Epidemiology and Clinical Management of Enterovirus Infections

Enteroviruses constitute a diverse group of non-enveloped, positive-strand RNA viruses responsible for a spectrum of diseases ranging from mild febrile illness to severe neurological and cardiopulmonary complications. Human enterovirus A71 (EV-A71), Coxsackievirus A16 and A6 and numerous other serotypes co-circulate worldwide, with seasonal peaks in temperate regions and year-round transmission in tropical zones. Transmission is chiefly faecal–oral or via respiratory droplets, and outbreaks of hand-foot-and-mouth disease (HFMD) and herpangina remain a major cause of paediatric morbidity. Surveillance systems have evolved to incorporate molecular typing and real-time reporting, enabling early detection of emergent strains and guiding vaccine policy. Clinically, most infections are self-limiting and managed with supportive measures such as fluid replacement, analgesia and monitoring for dehydration. Severe cases with neurological involvement or autonomic dysfunction demand intensive care, with intravenous immunoglobulin and management of raised intracranial pressure forming the cornerstone of therapy. Advances in rapid diagnostics, antiviral candidates and vaccine development are gradually reshaping prevention and treatment strategies, yet challenges remain in achieving broad serotype coverage and equitable access in resource-limited settings.

Research from Nature Portfolio

Studies of infection dynamics in human tissue models have revealed that intact EV-A71–infected epithelial cells can be mechanosensitively extruded from the apical surface of differentiated colonic organoids. This process preserves host tissue integrity while allowing protected dissemination of live, virus-laden cells, suggesting an unrecognised route of faecal–oral transmission that may influence outbreak persistence. In parallel, structural investigations of EV-A71 capsids have uncovered a trade-off between particle stability and efficiency of cell entry. A single-point mutation that increases thermal resilience imposes a conformational change, delaying uncoating and reducing infectivity, thereby illuminating the molecular balance viruses strike between environmental survival and host invasion.

Epidemiology and Clinical Management of Enterovirus Infections publication trend

The graph below shows the total number of articles in epidemiology and clinical management of enterovirus infections across all publications each year (not limited to Nature Index journals).

Technical terms

Serotype: a classification of viruses based on distinct antigenic surface proteins.

Basic reproduction number (R0): the average number of secondary infections produced by one case in a fully susceptible population.

Internal ribosome entry site (IRES): an RNA element that directs ribosome recruitment independent of the 5′ cap structure.

Mechanosensitive extrusion: the force-dependent expulsion of infected cells from epithelial layers.

References

1. Mechanosensitive extrusion of Enterovirus A71-infected cells from colonic organoids. Nature Microbiology (2023).
2. A tradeoff between enterovirus A71 particle stability and cell entry. Nature Communications (2023).
3. Hyperglycemia facilitates EV71 replication: Insights into miR-206-mediated regulation of G3BP2 promoting EV71 IRES activity. Theranostics (2024).
4. Current status of hand-foot-and-mouth disease. Journal of Biomedical Science (2023).
5. Advances in anti-EV-A71 drug development research. Journal of Advanced Research (2023).