What are enteroviruses?
Enteroviruses are small RNA viruses divided into 5 groups and many types, including Polioviruses (3 types), Coxsackieviruses A (23 types), Coxsackieviruses B (6 types), ECHO viruses (31 types), and Enteroviruses (4 types, EV-68 to EV-71). The enteroviruses that occur in the United States include coxsackieviruses and echoviruses. Polioviruses are also included in the term “enterovirus,” but they have been eradicated from the United States by vaccination. In all, more than 60 different types of enteroviruses have been identified.

How common are infections with these viruses?
Non-polio enteroviruses are second only to the "common cold" viruses, the rhinoviruses, as the most common viral infectious agents in humans. The enteroviruses cause an estimated 10-15 million or more symptomatic infections a year in the United States. All three types of polioviruses have been eliminated from the Western Hemisphere by the widespread use of vaccines.

Can a person develop immunity to these viruses?
Yes, immunity can occur after infection with one of these viruses. However, the immunity is only to one of the enteroviruses. It does not protect against infection from the others.

Who is at risk of infection and illness from these viruses?
Anyone can become infected and ill with these viruses. Infants, children and adolescents are more likely to become ill than are adults. Adults are more likely to be immune to specific enteroviruses than are younger persons.

How does one become infected with one of these viruses?
Enteroviruses can be found in respiratory secretions, such as saliva, sputum or nasal secretions, and in the feces of infected persons. Persons may become infected by direct contact with secretions from an infected person, or by contact with contaminated objects such as drinking and eating utensils. Transmission also may occur if an infected person coughs or sneezes directly in the face of another person. These viruses can be transmitted by contact with feces, such as when persons changing diapers of infants and toddlers do not wash their hands thoroughly. Persons with no symptoms of illness who are infected with an enterovirus can infect other persons who may or may not become ill after they become infected.

What time of year is someone at risk for enteroviruses?
In the United States, infections caused by the enteroviruses are most likely to occur during the summer and fall.

What illnesses do theses viruses cause?
Most people who are infected with an enterovirus have no symptoms at all. For persons who become ill with an enterovirus, most develop symptoms of a cold, an influenza-like illness with fever and muscle aches, or an illness with a rash. Less commonly, some persons develop meningitis caused by an enterovirus. Rarely, enterovirus infections can cause inflammation of the heart muscle or inflamation of the brain.

Are there any long-term complications when a person has meningitis due to an enterovirus infection?
Usually, there are no long-term complications from this mild form of meningitis. Meningitis due to an enterovirus infection resolves on its own and does not require antibiotic treatment.

Are enterovirus infections more common in some years than in others?
Enteroviruses occur more often in individual communities during some years compared to other years. There is no predictable pattern when an individual community will experience an increase in enterovirus infections.

Can enterovirus infections be prevented?
There is no vaccine to prevent the enteroviruses that occur in the United States. Frequent, thorough handwashing will prevent transmission of many infectious diseases, including enterovirus infections. Covering the mouth and nose when coughing or sneezing will also prevent transmission of these viruses. Hands should be washed when they come in contact with oral or nasal secretions or feces, before preparing food and before eating.


Personal hygiene is most important in avoiding the acquisition and transmission of enterovirus infection.
- Wash hands thoroughly before eating, after going to the toilet or handling nappy/excreta.
- Cover mouth and nose when coughing or sneezing.
- Clean thoroughly surfaces of toys and other appliances.
- If a child is suffering from HFMD/herpangina, he/she should stay at home, take adequate rest until the illness is over; refrain from going to school or day-care centres until the illness is over;
avoid sharing of eating utensils among household members; attend Accident and Emergency Department or consult a doctor when the child has any of the following conditions :

- persistent high fever;
- repeated vomiting and poor feeding;
- extreme tiredness and sleepiness;
- irritability;
- abdominal distension;
- urine retention;
- shortness of breath;
- fast heart beat or pulse (>160/min.);
- unsteady gait or limb weakness;
- muscle jerks;
- abnormal eye movement;
- cold sweating and poor circulation.


What are the health care costs of these infections?
The health care costs from enterovirus infections are unknown, but a large portion of the costs may come from use of over-the-counter medications to treat symptoms for millions of cases of "summer colds and flu." There are also significant costs associated with the 30,000 to 50,000 hospitalizations for aseptic meningitis each year in the United States.