Clinical Updates
28 September 2011
Hand, foot and mouth disease: East and South East Asia, 2011
In 2011 there has been an increase in the number of cases of hand, foot and mouth disease (HFMD) in East and South East Asia [1]. There has been high activity in Viet Nam, Japan, Democratic People's Republic of Korea, China (including mainland China and Macao) [1-3]. Hong Kong (China) and Singapore report ongoing activity [1].
An enterovirus, strain EV71, has been isolated as the causative agent for most of the outbreaks. HFMD caused by EV71 can result in higher numbers of severe and fatal cases compared with most other types of enteroviruses. [1].
Viet Nam
Since January 2011, a total of 42,673 cases have been reported from 49 provinces, mostly from the southern part of the country. There have been 98 deaths, mostly in children aged three years or younger. The World Health Organization and the US Centers for Disease Control and Prevention are supporting Viet Nam’s efforts to control this outbreak. These efforts include a nationwide public awareness campaign and training in surveillance, prevention and control for medical staff and pre-school teachers [2].
China
Mainland China: As of 14 September, a total of 1,096,966 cases of HFMD, including 365 deaths, were reported, with a peak of cases in June. This is less than the same time period in 2010 (1,465,600 cases) [1, 3].
Hong Kong (China): The usual peak season for HFMD in Hong Kong is from May to July with smaller winter peaks between October and December [4]. As of 14 September, 294 hospitalised cases have been reported [1]. Outbreaks have occurred in childcare facilities. The general public and parents of children attending nurseries and schools have been advised to observe strict personal and environmental hygiene to limit disease transmission [5].
Macao (China): As of 14 September, 914 cases have been reported compared to 748 cases for the same period in 2010 [1].
Japan
As of 14 September, 251,980 cases have been reported. This is nearly double the number of cases (126,113) reported for the same period in 2010 [1].
Democratic People's Republic of Korea
As of 4 September, the incidence rate of 11.4 HFMD cases/1,000 population has more than doubled compared with the rate for the same period in 2010 (4.8 HFMD cases/1,000) [1].
Singapore
As of 14 September, 12,300 cases have been reported. This is a decrease compared to the 22,503 cases reported for the same time period in 2010 [1].
Thailand
A total of 11,127 cases and four deaths were reported from 76 provinces between 1 January and 12 September, with the highest number of cases in the central region (5,120 cases) [6]. The majority of cases were reported in children age between one and three years.
Advice for travellers:
The risk of HFMD to travellers is low. Those at greater risk include children attending nursery or schools during outbreaks, those working in such establishments and their close contacts, or those visiting and staying with friends and relatives.
HFMD is a common illness usually affecting young children. Outbreaks frequently occur around the world, particularly in the summer months in temperate regions. Outbreaks are often associated with school settings, where the virus is easily spread amongst children from contact with infective saliva, blister fluid or stools [7].
The disease is caused by an enterovirus, often EV-71 or Coxsackievirus A16 . Although the infection may be asymptomatic, these viruses are also associated with outbreaks in which a larger-than-usual number of patients develop clinical disease [8].
HFMD is usually mild and presents after an incubation period of three to five days, with fever, malaise and sore throat. This is followed by painful mouth lesions and a vesicular rash on the palms, fingers, feet and occasionally the buttocks [7]. Rarely, serious complications such as aseptic meningitis and brain stem complications can occur, which can be fatal [8].
The risk of HFMD can be reduced by practising good personal hygiene precautions:
Wash hands frequently, especially before eating, after using the toilet, and after nappy changes.
Any contaminated surfaces should be cleaned with disinfectant and contaminated tissues and other materials disposed of appropriately.
Children should be kept away from school or nursery until they have fully recovered.
There is no vaccine to protect against HFMD and the only treatment is symptomatic.
References
1. World Health Organization, Western Pacific Region. Overview of Hand, Foot and Mouth disease (HFMD) Situation Update. 14 September 2011. [Accessed 28 September 2011]. Available at:
http://www.wpro.who.int/health_topics/hfmd/
2. World Health Organization Representative Office in Viet Nam. Hand, Foot and Mouth Disease in Viet Nam. 07 September 2011. [Accessed 28 September 2011]. Available at:
http://www.wpro.who.int/vietnam/media_centre/press_
3. World Health Organization, Western Pacific Region. Emerging disease surveillance and response. Risk Assessment of EV71 for the Western Pacific Regions. Undated. [Accessed 28 September 2011]. Available at:
http://www.wpro.who.int/sites/csr/data/RAEV71inWPR.htm
4. The Centre for Health Protection, Department of Health, Government of Hong Kong Special Administrative Region. Hand, Foot and Mouth Disease. EV Scan (Week 39, September 23, 2011. [Accessed 28 September 2011]. Available at: http://www.chp.gov.hk/files/pdf/ev_scan_wk39_2011.pdf
5. The Centre for Health Protection, Department of Health, Government of Hong Kong Special Administrative Region. Public urged to prevent EV71 infection and HFMD. 22 August 2011. [Accessed 28 September 2011]. Available at:
http://www.chp.gov.hk/en/content/586/23712.html
6. Thai Ministry of Public Health, Bureau of Epidemiology's (BOE). Weekly Epidemiological Surveillance Report. 23 September 2011. [Accessed 28 September 2011]. Available at: http://epid.moph.go.th/wesr/file/y54/H54372011-09-112011-09-17.pdf
7. Health Protection Agency. Essex Health Protection Unit. Factsheet on Hand, Foot and Mouth disease. Last reviewed December 2010. [Accessed 28 September. 2011]. Available at: http://www.hpa.org.uk/web/HPAwebFile/HPAweb_C/
8. Centers for Disease Control and Prevention. Division of Viral Disease. Hand, foot and mouth disease. Last reviewed: 14 March 2011. [Accessed 28 September 2011]. Available at:
http://www.cdc.gov/ncidod/dvrd/revb/enterovirus/hfhf.htm
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