Abstract
Introduction: The major burden of diseases in childhood has shifted from infectious diseases to chronic health conditions in recent decades. Although the rates of infectious diseases have decreased, the incidence of chronic diseases stemming from infectious agents continues to grow. Enterovirus is a major infectious disease of childhood and has been linked to numerous chronic diseases. We analyzed population-based data from Taiwan's National Health Insurance Research Database (NHIRD) to investigate the correlations between enterovirus infection and major chronic health conditions in children.Method: Children diagnosed with enterovirus (EV) infection during 1999–2003 were identified from the Longitudinal Health Insurance Database 2000 (LHID 2000), a subdataset of Taiwan's National Health Insurance Research Database (NHIRD). A total of 14,168 patients were selected after excluding patients with existing chronic diseases and missing data. Another 14,168 children matched by age and sex were selected as the control group. Five primary outcomes, including attention deficit and hyperactivity disorder (ADHD), epilepsy, asthma, allergic rhinitis, and atopic dermatitis, were recorded.Results: The risks of ADHD, asthma, allergic rhinitis, and epilepsy were significantly increased in the EV group compared with the control group. The risk of atopic dermatitis was significantly increased in the crude model. However, there were no significant differences in the adjusted model. The risks of ADHD, asthma, allergic rhinitis, and epilepsy were also significantly increased in patients with severe EV infection compared with patients with non-severe EV infection.Conclusion: Chronic diseases, such as ADHD, epilepsy, asthma, allergic rhinitis, and atopic dermatitis were shown to be associated with enterovirus infection during childhood. EV infection during early childhood might have long-term public health implications and thus prevention strategies should be implemented.
Highlights
The major burden of diseases in childhood has shifted from infectious diseases to chronic health conditions in recent decades
Individuals diagnosed with attention deficit and hyperactive disorder (ADHD), epilepsy, atopic diseases, coronary artery disease (CAD), stroke, rheumatoid arthritis (RA), or systemic lupus erythematosus (SLE) before the diagnosis of enterovirus were excluded
Followup was terminated in each cohort when: the study subjects withdrew from the National Health Insurance (NHI) program, a major outcome such as ADHD, epilepsy, asthma, allergic rhinitis, or atopic dermatitis occurred, or until December 31, 2013 was reached, as this was the end of the study period
Summary
The major burden of diseases in childhood has shifted from infectious diseases to chronic health conditions in recent decades. The major burden of disease in children and adolescents has shifted from infectious diseases to chronic health conditions in recent decades [1, 2]. Enteroviruses are among the most common infectious pathogens in infants and children They are associated various clinical presentations from mild to severe illness, including non-specific febrile illness, mucosa-cutaneous presentation (herpangina, hand-foot-mouth disease, conjunctivitis, and various exanthems), CNS involvement (aseptic meningitis, encephalitis, poliomyelitis, Guillain-Barré syndrome, etc.), heart infection (myopericarditis), neonatal infection, and newly recognized clinical syndrome (asthma exacerbation secondary to EV D68 and Eczema Coxsackium) [4, 5]. Enterovirus infection has been shown to have other long-term effects resulting in common health problems, such as allergy diseases, autoimmune diseases, and diseases involving other systems, and for this reason enterovirus infection has become a major public health issue in children [5, 9]
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