News
7 May 2008
Enterovirus in Asia
Outbreaks of hand, foot, and mouth disease caused by enterovirus 71 (EV-71) have been reported from three countries in Asia: China, Singapore, and Taiwan.
China
Between the end of March and 29 April 2008, 1,884 cases of hand, foot, and mouth disease were reported in China, including 20 deaths [1]. The number of cases has been increasing rapidly and as of 5 May 2008, over 10,000 cases have been reported in China via various media reports [2,3]. All cases are children under the age of six years with the majority under two years. Enterovirus 71 (EV-71) has been isolated from a number of cases [1].
The most affected region is Anhui province, where 5,151 cases and 22 deaths have been reported, most of them in the city of Fuyang [4]. Other provinces affected include: Guangdong (925 cases and three deaths) [5], Zhejiang (1,198 cases and one death) [3], and Beijing municipality (1,482 cases and no deaths) [3].
In response to this outbreak, Chinese health authorities have put in place targeted prevention and control measures in Anhui Province, including enhanced surveillance, training of health care workers, strengthening of environmental health management, and the supervision and monitoring of drinking water quality. A public awareness campaign is ongoing. Heightened surveillance for cases and severe complications in children is now being implemented in other countries in the World Health Organization Western Pacific region [1].
Singapore
As of 3 May 2008, 10,490 cases of hand, foot, and mouth disease have been reported, only 17 of which required hospitalisation; so far there have been no deaths reported [6]. A number of schools have been closed or ordered to close to allow cleaning in an effort to prevent spread of infection. EV-71 has been isolated in 26% of samples tested during sentinel surveillance.
Taiwan
In January 2008, cases of enterovirus infection were reported after very few had been seen in Taiwan since an outbreak in 2005. As of 5 May 2008, 60 cases of confirmed enterovirus infection with serious complications were reported in 2008 including two deaths. The number of mild infections has not been disclosed [7,8]
Clinical features of hand, foot and mouth disease
The most common causes of hand, foot, and mouth disease are coxsackievirus A16 and EV-71, but other enteroviruses of the same species can also cause the disease.
Hand, foot, and mouth disease caused by EV-71 is a common illness affecting young children and outbreaks frequently occur around the world, particularly during the summer months. Outbreaks involving EV-71 have previously been reported in South East Asia [9-13]. Outbreaks are usually associated with kindergarten and school settings, where the virus is easily spread among children.
Hand, foot, and mouth disease is usually a mild infection presenting with fever, malaise and sore throat, followed by painful lesions in the mouth and a vesicular rash developing on the palms of the hands and the soles of the feet. It is not related to the foot and mouth disease that occurs in animals. It is transmitted from person-to-person by direct contact with nose and throat secretions, saliva, blister fluid, or stools from an infected person; the incubation period is three to seven days. Most patients will recover without medical intervention within seven to ten days, although in rare cases, meningitis and brain stem complications can occur sometimes resulting in death. More detailed information about the clinical features of hand, foot, and mouth disease is available in the NaTHNaC Clinical Update of 14 March 2006 [13].
Advice for travellers
The risk of hand, foot, and mouth disease can be reduced by taking good personal hygiene precautions.
- Wash hands frequently, especially before eating, after using the toilet, and after nappy changes.
- Ensure contaminated surfaces are cleaned with disinfectant.
- Ensure contaminated tissues and other materials are disposed of appropriately.
References
1. World Health Organization. Enterovirus in China. Disease Outbreak News [online] 1 May 2008 [accessed 6 May 2008]. Available at http://www.who.int/csr/don/2008_05_01/en/index.html
2. Times online. Virus epidemic kills 26 toddlers in China, 6 May 2008 [accessed 6 May 2008]. Available at http://www.timesonline.co.uk/tol/news/world/asia/article3876
3. ProMED-mail. Hand, foot and mouth disease - China (05): Beijing, provinces 5 May 2008; Archive No: 20080505.1537 [accessed 6 May 2008] Available at http://www.promedmail.org/pls/otn/f?p=2400:1001:352658243
7495911::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PU
4. Chinese Center for Disease Control and Prevention. China's Anhui sees 622 new EV71 virus cases; total exceeds 5,100 [online] 5 May 2008 [accessed 6 May 2008]. Available at http://www.chinacdc.net.cn/n272562/n276003/23552.html
5. Chinese Center for Disease Control and Prevention. Guangdong reports third child death from EV71 virus [online] 5 May 2008 [accessed 6 May 2008]. Available at http://www.chinacdc.net.cn/n272562/n276003/23553.html
6. Ministry of Health, Singapore. Update On Hand, Foot And Mouth Disease (HFMD) Situation in Singapore (6). Press release [online] 6 May 2008 [accessed 7 May 2008]. Available at http://www.moh.gov.sg/mohcorp/pressreleases.aspx?id=190
7. ProMED-mail. Hand, foot, and mouth disease - Asia (03): China, Taiwan.6 May 2008: 20080506.1553 [accessed 7 May 2008] Available at http://www.promedmail.org/pls/otn/f?p=2400:1001:26155733
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8. Department of Health, Taiwan. The first death due to Enterovirus this year – please pay attention to the signs of severe conditions of Enterovirus infection and seek medical attention on time. Press release [online] 2 May 2008 [accessed 7 May 2008]. Available at http://www.doh.gov.tw/EN2006/Newsroom/Press_list.aspx?ye
9. ProMED-mail. Hand, foot and mouth disease - Malaysia (Sarawak) (02). 2006; 4 March: 20060305.0712 [accessed 6 May 2008] Available at http://www.promedmail.org/pls/otn/f?p=2400:1202:531480284
8235821::NO::F2400_P1202_CHECK_DISPLAY,F2400_P120
10. World Health Organization. Outbreak of hand, foot and mouth disease in Sarawak. Wkly Epid Rec 1997; 28: 211-212. Available at http://www.who.int/docstore/wer/pdf/1997/wer7228.pdf
11. Centers for Disease Control and Prevention. Deaths among children during an outbreak of hand, foot and mouth disease - Taiwan, Republic of China, April - July 1998. MMWR 1998; 47: 629-632. Available at http://www.cdc.gov/mmwr/preview/mmwrhtml/00054640.htm
12. Chan KP, Goh KT, Chong CY, et al. Epidemic hand, foot and mouth disease caused by human enterovirus 71, Singapore. Emerg Infect Dis 2003; 9 (1): 78-85. Available at http://www.cdc.gov/ncidod/eid/vol9no1/02-0112.htm
13. National Travel Health Network and Centre. Hand, Foot and Mouth Disease in Malaysia and Brunei. Clinical update [online] 14 March 2006 [accessed 6 May 2008]. Available at http://www.nathnac.org/pro/clinical_updates/hfmd_140306.htmDisclaimer | Copyright | Privacy | Sitemap | Accessibility