Fig. 6. Model for implications of infected cell extrusion on EV-A71 spread.

EV-A71-infected cells extruded from the colon into the gastrointestinal lumen may play an integral role in faecal–oral transmission. When cells carrying infectious virus are extruded, progeny virions are expected to transit through the gut and be excreted in stool within live extruded cells. Within cells, virions may be protected from intestinal contents such as mucosal antibodies. Within-cell bundling of virions might additionally facilitate en bloc transmission, allowing for viral genomic diversity to be maintained. The potential for host benefits of infected cell extrusion in vivo such as quicker viral clearance or improved tolerance to infection remain intriguing open questions for further study.