1484. Severe Enterovirus 71 Infections in Children Cambodia, 2012
Session: Poster Abstract Session: Global Health
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Background: Outbreaks of enterovirus 71 (EV71) infections in the Asia-Pacific region have caused disease in children ranging from self-limited febrile illness to fatal neuropulmonary disease, but little is known about risk factors for severe disease.  From April through September 2012, 113 cases of severe illness associated with EV71 infections were reported in Cambodia for the first time.  We investigated to describe severe EV71 disease and generate hypotheses for risk factors. 

Methods: Cases were defined as hospitalized, laboratory-confirmed EV71-positive children <15 years old with fever, neurological and respiratory signs/symptoms within 7 days of illness onset, and were identified through hospital-based reporting or sentinel surveillance.  From September 11–26, 2012, we conducted open-ended interviews (case-patient families, medical providers) and medical record reviews for a convenience sample of cases.

Results: Twenty-nine cases from 12 provinces were investigated through 22 chart reviews and interviews of 25 families, 20 clinics/pharmacies, and 7 physicians.   Although most case-patients presented with symptoms of hand, foot, and mouth disease, the severity of pulmonary manifestations varied widely, ranging from mild upper respiratory symptoms to respiratory failure.  Twelve case-patients died, at least eight were intubated, and 17 were discharged.  The majority of case-patients were male (66%) and had no underlying medical conditions (93%); 28% were underweight for age.  Most resided in rural areas (64%), and the median annual household income was $600.  Although 85% received treatment prior to hospitalization, 67% received medications their primary caretakers could not identify.  No other attributes were identified as potential risk factors for severe disease. 

Conclusion: We describe cases of severe EV71 infections from the first documented outbreak of EV71 disease in Cambodia.  Common features of case-patients included rural residence and receiving unknown medications prior to hospitalization.  Characterizing outpatient prescribing practices and revising surveillance case definitions may be helpful in future efforts to identify risk factors for severe disease.

Brian Rha, MD, MSPH1, Glen Abedi, MPH1, Paul Kitsutani, MD, MPH2, Borann Sar, MD, PhD2, Aun Lor, MPH1, Craig Hales, MD, MPH1, Catherine Chow, MD, MPH1, Susan Gerber, MD1 and Eileen Schneider, MD, MPH1, (1)Centers for Disease Control and Prevention, Atlanta, GA, (2)Centers for Disease Control and Prevention, Cambodia Country Office, Phnom Penh, Cambodia


B. Rha, None

G. Abedi, None

P. Kitsutani, None

B. Sar, None

A. Lor, None

C. Hales, None

C. Chow, None

S. Gerber, None

E. Schneider, None

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