Objective:

To review current evidence on the epidemiology, virology, viral entry mechanisms, virus-host interactions, clinical diagnosis, and management of enterovirus (EV) infections in children.

Approach:

• Epidemiology and Virology: Investigators synthesized recent advances and barriers to diagnosis, treatment, antiviral development, and vaccination across various pediatric EV infections.
• Molecular Testing: Molecular testing, particularly reverse transcription–polymerase chain reaction, has become central to EV diagnosis, with high sensitivity but potential for false negatives due to genetic diversity.
• Clinical Management: Management of EV infections remains primarily supportive and symptomatic, with investigational approaches targeting various viral mechanisms.
• Vaccine Development: The study highlighted the progress and limitations of current vaccines, particularly the inactivated EV-A71 vaccine, and the need for multivalent and broad-spectrum vaccines.

Key Findings:

• EVs account for about 58% of meningitis or encephalitis cases in children.
• Most pediatric patients with EV-related central nervous system disease recover within 3 to 7 days.
• No antiviral drug has been approved for routine clinical use against EV infections.
• The inactivated EV-A71 vaccine has shown over 90% efficacy against severe HFMD but limited efficacy against milder symptoms.

Interpretation:

The diversity and rapid evolution of enteroviruses complicate prevention and control, with significant challenges in developing effective treatments and vaccines.

Limitations:

• Genetic diversity can lead to primer mismatches in molecular testing.
• Limited efficacy and emergence of resistance have stalled clinical development of several antiviral candidates.
• Vaccines for other human EV infections remain unavailable.

Conclusion:

Future research should prioritize broad-spectrum agents with high resistance barriers and acceptable pediatric safety.

Sources:

• Pediatric Investigation