29 July 2008

Enterovirus in Asia – update 2

As of 23 July 2008, cases of hand, foot and mouth disease (HFMD) caused by Enterovirus 71 (EV-71), continue to be reported from China (including Hong Kong and Macao), Singapore and Taiwan [1-3]. An outbreak has also now been officially recognised in Mongolia [4].

This report updates the previous NaTHNaC Clinical Update on Enterovirus in Asia 5 June 2008.

China

In mainland China, more than 176,000 cases of HFMD were reported during May 2008, with daily reported cases peaking at 11,501  on 14 May; by 5 June, daily reports had declined to 3,922 [1]. The worst hit provinces and regions have been Guangdong, Zhejiang, Hebei, Shangdong and Hunan. In the local media health officials have reported a rise in the number of cases in Jilin province, northeastern China, during the period 1 May to 23 July, bringing the total number of cases to 4,141 [4]. Three deaths have been confirmed in young children and it is reported that all kindergartens in the area have been closed for three weeks [4,5].

Hong Kong and Macao (China)

As of 17 July 2008, there have been 73 confirmed cases of HFMD due to EV-71, reported in Hong Kong [2]. This is an increase on the number of EV-71 cases reported over the past ten years, and further cases are expected to occur during the summer months. Macao reported 395 cases up to 30 June 2008, 56 of which were confirmed to be caused by EV-71 [2].

Singapore

Cases of HFMD in Singapore peaked between the end of April and beginning of May 2008, with over 16,000 cases reported, compared with 11,000 during the same period in 2007 [3]. The outbreak appears to be waning; during the week of 6-12 July, only 293 cases were reported.

Taiwan

An increase in HFMD activity has been reported in Taiwan. As of 17 July 2008, 324 confirmed cases of HFMD were reported, mostly in children aged between one and two years of age [2]. There have been 10 deaths. The majority of the cases were caused by EV-71 and were from the southern areas of the country, with Tainan county most severely affected [6].

Mongolia

An outbreak of HFMD due to EV-71 has been documented since 8 May 2008 [7]. The most affected areas are Ulaanbaatar, the Eastern region (Sukhbaatar, Khentii, and Dornod provinces), the Orkhon-Selenge region (Selenge province), the Gobi or Southern region (Dornogobi province) and the Khangai region (Uvurhangai province). As of 7 July, 2,618 cases have been reported, with 83% of them occurring in children less than 10 years and 10% under 12 months of age. Aid agencies are co-ordinating a country-wide campaign to improve health awareness of good hygiene practices [7].

Malaysia

The media have reported that an average of 138 cases of HFMD have occurred weekly since early 2008, for a total number of cases of 4,017[8].

Advice for travellers

There is no vaccine available to treat HFMD and the only treatment is symptomatic. The risk of transmission can be reduced by taking good personal hygiene precautions, such as:

 

• Wash hands frequently, especially before eating, after using the toilet, and after nappy changes.
• Ensure that contaminated surfaces are cleaned with disinfectant.
• Ensure that contaminated tissues and other materials are disposed of safely.

 

Further information about the transmission and clinical symptoms of HFMD can be found in the NaTHNaC Clinical Update Enterovirus in Asia 7 May 2008

References

1. Chinese Centers for Disease Control and Prevention. Hand, foot and mouth disease in Asia. 16 June 2008 [accessed 17 July 008]. Available at: http://www.chinacdc.net.cn/n272562/n276003/25444.html

2. Centre for Health Protection, Government of the Hong Kong Special Administrative Region. HFMD and EV71 Daily Situation Report; 17 July 2008 [accessed 17 July 2008]. Available at: http://www.chp.gov.hk/files/pdf/HFMD_EV_Daily_Update_08071

7.pdf

3. Ministry of Health Singapore. Weekly Epidemiological Disease Bulletin. 6-12 July 2008 [accessed 17 July 2008]. Available at: http://www.moh.gov.sg/mohcorp/uploadedFiles/Statistics/Infecti

ous_Diseases_Bulletin/2008/2008_week_27.pdf

4. Infectious intestinal deaths on the rise in China, causing three deaths. China View. 25 July 2008 [accessed 29 July 2008]. Available at: http://news.xinhuanet.com/english/2008-07/25/content_8769279.htm

5. Hand-foot-mouth disease kills three children in northeastern China. Epoch Times. 25 July 2008 [accessed 29 July 2008]. Available at: http://en.epochtimes.com/n2/china/hand-foot-mouth-disease-china-1707.html

6. Taiwan Centers for Disease Control. Enterovirus infection with severe complications in Taiwan. 15 July 2008 [accessed 17 July 2008]. Available at: http://www.cdc.gov.tw/ct.asp?xItem=17701&ctNode=2054&mp=5

7. Mongolia: hand, foot and mouth disease. Disaster Relief Emergency Fund operation update. 14 July 2008 [accessed 17 July 2008]. Available at: http://www.reliefweb.int/rw/RWB.NSF/db900SID/ASAZ-7GKCKN?OpenDocument

8. Bernama; Malaysian National News Agency. HFMD outbreak under control despite latest outbreak. 18 July 2008 [accessed 25 July 2008]. Available at: http://www.bernama.com.my/bernama/v3/news.php?id=347064

Links

Singapore Government, Health Promotion Board. Hand, foot and mouth disease