Table of ContentsView AllTable of ContentsOverviewStrainsWhat Are the Symptoms of Enterovirus?IllnessesHow Do You Get Rid of Enterovirus?Prevention
Table of ContentsView All
View All
Table of Contents
Overview
Strains
What Are the Symptoms of Enterovirus?
Illnesses
How Do You Get Rid of Enterovirus?
Prevention
Enteroviruses(EVs) are a group of viruses that cause a variety of contagious illnesses. At least 106 enteroviruses are known to infect humans. Most enterovirus cases do not cause symptoms, but some have the potential to cause dangerous conditions and diseases, such asencephalitis(inflammation of the brain), andmyocarditis(inflammation of the heart muscle).
This article discusses the causes and symptoms of enterovirus infections, how they are treated, and several ways you can protect yourself from getting sick.
Ariel Skelley / undefined
Overview of Enterovirus Infections
Enterovirus infection is common. Each year in the United States, between 10 and 15 million people have an enterovirus infection. Most people who get infected with these viruses do not get sick.
Enteroviruses can exist in a person’s stool, saliva, mucus, or fluid from blisters. They can also survive on surfaces for several days.
Mothers can also pass an enterovirus to their children during childbirth or breastfeeding.
Even if you have no symptoms, you can be contagious with an enterovirus for several weeks. From the time you are infected, it can take between three days and three weeks before symptoms first appear.
Enterovirus Strains
Some types of enteroviruses may be more likely to cause certain symptoms and illnesses than others. Over 100 strains of enteroviruses have been identified, including the following:
What You Need to Know About the Nervous System
If you have an enterovirus infection, the symptoms you develop largely depend on how the enterovirus strain interacts with your body and how strong yourimmune systemis.
For most people, enterovirus infection causes mild symptoms, if any at all. When symptoms do appear, they may affect one of the following areas:
An enterovirus infection generally begins in your stomach and then moves to your intestines, resulting in mild, flu-like symptoms.
If the virus infects your central nervous system, you can develop serious and life-threatening conditions like paralysis andmeningitis—a condition that causes inflammation around the brain.
Young children and people who are immunocompromised are most likely to develop serious enterovirus complications, as their immune systems are not strong enough to stop enteroviruses from infecting their bloodstream, brain, and other body systems.
Enterovirus Illnesses
Most immune systems are well-equipped to protect against severe enterovirus infections. Certain virus strains may be more likely to cause serious symptoms in children but no symptoms in adults.
More serious enterovirus infections can lead to the following illnesses:
Herpangina
Severe coxsackievirus, echovirus, and enterovirus 71 (EV71) infections are known to causeherpangina. The main symptom of herpangina is blisters that form in the back of the mouth and near the tonsils. Other symptoms include a sore throat and fever.
Children are more likely to develop herpangina than adults. Most of the time, herpangina blisters heal in about a week. Ones that don’t can become chronic ulcers.
How a Sore Throat Is Treated
Hand, Foot, and Mouth Disease
Out of all enteroviruses, coxsackievirus A16 seems to cause hand, foot, and mouth disease most. In 2011, a coxsackievirus A6 outbreak at a daycare caused 99 children to become sick with HFMD, seven of whom needed to be hospitalized.
Acute Hemorrhagic Conjunctivitis
Conjunctivitisis often referred to as pink eye. The symptoms of acute hemorrhagic conjunctivitis (AHC) come on fast and include painful, swollen, and red eyes that water excessively. Symptoms tend to resolve within two weeks at most, usually without long-term eye problems.
Two enteroviruses known for causing AHC are coxsackievirus A24 and enterovirus 70.
Encephalitis
Encephalitisis inflammation of the brain. Symptoms include blindness, coma, seizures, and loss of movement or coordination. Around 10% of people who get encephalitis do not survive.
In Asia, large outbreaks of EV71 that led to encephalitis have cost many children their lives. Some children develop encephalitis of the brainstem, which is considered the most serious form.
Two EV71 vaccines are available in China and have been shown to be effective in preventing encephalitis. There are no FDA-approved vaccines available for use in the United States.
Myopericarditis
Myopericarditisis inflammation of the heart muscle and the sac surrounding the heart—a structure known as thepericardium. The enteroviruses that most often cause it include coxsackieviruses B3 and B2.
Symptoms of myopericarditis include shortness of breath, fatigue, and chest pain. Symptoms can mimic the feeling of having aheart attackand may worsen when lying down.
Some patients who develop severe myopericarditis go intoheart failureas excess fluid builds up in their lungs. This can be life-threatening.
Viral (Aseptic) Meningitis
Meningitis is the inflammation of the membranes that surround the brain and spinal cord. Echoviruses 13, 18, and 30 are most known for causing viral meningitis. Like other enteroviruses, viral meningitis is most likely to occur in young children and people with weakened immune systems.
People with viral meningitis develop tiredness, fever, headache, and sometimes confusion. They may lose consciousness and have impaired function. Mild viral meningitis often resolves on its own within seven to 10 days without treatment.
Prevention of Meningitis
Neonatal Viral Sepsis
Viral sepsisoccurs when the immune system attacks its own tissues rather than the virus. Neonatal viral sepsis (NVS) is sepsis that specifically affects newborns.
Two enteroviruses that are most likely to cause NVS are echoviruses and types of coxsackievirus B.
Signs of sepsis in newborns include difficulty breathing, yellowed skin and eyes (jaundice), trouble feeding, and lethargy.
Pleurodynia
For most adults with pleurodynia, symptoms will resolve within a few days. Pleurodynia infection in children is more serious and can be deadly.
The enteroviruses that are most likely to cause pleurodynia are echoviruses and coxsackieviruses.
EV-D68 Infection
Enterovirus D68 (EV-D68) causes symptoms that are similar to the common cold. In some cases, it can develop into a severe infection that requires hospitalization.
Symptoms of EV-D68 infection include difficulty breathing and wheezing. Children with the infection can become weak in their arms and legs. Eventually, this may lead toacute flaccid paralysis.Fewer than one in four people develop a fever.
Children who have asthma are at a higher risk of complications with EV-D68 infection.
Since most enterovirus infections are mild, doctors don’t typically do lab tests to find out which strain is making you sick. Unless your illness is unusual or severe, your doctor may treat you based on your symptoms.
There is no specific medication that targets enteroviruses themselves. Resting, drinking plenty of fluids, and taking over-the-counter medications can often relieve mild symptoms of enterovirus infections at home.
People who develop meningitis, encephalitis, or viral sepsis may be prescribed antiviral medication to stop the virus from reproducing. Other forms of infection, like EV-D68, may not respond to antiviral medication.
Supportive care is given to hospitalized people whose enterovirus infection does not respond to other treatments. The goal of supportive care is to relieve symptoms until the virus has passed. For example, people with severe respiratory symptoms may be put on aventilatorto help them breathe.
Preventing Enterovirus Infections
The only enterovirus that can be avoided with a vaccine is the poliovirus. There are no vaccines available in the United States to prevent non-polio enterovirus infections.
Without a specific treatment for enteroviruses, the best thing you can do is prevent yourself from coming in contact with them.
First and foremost, wash your hands often—especially before eating, when using a bathroom, changing diapers, or visiting anyone who is ill.
If available, wash your hands with soap and water or carry an alcohol-based hand sanitizer with you. Avoid shaking hands as much as possible and try not to touch your face.
Keep in mind that you can have an enterovirus infection and not know it. Furthermore, the same virus that gives you cold-like symptoms may cause severe symptoms in animmunocompromisedindividual you come in contact with.
For your own health and out of courtesy to others, wash your hands often whether you feel sick or not. Remember to cover your coughs and sneezes with a tissue or your upper sleeve, and keep surfaces around your home and workspace clean.
An Overview of Airborne Viruses
Summary
Enterovirus infections are common, but they don’t always cause symptoms. Young children and people with weakened immune systems are most likely to develop serious illnesses if the virus infects their central nervous system.
Coxsackievirus Infections
26 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Brouwer L, Moreni G, Wolthers K, Pajkrt D.World-wide prevalence and genotype distribution of enteroviruses.Viruses. 2021 Mar;13(3):434. doi:10.3390/v13030434Centers for Disease Control and Prevention.About non-polio enteroviruses.Centers for Disease Control and Prevention.How it spreads.Harvala H, Broberg E, Benschop K, et al.Recommendations for enterovirus diagnostics and characterisation within and beyond Europe.J Clin Virol. 2018 Apr;101(1):11-17. doi:10.1016/j.jcv.2018.01.008Centers for Disease Control and Prevention.Common cold.Lugo D, Krogstad P.Enteroviruses in the early 21st century: new manifestations and challenges.Curr Opin Pediatr. 2016 Feb;28(1):107-113. doi:10.1097/MOP.0000000000000303Wells AI, Coyne CB.Enteroviruses: A gut-wrenching game of entry, detection, and evasion.Viruses. 2019 May;11(5):460. doi:10.3390/v11050460Centers for Disease Control and Prevention.Viral meningitis.Centers for Disease Control and Prevention.Who is at risk.Mount Sinai.Herpangina.Stanford Children’s Health.Herpangina in children.Centers for Disease Control and Prevention.HFMD symptoms and complications.Centers for Disease Control and Prevention.Hand, foot, and mouth disease outbreak and Coxsackievirus A6, northern Spain, 2011.Langford MP, Anders EA, Burch MA.Acute hemorrhagic conjunctivitis: anti-coxsackievirus A24 variant secretory immunoglobulin A in acute and convalescent tear.Clin Ophthalmol. 2015 Sep;9(1):1665-1673. doi:10.2147/OPTH.S85358Frederick D.81 - conjunctivitis beyond the neonatal period. In:Principles and Practice of Pediatric Infectious Diseases (Fifth Edition). 2018;5(1):501-505. doi:10.1016/B978-0-323-40181-4.00081-5Johns Hopkins Medicine.Encephalitis.Yeon Lee K.Enterovirus 71 infection and neurological complications.Korean J Pediatr. 2016 Oct;59(10):395-401. doi:10.3345/kjp.2016.59.10.395Li J, Yin X, Lin A, et al.EV71 vaccination impact on the incidence of encephalitis in patients with hand, foot, and mouth disease.Hum Vaccin Immunother. 2021 Jul;17(7):2097-2100. doi:10.1080/21645515.2020.1851129Persichino J, Garrison R, Krishnan R, Sutjita M.Effusive-constrictive pericarditis, hepatitis, and pancreatitis in a patient with possible coxsackievirus B infection: a case report.BMC Infect Dis. 2016 Aug;16(1):1-6. doi:10.1186/s12879-016-1752-3American Heart Association.Pericarditis.Cedars Sinai.Pericardial effusion.Chuang YY, Huang YC.Enteroviral infection in neonates.JMicrobiol Immunol Infect. 2019 Dec;52(6):851-857. doi:10.1016/j.jmii.2019.08.018Cleveland Clinic.Sepsis in newborns.Messacar K, Modlin J, Abzug M.236 - Enteroviruses and parechoviruses. In:Principles and Practices of Pediatric Infectious Diseases. 2018;5(1):1205-1213. doi:10.1016/B978-0-323-40181-4.00236-XLal A, Akhtar J, Isaac S, et al.Unusual cause of chest pain, Bornholm disease, a forgotten entity; case report and review of literature.Respir Med Case Rep. 2018 Oct;25(1):270-273. doi:10.1016/j.rmcr.2018.10.005Centers for Disease Control and Prevention.Enterovirus D68.
26 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Brouwer L, Moreni G, Wolthers K, Pajkrt D.World-wide prevalence and genotype distribution of enteroviruses.Viruses. 2021 Mar;13(3):434. doi:10.3390/v13030434Centers for Disease Control and Prevention.About non-polio enteroviruses.Centers for Disease Control and Prevention.How it spreads.Harvala H, Broberg E, Benschop K, et al.Recommendations for enterovirus diagnostics and characterisation within and beyond Europe.J Clin Virol. 2018 Apr;101(1):11-17. doi:10.1016/j.jcv.2018.01.008Centers for Disease Control and Prevention.Common cold.Lugo D, Krogstad P.Enteroviruses in the early 21st century: new manifestations and challenges.Curr Opin Pediatr. 2016 Feb;28(1):107-113. doi:10.1097/MOP.0000000000000303Wells AI, Coyne CB.Enteroviruses: A gut-wrenching game of entry, detection, and evasion.Viruses. 2019 May;11(5):460. doi:10.3390/v11050460Centers for Disease Control and Prevention.Viral meningitis.Centers for Disease Control and Prevention.Who is at risk.Mount Sinai.Herpangina.Stanford Children’s Health.Herpangina in children.Centers for Disease Control and Prevention.HFMD symptoms and complications.Centers for Disease Control and Prevention.Hand, foot, and mouth disease outbreak and Coxsackievirus A6, northern Spain, 2011.Langford MP, Anders EA, Burch MA.Acute hemorrhagic conjunctivitis: anti-coxsackievirus A24 variant secretory immunoglobulin A in acute and convalescent tear.Clin Ophthalmol. 2015 Sep;9(1):1665-1673. doi:10.2147/OPTH.S85358Frederick D.81 - conjunctivitis beyond the neonatal period. In:Principles and Practice of Pediatric Infectious Diseases (Fifth Edition). 2018;5(1):501-505. doi:10.1016/B978-0-323-40181-4.00081-5Johns Hopkins Medicine.Encephalitis.Yeon Lee K.Enterovirus 71 infection and neurological complications.Korean J Pediatr. 2016 Oct;59(10):395-401. doi:10.3345/kjp.2016.59.10.395Li J, Yin X, Lin A, et al.EV71 vaccination impact on the incidence of encephalitis in patients with hand, foot, and mouth disease.Hum Vaccin Immunother. 2021 Jul;17(7):2097-2100. doi:10.1080/21645515.2020.1851129Persichino J, Garrison R, Krishnan R, Sutjita M.Effusive-constrictive pericarditis, hepatitis, and pancreatitis in a patient with possible coxsackievirus B infection: a case report.BMC Infect Dis. 2016 Aug;16(1):1-6. doi:10.1186/s12879-016-1752-3American Heart Association.Pericarditis.Cedars Sinai.Pericardial effusion.Chuang YY, Huang YC.Enteroviral infection in neonates.JMicrobiol Immunol Infect. 2019 Dec;52(6):851-857. doi:10.1016/j.jmii.2019.08.018Cleveland Clinic.Sepsis in newborns.Messacar K, Modlin J, Abzug M.236 - Enteroviruses and parechoviruses. In:Principles and Practices of Pediatric Infectious Diseases. 2018;5(1):1205-1213. doi:10.1016/B978-0-323-40181-4.00236-XLal A, Akhtar J, Isaac S, et al.Unusual cause of chest pain, Bornholm disease, a forgotten entity; case report and review of literature.Respir Med Case Rep. 2018 Oct;25(1):270-273. doi:10.1016/j.rmcr.2018.10.005Centers for Disease Control and Prevention.Enterovirus D68.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Brouwer L, Moreni G, Wolthers K, Pajkrt D.World-wide prevalence and genotype distribution of enteroviruses.Viruses. 2021 Mar;13(3):434. doi:10.3390/v13030434Centers for Disease Control and Prevention.About non-polio enteroviruses.Centers for Disease Control and Prevention.How it spreads.Harvala H, Broberg E, Benschop K, et al.Recommendations for enterovirus diagnostics and characterisation within and beyond Europe.J Clin Virol. 2018 Apr;101(1):11-17. doi:10.1016/j.jcv.2018.01.008Centers for Disease Control and Prevention.Common cold.Lugo D, Krogstad P.Enteroviruses in the early 21st century: new manifestations and challenges.Curr Opin Pediatr. 2016 Feb;28(1):107-113. doi:10.1097/MOP.0000000000000303Wells AI, Coyne CB.Enteroviruses: A gut-wrenching game of entry, detection, and evasion.Viruses. 2019 May;11(5):460. doi:10.3390/v11050460Centers for Disease Control and Prevention.Viral meningitis.Centers for Disease Control and Prevention.Who is at risk.Mount Sinai.Herpangina.Stanford Children’s Health.Herpangina in children.Centers for Disease Control and Prevention.HFMD symptoms and complications.Centers for Disease Control and Prevention.Hand, foot, and mouth disease outbreak and Coxsackievirus A6, northern Spain, 2011.Langford MP, Anders EA, Burch MA.Acute hemorrhagic conjunctivitis: anti-coxsackievirus A24 variant secretory immunoglobulin A in acute and convalescent tear.Clin Ophthalmol. 2015 Sep;9(1):1665-1673. doi:10.2147/OPTH.S85358Frederick D.81 - conjunctivitis beyond the neonatal period. In:Principles and Practice of Pediatric Infectious Diseases (Fifth Edition). 2018;5(1):501-505. doi:10.1016/B978-0-323-40181-4.00081-5Johns Hopkins Medicine.Encephalitis.Yeon Lee K.Enterovirus 71 infection and neurological complications.Korean J Pediatr. 2016 Oct;59(10):395-401. doi:10.3345/kjp.2016.59.10.395Li J, Yin X, Lin A, et al.EV71 vaccination impact on the incidence of encephalitis in patients with hand, foot, and mouth disease.Hum Vaccin Immunother. 2021 Jul;17(7):2097-2100. doi:10.1080/21645515.2020.1851129Persichino J, Garrison R, Krishnan R, Sutjita M.Effusive-constrictive pericarditis, hepatitis, and pancreatitis in a patient with possible coxsackievirus B infection: a case report.BMC Infect Dis. 2016 Aug;16(1):1-6. doi:10.1186/s12879-016-1752-3American Heart Association.Pericarditis.Cedars Sinai.Pericardial effusion.Chuang YY, Huang YC.Enteroviral infection in neonates.JMicrobiol Immunol Infect. 2019 Dec;52(6):851-857. doi:10.1016/j.jmii.2019.08.018Cleveland Clinic.Sepsis in newborns.Messacar K, Modlin J, Abzug M.236 - Enteroviruses and parechoviruses. In:Principles and Practices of Pediatric Infectious Diseases. 2018;5(1):1205-1213. doi:10.1016/B978-0-323-40181-4.00236-XLal A, Akhtar J, Isaac S, et al.Unusual cause of chest pain, Bornholm disease, a forgotten entity; case report and review of literature.Respir Med Case Rep. 2018 Oct;25(1):270-273. doi:10.1016/j.rmcr.2018.10.005Centers for Disease Control and Prevention.Enterovirus D68.
Brouwer L, Moreni G, Wolthers K, Pajkrt D.World-wide prevalence and genotype distribution of enteroviruses.Viruses. 2021 Mar;13(3):434. doi:10.3390/v13030434
Centers for Disease Control and Prevention.About non-polio enteroviruses.
Centers for Disease Control and Prevention.How it spreads.
Harvala H, Broberg E, Benschop K, et al.Recommendations for enterovirus diagnostics and characterisation within and beyond Europe.J Clin Virol. 2018 Apr;101(1):11-17. doi:10.1016/j.jcv.2018.01.008
Centers for Disease Control and Prevention.Common cold.
Lugo D, Krogstad P.Enteroviruses in the early 21st century: new manifestations and challenges.Curr Opin Pediatr. 2016 Feb;28(1):107-113. doi:10.1097/MOP.0000000000000303
Wells AI, Coyne CB.Enteroviruses: A gut-wrenching game of entry, detection, and evasion.Viruses. 2019 May;11(5):460. doi:10.3390/v11050460
Centers for Disease Control and Prevention.Viral meningitis.
Centers for Disease Control and Prevention.Who is at risk.
Mount Sinai.Herpangina.
Stanford Children’s Health.Herpangina in children.
Centers for Disease Control and Prevention.HFMD symptoms and complications.
Centers for Disease Control and Prevention.Hand, foot, and mouth disease outbreak and Coxsackievirus A6, northern Spain, 2011.
Langford MP, Anders EA, Burch MA.Acute hemorrhagic conjunctivitis: anti-coxsackievirus A24 variant secretory immunoglobulin A in acute and convalescent tear.Clin Ophthalmol. 2015 Sep;9(1):1665-1673. doi:10.2147/OPTH.S85358
Frederick D.81 - conjunctivitis beyond the neonatal period. In:Principles and Practice of Pediatric Infectious Diseases (Fifth Edition). 2018;5(1):501-505. doi:10.1016/B978-0-323-40181-4.00081-5
Johns Hopkins Medicine.Encephalitis.
Yeon Lee K.Enterovirus 71 infection and neurological complications.Korean J Pediatr. 2016 Oct;59(10):395-401. doi:10.3345/kjp.2016.59.10.395
Li J, Yin X, Lin A, et al.EV71 vaccination impact on the incidence of encephalitis in patients with hand, foot, and mouth disease.Hum Vaccin Immunother. 2021 Jul;17(7):2097-2100. doi:10.1080/21645515.2020.1851129
Persichino J, Garrison R, Krishnan R, Sutjita M.Effusive-constrictive pericarditis, hepatitis, and pancreatitis in a patient with possible coxsackievirus B infection: a case report.BMC Infect Dis. 2016 Aug;16(1):1-6. doi:10.1186/s12879-016-1752-3
American Heart Association.Pericarditis.
Cedars Sinai.Pericardial effusion.
Chuang YY, Huang YC.Enteroviral infection in neonates.JMicrobiol Immunol Infect. 2019 Dec;52(6):851-857. doi:10.1016/j.jmii.2019.08.018
Cleveland Clinic.Sepsis in newborns.
Messacar K, Modlin J, Abzug M.236 - Enteroviruses and parechoviruses. In:Principles and Practices of Pediatric Infectious Diseases. 2018;5(1):1205-1213. doi:10.1016/B978-0-323-40181-4.00236-X
Lal A, Akhtar J, Isaac S, et al.Unusual cause of chest pain, Bornholm disease, a forgotten entity; case report and review of literature.Respir Med Case Rep. 2018 Oct;25(1):270-273. doi:10.1016/j.rmcr.2018.10.005
Centers for Disease Control and Prevention.Enterovirus D68.
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