Further Inpatient and Outpatient Care
Inpatient care
The course of enterovirus infection widely varies; therefore, each case must be individually handled. Neonatal meningitis and sepsis cases require careful observation for CNS changes. Cultures must be carefully obtained and monitored.
Patients with paralytic poliovirus should be admitted to the intensive care unit (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 provided with 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.
Outpatient care
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 a pediatrician in 1-2 days.
Outpatient medications consist of antipyretics and analgesics to be used as needed.
Transfer
No specific indications for transfer are recognized in patients with enteroviral infections.
Transfer may be needed for lack of an intensive care setting, in such cases as a 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 before transfer.
Deterrence/Prevention
Vaccination
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 oral polio vaccine (OPV), developed by Sabin, consists of live-attenuated poliovirus. OPV creates local community and herd immunity through viral shedding by the intestinal tract and is less invasive. This continues to be used in areas where poliovirus infection persists.
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.
Guidelines for increasing immunization coverage have been established. [37]
Other preventive measures
Frequent handwashing and good hygiene can reduce the risk of acquiring an enteroviral infection.
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Erosions on the base of the tongue.
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A red halo surrounds several vesicles on the finger flexures and palms.
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Small linear vesicle on the thumb.
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Vesicle on the dorsal hand of a young adult.
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Calf blisters from coxsackievirus A6 as seen in atypical hand-foot-mouth disease. Courtesy of Elsevier (Feder HM Jr, Bennett N, Modlin JF. Atypical hand, foot, and mouth disease: a vesiculobullous eruption caused by Coxsackie virus A6. Lancet Infect Dis. Jan 2014;14(1):83-6).
