Hand, foot and mouth disease is usually caused by either coxsackievirus A16 or enterovirus 71 (EV71). Coxsackievirus A16 infection usually causes mild disease. Outbreaks of severe, and sometimes fatal, hand, foot and mouth disease with encephalitis and myocarditis have been reported from Bulgaria, Hungary, Malaysia, Singapore and Taiwan. These severe outbreaks have been related to EV71. A follow-up study in Taiwan (

) has shown that neurological development is particularly impaired in children who develop cardiopulmonary failure after CNS involvement in the acute phase of EV71 …