Recent advances in the molecular epidemiology and control of human enterovirus 71 infection

► Human enterovirus 71 has emerged as a major cause of viral encephalitis in the Southeast Asia over the past fifteen years. ► Increased epidemic activity of HEV71 is associated with the regular emergence of new genetic lineages. ► The reason for this increase in HEV71 circulation remains unknown. ► Prevention of HEV71 epidemics is likely to require the development of an effective vaccine. ► Several candidate EV71 vaccines have recently been reported, several of which have been shown to be effective in animal models. Human enterovirus 71 (HEV71) has emerged as an important cause of viral encephalitis in the Southeast Asia over the past 15 years. A pattern of increased epidemic activity and endemic circulation of HEV71 has been observed since 1997 and is associated with the regular emergence of new genetic lineages. Although the reason for this increase in HEV71 circulation remains unknown, evidence is accumulating that recombination events may drive the evolution of new genetic lineages. Prevention of HEV71 epidemics is likely to require the development of an effective vaccine. Fortunately, several candidate EV71 vaccines have recently been reported, several of which have been shown to be effective in animal models and commenced clinical trial in 2010. Furthermore, ongoing investigations into the molecular basis of HEV71 infection and virulence have pointed the way towards novel approaches to live attenuated vaccine development.