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What Is Enterovirus (Non-Polio Enterovirus Infection)?

Non-polio enteroviruses cause a variety of infections, including aseptic meningitis, hand, foot, and mouth disease, herpangina, and the common cold. Symptoms and signs of enterovirus infection include hypoxia, eye pain, shortness of breath, chest pain, and fever. Treatment involves supportive care to reduce symptoms.
Non-polio enteroviruses cause a variety of infections, including aseptic meningitis, hand, foot, and mouth disease, herpangina, and the common cold. Symptoms and signs of enterovirus infection include hypoxia, eye pain, shortness of breath, chest pain, and fever. Treatment involves supportive care to reduce symptoms.

Human enteroviruses are a genus in the family Picornaviridae (small positive-sense single-stranded RNA viruses) that were originally classified or named as polioviruses, Coxsackie A viruses, Coxsackie B viruses, echoviruses, and enteroviruses. Rhinoviruses are included as enteroviruses by many researchers but not all. There are well over 100 types of known enteroviruses (genus Enterovirus). The virus that causes hand, foot, and mouth disease belongs to the group of so-called non-polio enteroviruses.

These enteroviruses usually spread from person to person by direct contact with the viruses that shed from the gastrointestinal tract or upper respiratory tract. In general, health care providers categorize these viruses as either polio or non-polioviruses. Polioviruses (only three types, P1-3) and non-polioviruses may have similar initial symptoms.

In the majority of infections caused by both polio and non-polioviruses, an infected person may be asymptomatic (not show any symptoms) or only have mild symptoms, including fever, headache, sore throat, loss of appetite, and abdominal discomfort that resolves with no sequelae (complications). However, in some patients, especially children, these infections may cause serious disease that may produce lifelong problems and, infrequently, may cause death.

Recently, non-enterovirus species names were revised to remove host names (human, bovine, simian, and porcine) and replaced with the group designation (A through J) and serotype number. The group is based on the similarity within the RNA region that codes for the outer protein of the virus, and serotype number corresponds to a specific neutralizing serum (antibody). Consequently, human enterovirus 68, for example (also called HEV-68 and ED68) is now termed EV-D68.

There will be confusion and overlap of enterovirus names for the next few years as researchers and clinicians adjust to this extensive name change. In this article, both new and currently accepted names of these viruses and the disease(s) they may cause will be used. For example, Coxsackie viruses could be labeled CV-A4 or CV-B5, depending on their group and/or serotype; similarly, echovirus=E-14 or rhinovirus=RV-A25, RV-B79, or RV-C41.

What types of illnesses do enteroviruses cause?

As stated previously, enteroviruses cause two main types of human disease, polio, and non-polio disease. In this article, the focus will be on the non-polio disease-causing enteroviruses. Non-polio enteroviruses may cause a wide range of infections that overlap. For example:

What are causes and risk factors for an enterovirus infection?

The causes for enterovirus infections are simply the passage of one of the many enteroviruses from one person directly to another, usually by contact with respiratory secretions and/or stool from infected individuals. Occasionally, enteroviruses may contaminate environmental sources such as water. The most common risk factor for getting an enterovirus infection is direct contact with any bodily secretions (especially respiratory and/or fecal) from an infected individual.

Individuals with immature (neonates and infants) or compromised immune systems (for example, children with type 1 diabetes) also are at higher risk for enterovirus infections than normal children or adults. Pregnant females and individuals with respiratory problems like asthma are at higher risk. Individuals are at highest risk during the fall and summer months.

Are enteroviruses contagious?

Yes, enteroviruses are contagious often by direct contact from person to person with respiratory secretions or by contact with fecal material. Some enteroviruses spread indirectly when uninfected people come in contact with food or fluids contaminated by secretions (feces, oral secretions, or droplets) from infected individuals. The viruses are capable of surviving on surfaces like tables and door handles for several days.

What is the incubation period for an enterovirus infection?

The average incubation period (time from exposure to first symptoms) ranges from about three to 10 days. Symptoms, when present in uncomplicated infections, last about a week.

What is the contagious period for an enterovirus infection?

In general, individuals are contagious about three days after exposure to the virus and remain contagious until about 10 days after they develop symptoms. Individuals can shed infectious viruses even if they have no symptoms or during the incubation period and/or after symptoms stop.

What are symptoms and signs of an enterovirus infection in children and adults?

Stated previously, many individuals who become infected with enteroviruses have no or only mild symptoms (fever, headache, sore throat, loss of appetite, and abdominal discomfort, often without diarrhea) of infection that may last about a week and resolve with no further problems. However, those people at higher risk may develop one or more of the following symptoms:

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