Pediatric Enteroviral Infections Follow-up

Updated: Jun 16, 2017
  • Author: Nicholas John Bennett, MBBCh, PhD, MA(Cantab), FAAP; Chief Editor: Russell W Steele, MD  more...
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Follow-up

Further Outpatient Care

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  • Pediatric patients with nonpolio infections can be discharged if they are not septic and if they do not have symptoms of meningitis. Arrange for follow-up with pediatrician in 1-2 days.
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Further Inpatient Care

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  • The course of enterovirus infection widely varies; therefore, each case must be individually handled. Neonatal meningitis and septic cases require careful observation for CNS changes. Cultures must be carefully obtained and monitored.
  • Patients with paralytic poliovirus should be admitted to the ICU. Ventilatory support should be arranged as needed.
  • Bulbar poliomyelitis involves cranial nerve weakness, respiratory problems, and circulatory problems. These patients should be carefully handled and should be liberally offered ventilatory support.
  • Patients with poliomyelitis who have bladder paresis may require urinary catheterization. Constipation, another effect of poliomyelitis, can be treated with stool softeners and cathartics as needed.
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Inpatient & Outpatient Medications

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  • Outpatient medications consist of antipyretics and analgesics to be used as needed.
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Transfer

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  • No specific indications for transfer are recognized in patients with enteroviral infections.
    • Transfer may be needed for lack of intensive care setting, in such cases as neonatal setting or poliomyelitis.
    • As is the general rule of transfer, the main concern is to ensure airway patency prior to travel. If any question of airway stability is present, the physician should intubate the patient prior to transfer.
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Deterrence/Prevention

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  • All children should receive vaccination for poliovirus. Two forms of the vaccine are available, and both are equally effective in creating immunity.
    • The inactivated poliovirus vaccine, developed by Salk, offers immunity without the risk of vaccine-associated paralytic polio (VAPP). The inactivated poliovirus vaccine is more invasive, which means the child receives more injections.
    • The OPV, developed by Sabin, consists of live-attenuated poliovirus. Oral polio vaccine (OPV) creates local community and herd immunity through viral shedding by the intestinal tract and is less invasive.
    • As of June 1999, recommendations by the Advisory Committee on Immunization Practices (ACIP) suggest inactivated polio vaccine administration. Because of decreased worldwide incidence of polio and likelihood of imported cases, a regimen consisting solely of inactivated polio vaccine has replaced the former combined inactivated polio vaccine and OPV regimen. This change reflects an effort to decrease the cases of vaccine-associated polio. All children should receive the inactivated polio vaccine at age 2 months, age 4 months, age 6-18 months, and age 4-6 years.
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Complications

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  • Both coxsackievirus and enterovirus have been associated with the development of Guillain-Barré syndrome.
  • Coxsackieviruses have been hypothesized to play a role in the development of insulin-dependent diabetes mellitus. Rodent models have demonstrated enteroviral destruction of pancreatic beta-islet cells, but no definitive link has been established. In a 1995 study in Finland, Hyoty et al demonstrated elevated blood levels of enteroviral immunoglobulins in the mothers of children with insulin-dependent diabetes mellitus as compared with pregnant mothers of nondiabetic children. [21]
  • Several studies have investigated a possible link between enteroviral infections and increased risk of myocardial infarction, but no definite conclusions have been proven.
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Prognosis

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  • The prognosis for nonpolio enteroviral infections is excellent. Bad outcomes are specifically related to cases of newborn infections and older children with myocarditis and encephalitis.
  • In most cases of polio, patients have some return of muscle function. Prognosis of final ability is determined 6 months or longer following the infection.
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Patient Education

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  • Frequent handwashing and good hygiene can reduce the risk of acquiring an enteroviral infection.
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