epidemiol Microbiol Immunol 1979; 23:284.
  33. Hayward JC, Gillespie SM, Kaplan KM, et al. Outbreak of poliomyelitis-like paralysis associated with enterovirus 71. Pediatr Infect Dis J 1989; 8:611.
  34. McMinn P, Stratov I, Nagarajan L, Davis S. Neurological manifestations of enterovirus 71 infection in children during an outbreak of hand, foot, and mouth disease in Western Australia. Clin Infect Dis 2001; 32:236.
  35. Chang LY, Tsao KC, Hsia SH, et al. Transmission and clinical features of enterovirus 71 infections in household contacts in Taiwan. JAMA 2004; 291:222.
  36. Chang LY, Huang LM, Gau SS, et al. Neurodevelopment and cognition in children after enterovirus 71 infection. N Engl J Med 2007; 356:1226.
  37. Ayscue P, Van Haren K, Sheriff H, et al. Acute flaccid paralysis with anterior myelitis - California, June 2012-June 2014. MMWR Morb Mortal Wkly Rep 2014; 63:903.
  38. Greninger AL, Naccache SN, Messacar K, et al. A novel outbreak enterovirus D68 strain associated with acute flaccid myelitis cases in the USA (2012-14): a retrospective cohort study. Lancet Infect Dis 2015; 15:671.
  39. Sejvar JJ, Lopez AS, Cortese MM, et al. Acute Flaccid Myelitis in the United States, August-December 2014: Results of Nationwide Surveillance. Clin Infect Dis 2016; 63:737.
  40. Pastula DM, Aliabadi N, Haynes AK, et al. Acute neurologic illness of unknown etiology in children - Colorado, August-September 2014. MMWR Morb Mortal Wkly Rep 2014; 63:901.
  41. Messacar K, Schreiner TL, Maloney JA, et al. A cluster of acute flaccid paralysis and cranial nerve dysfunction temporally associated with an outbreak of enterovirus D68 in children in Colorado, USA. Lancet 2015; 385:1662.
  42. Sklar VE, Patriarca PA, Onorato IM, et al. Clinical findings and results of treatment in an outbreak of acute hemorrhagic conjunctivitis in southern Florida. Am J Ophthalmol 1983; 95:45.
  43. WARIN JF, DAVIES JB, SANDERS FK, VIZOSO AD. Oxford epidemic of Bornholm disease, 1951. Br Med J 1953; 1:1345.
  44. CURNEN EC, SHAW EW, MELNICK JL. Disease resembling nonparalytic poliomyelitis associated with a virus pathogenic for infant mice. J Am Med Assoc 1949; 141:894.
  45. WELLER TH, ENDERS JF, BUCKINGHAM M, FINN JJ Jr. The etiology of epidemic pleurodynia: a study of two viruses isolated from a typical outbreak. J Immunol 1950; 65:337.
  46. Bell EJ, Grist NR. ECHO viruses, carditis, and acute pleurodynia. Am Heart J 1971; 82:133.
  47. Smith WG. Adult heart disease due to the Coxsackie virus group B. Br Heart J 1966; 28:204.
  48. Verma NA, Zheng XT, Harris MU, et al. Outbreak of life-threatening coxsackievirus B1 myocarditis in neonates. Clin Infect Dis 2009; 49:759.
  49. Freund MW, Kleinveld G, Krediet TG, et al. Prognosis for neonates with enterovirus myocarditis. Arch Dis Child Fetal Neonatal Ed 2010; 95:F206.
  50. Centers for Disease Control and Prevention (CDC). Clusters of acute respiratory illness associated with human enterovirus 68--Asia, Europe, and United States, 2008-2010. MMWR Morb Mortal Wkly Rep 2011; 60:1301.
  51. Midgley CM, Jackson MA, Selvarangan R, et al. Severe respiratory illness associated with enterovirus D68 - Missouri and Illinois, 2014. MMWR Morb Mortal Wkly Rep 2014; 63:798.
  52. Modlin JF. Enterovirus déjà vu. N Engl J Med 2007; 356:1204.
  53. Johansson ME, Holmström S, Abebe A, et al. Intrauterine fetal death due to echovirus 11. Scand J Infect Dis 1992; 24:381.
  54. Amstey MS, Miller RK, Menegus MA, di Sant 'Agnese PA. Enterovirus in pregnant women and the perfused placenta. Am J Obstet Gynecol 1988; 158:775.
  55. Modlin JF, Bowman M. Perinatal transmission of coxsackievirus B3 in mice. J Infect Dis 1987; 156:21.
  56. Modlin JF. Fatal echovirus 11 disease in premature neonates. Pediatrics 1980; 66:775.
  57. Modlin JF, Kinney JS. Perinatal enterovirus infections. In: Advances in Pediatric Infectious Diseases, Aronoff SC, Hughes WT, Kohl S (Eds), Year Book Medical Publishers, Chicago Vol 2.
  58. Modlin JF. Perinatal echovirus infection: insights from a literature review of 61 cases of serious infection and 16 outbreaks in nurseries. Rev Infect Dis 1986; 8:918.
  59. Modlin JF, Kinney JS. Perinatal enterovirus infections. In: Advances in Pediatric Infectious Diseases, Aronoff SC, Hughes WT, Kohl S, et al (Eds), Year Book Medical Publishers, Chicago 1987.
  60. Lake AM, Lauer BA, Clark JC, et al. Enterovirus infections in neonates. J Pediatr 1976; 89:787.
  61. Kinney JS, McCray E, Kaplan JE, et al. Risk factors associated with echovirus 11' infection in a hospital nursery. Pediatr Infect Dis 1986; 5:192.
  62. Kaplan MH, Klein SW, McPhee J, Harper RG. Group B coxsackievirus infections in infants younger than three months of age: a serious childhood illness. Rev Infect Dis 1983; 5:1019.
  64. Gear JH, Measroch V. Coxsackievirus infections of the newborn. Prog Med Virol 1973; 15:42.
  65. Chambon M, Delage C, Bailly JL, et al. Fatal hepatic necrosis in a neonate with echovirus 20 infection: use of the polymerase chain reaction to detect enterovirus in liver tissue. Clin Infect Dis 1997; 24:523.
  66. Georgieff MK, Johnson DE, Thompson TR, et al. Fulminant hepatic necrosis in an infant with perinatally acquired echovirus 21 infection. Pediatr Infect Dis J 1987; 6:71.
  67. Spector SA, Straube RC. Protean manifestations of perinatal enterovirus infections. West J Med 1983; 138:847.
  68. Speer ME, Yawn DH. Fatal hepatoadrenal necrosis in the neonate associated with echovirus types 11 and 12 presenting as a surgical emergency. J Pediatr Surg 1984; 19:591.
  69. Wreghitt TG, Gandy GM, King A, Sutehall G. Fatal neonatal echo 7 virus infection. Lancet 1984; 2:465.
  70. Modlin JF, Polk BF, Horton P, et al. Perinatal echovirus infection: risk of transmission during a community outbreak. N Engl J Med 1981; 305:368.
  71. Berry PJ, Nagington J. Fatal infection with echovirus 11. Arch Dis Child 1982; 57:22.
  72. McKinney RE Jr, Katz SL, Wilfert CM. Chronic enteroviral meningoencephalitis in agammaglobulinemic patients. Rev Infect Dis 1987; 9:334.
  73. Aquino VM, Farah RA, Lee MC, Sandler ES. Disseminated coxsackie A9 infection complicating bone marrow transplantation. Pediatr Infect Dis J 1996; 15:1053.
  74. Biggs DD, Toorkey BC, Carrigan DR, et al. Disseminated echovirus infection complicating bone marrow transplantation. Am J Med 1990; 88:421.
  75. Galama JM, de Leeuw N, Wittebol S, et al. Prolonged enteroviral infection in a patient who developed pericarditis and heart failure after bone marrow transplantation. Clin Infect Dis 1996; 22:1004.
  76. O'Neil KM, Pallansch MA, Winkelstein JA, et al. Chronic group A coxsackievirus infection in agammaglobulinemia: demonstration of genomic variation of serotypically identical isolates persistently excreted by the same patient. J Infect Dis 1988; 157:183.
  77. Harvala H, Robertson I, McWilliam Leitch EC, et al. Epidemiology and clinical associations of human parechovirus respiratory infections. J Clin Microbiol 2008; 46:3446.
  78. Harvala H, Wolthers KC, Simmonds P. Parechoviruses in children: understanding a new infection. Curr Opin Infect Dis 2010; 23:224.
  79. Verboon-Maciolek MA, Krediet TG, Gerards LJ, et al. Severe neonatal parechovirus infection and similarity with enterovirus infection. Pediatr Infect Dis J 2008; 27:241.
  80. Wolthers KC, Benschop KS, Schinkel J, et al. Human parechoviruses as an important viral cause of sepsislike illness and meningitis in young children. Clin Infect Dis 2008; 47:358.
  81. Levorson RE, Jantausch BA. Human parechoviruses. Pediatr Infect Dis J 2009; 28:831.
  82. Abed Y, Boivin G. Human parechovirus types 1, 2 and 3 infections in Canada. Emerg Infect Dis 2006; 12:969.
  83. Sharp J, Harrison CJ, Puckett K, et al. Characteristics of young infants in whom human parechovirus, enterovirus or neither were detected in cerebrospinal fluid during sepsis evaluations. Pediatr Infect Dis J 2013; 32:213.
  84. Selvarangan R, Nzabi M, Selvaraju SB, et al. Human parechovirus 3 causing sepsis-like illness in children from midwestern United States. Pediatr Infect Dis J 2011; 30:238.
  85. Harvala H, Robertson I, Chieochansin T, et al. Specific association of human parechovirus type 3 with sepsis and fever in young infants, as identified by direct typing of cerebrospinal fluid samples. J Infect Dis 2009; 199:1753.
  86. Khatami A, McMullan BJ, Webber M, et al. Sepsis-like disease in infants due to human parechovirus type 3 during an outbreak in Australia. Clin Infect Dis 2015; 60:228.
  87. Shoji K, Komuro H, Kobayashi Y, et al. An infant with human parechovirus type 3 infection with a distinctive rash on the extremities. Pediatr Dermatol 2014; 31:258.
  88. Shoji K, Komuro H, Miyata I, et al. Dermatologic manifestations of human parechovirus type 3 infection in neonates and infants. Pediatr Infect Dis J 2013; 32:233.
  89. Levorson RE, Jantausch BA, Wiedermann BL, et al. Human parechovirus-3 infection: emerging pathogen in neonatal sepsis. Pediatr Infect Dis J 2009; 28:545.
  90. Verboon-Maciolek MA, Groenendaal F, Hahn CD, et al. Human parechovirus causes encephalitis with white matter injury in neonates. Ann Neurol 2008; 64:266.
  91. Rotbart HA, Sawyer MH, Fast S, et al. Diagnosis of enteroviral meningitis by using PCR with a colorimetric microwell detection assay. J Clin Microbiol 1994; 32:2590.
  92. Sawyer MH, Holland D, Aintablian N, et al. Diagnosis of enteroviral central nervous system infection by polymerase chain reaction during a large community outbreak. Pediatr Infect Dis J 1994; 13:177.
  93. Pozo F, Casas I, Tenorio A, et al. Evaluation of a commercially available reverse transcription-PCR assay for diagnosis of enteroviral infection in archival and prospectively collected cerebrospinal fluid specimens. J Clin Microbiol 1998; 36:1741.
  94. Rotbart HA, Ahmed A, Hickey S, et al. Diagnosis of enterovirus infection by polymerase chain reaction of multiple specimen types. Pediatr Infect Dis J 1997; 16:409.
  95. Pérez-Vélez CM, Anderson MS, Robinson CC, et al. Outbreak of neurologic enterovirus type 71 disease: a diagnostic challenge. Clin Infect Dis 2007; 45:950.
  96. Holm-Hansen CC, Midgley SE, Fischer TK. Global emergence of enterovirus D68: a systematic review. Lancet Infect Dis 2016; 16:e64.
  97. Mirand A, Henquell C, Archimbaud C, et al. Prospective identification of enteroviruses involved in meningitis in 2006 through direct genotyping in cerebrospinal fluid. J Clin Microbiol 2008; 46:87.
  98. Oberste MS, Maher K, Kilpatrick DR, et al. Typing of human enteroviruses by partial sequencing of VP1. J Clin Microbiol 1999; 37:1288.
  99. Nix WA, Oberste MS, Pallansch MA. Sensitive, seminested PCR amplification of VP1 sequences for direct identification of all enterovirus serotypes from original clinical specimens. J Clin Microbiol 2006; 44:2698.
  100. Nix WA, Maher K, Pallansch MA, Oberste MS. Parechovirus typing in clinical specimens by nested or semi-nested PCR coupled with sequencing. J Clin Virol 2010; 48:202.
  101. Selvaraju SB, Nix WA, Oberste MS, Selvarangan R. Optimization of a combined human parechovirus-enterovirus real-time reverse transcription-PCR assay and evaluation of a new parechovirus 3-specific assay for cerebrospinal fluid specimen testing. J Clin Microbiol 2013; 51:452.
  102. Dagan R, Menegus MA. A combination of four cell types for rapid detection of enteroviruses in clinical specimens. J Med Virol 1986; 19:219.
  103. MELNICK JL, SHAW EW, CURNEN EC. A virus isolated from patients diagnosed as non-paralytic poliomyelitis or aseptic meningitis. Proc Soc Exp Biol Med 1949; 71:344.
  104. GORDON RB, LENNETTE EH, SANDROCK RS. The varied clinical manifestations of Coxsackie virus infections: observations and comments on an outbreak in California. AMA Arch Intern Med 1959; 103:63.
  105. Trabelsi A, Grattard F, Nejmeddine M, et al. Evaluation of an enterovirus group-specific anti-VP1 monoclonal antibody, 5-D8/1, in comparison with neutralization and PCR for rapid identification of enteroviruses in cell culture. J Clin Microbiol 1995; 33:2454.
  106. Bell EJ, McCartney RA, Basquill D, Chaudhuri AK. Mu-antibody capture ELISA for the rapid diagnosis of enterovirus infections in patients with aseptic meningitis. J Med Virol 1986; 19:213.
  107. Pozzetto B, Gaudin OG, Aouni M, Ros A. Comparative evaluation of immunoglobulin M neutralizing antibody response in acute-phase sera and virus isolation for the routine diagnosis of enterovirus infection. J Clin Microbiol 1989; 27:705.
  108. Mease PJ, Ochs HD, Wedgwood RJ. Successful treatment of echovirus meningoencephalitis and myositis-fasciitis with intravenous immune globulin therapy in a patient with X-linked agammaglobulinemia. N Engl J Med 1981; 304:1278.
  109. Rotbart HA, Webster AD, Pleconaril Treatment Registry Group. Treatment of potentially life-threatening enterovirus infections with pleconaril. Clin Infect Dis 2001; 32:228.
  110. Centers for Disease Control and Prevention (CDC). Prolonged poliovirus excretion in an immunodeficient person with vaccine-associated paralytic poliomyelitis. MMWR Morb Mortal Wkly Rep 1997; 46:641.
  111. Johnston JM, Overall JC Jr. Intravenous immunoglobulin in disseminated neonatal echovirus 11 infection. Pediatr Infect Dis J 1989; 8:254.
  112. Yen MH, Huang YC, Chen MC, et al. Effect of intravenous immunoglobulin for neonates with severe enteroviral infections with emphasis on the timing of administration. J Clin Virol 2015; 64:92.
  113. Abzug MJ, Keyserling HL, Lee ML, et al. Neonatal enterovirus infection: virology, serology, and effects of intravenous immune globulin. Clin Infect Dis 1995; 20:1201.
  114. Drucker NA, Colan SD, Lewis AB, et al. Gamma-globulin treatment of acute myocarditis in the pediatric population. Circulation 1994; 89:252.
  115. Bhatt GC, Sankar J, Kushwaha KP. Use of intravenous immunoglobulin compared with standard therapy is associated with improved clinical outcomes in children with acute encephalitis syndrome complicated by myocarditis. Pediatr Cardiol 2012; 33:1370.
  116. McNamara DM, Holubkov R, Starling RC, et al. Controlled trial of intravenous immune globulin in recent-onset dilated cardiomyopathy. Circulation 2001; 103:2254.
  117. Robinson JL, Hartling L, Crumley E, et al. A systematic review of intravenous gamma globulin for therapy of acute myocarditis. BMC Cardiovasc Disord 2005; 5:12.
  118. Collett MS, Hincks JR, Benschop K, et al. Antiviral Activity of Pocapavir in a Randomized, Blinded, Placebo-Controlled Human Oral Poliovirus Vaccine Challenge Model. J Infect Dis 2017; 215:335.
  119. Abzug MJ, Michaels MG, Wald E, et al. A Randomized, Double-Blind, Placebo-Controlled Trial of Pleconaril for the Treatment of Neonates With Enterovirus Sepsis. J Pediatric Infect Dis Soc 2016; 5:53.
  120. Desmond RA, Accortt NA, Talley L, et al. Enteroviral meningitis: natural history and outcome of pleconaril therapy. Antimicrob Agents Chemother 2006; 50:2409.
  121. Ruan F, Yang T, Ma H, et al. Risk factors for hand, foot, and mouth disease and herpangina and the preventive effect of hand-washing. Pediatrics 2011; 127:e898.
  122. Chang SC, Li WC, Huang KY, et al. Efficacy of alcohols and alcohol-based hand disinfectants against human enterovirus 71. J Hosp Infect 2013; 83:288.
  123. Siegel JD, Rhinehart E, Jackson M, Chiarello L, and the Healthcare Infection Control Practices Advisory Committee, 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Healthcare Settings. https://www.cdc.gov/infectioncontrol/guidelines/isolation/ (Accessed on June 23, 2017).
  124. CDC Health Alert Network. Severe respiratory illness associated with enterovirus D68 - Multiple states, 2014. September 12, 2014 http://emergency.cdc.gov/han/han00369.asp (Accessed on September 26, 2014).
  125. Zhu FC, Meng FY, Li JX, et al. Efficacy, safety, and immunology of an inactivated alum-adjuvant enterovirus 71 vaccine in children in China: a multicentre, randomised, double-blind, placebo-controlled, phase 3 trial. Lancet 2013; 381:2024.
  126. Li R, Liu L, Mo Z, et al. An inactivated enterovirus 71 vaccine in healthy children. N Engl J Med 2014; 370:829.
  127. Zhu F, Xu W, Xia J, et al. Efficacy, safety, and immunogenicity of an enterovirus 71 vaccine in China. N Engl J Med 2014; 370:818.
  128. Wei M, Meng F, Wang S, et al. 2-Year Efficacy, Immunogenicity, and Safety of Vigoo Enterovirus 71 Vaccine in Healthy Chinese Children: A Randomized Open-Label Study. J Infect Dis 2017; 215:56.