News
5 June 2008
Enterovirus in Asia - update
Since January 2008, outbreaks of hand, foot, and mouth disease (HFMD) have been reported in China (including Hong Kong and Macao), Singapore and Taiwan. Local media have also reported outbreaks in Mongolia and Viet Nam [1, 2]. Enterovirus 71 (EV-71) has been documented as the cause of many of these cases, although other strains of enterovirus may also cause HFMD. This report updates the previous report NaTHNaC News item of 7 May 2008.
China
As of 23 May 2008, 10,696 cases including 26 deaths had been reported in Anhui Province, the majority of which were reported from Fuyang City [3]. Between 1 March and 9 May 2008, 6,049 cases were reported in Fuyang City, of which 3,023 required hospitalisation and 22 were fatal [4].
HFMD has been reported in most provinces of mainland China, with 61,459 cases including 38 deaths reported between 1 January and 9 May 2008 [4]. By 14 May 2008, 42 deaths had been reported [5]. Of the 582 laboratory confirmed cases, 52% were due to EV-71 [4].
As of early May 2008, the five most affected provinces were Guangdong, Anhui, Zhejiang, Shandong, and Henan [4].
As of 2 June 2008, 283 cases had also been reported in the Special Administrative Region of Macao [6].
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, the supervision and monitoring of drinking water quality, and a public awareness campaign [4, 7]. The number of cases reported in Anhui is now declining and kindergartens and nurseries in the province are re-opening [3].
Hong Kong (China)
Between 1 January and 4 June 2008, 66 cases of HFMD were reported. Of these, 43 have been confirmed as due to EV-71, one of which resulted in severe complications [8].
Singapore
As of 3 June 2008, 14,063 cases of HFMD had been reported. Thirty-two percent of samples tested during sentinel surveillance were positive for EV-71. The number of new cases reported has decreased weekly since 13 May 2008. A number of preschools and childcare centres have been closed in an effort to control the outbreak [9].
Taiwan
As of 3 June 2008, 132 cases of HFMD due to EV-71 had been reported, including 4 deaths [8].
Advice for travellers
The risk of HFMD 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.
HFMD is a common illness affecting young children and outbreaks frequently occur around the world, particularly during the summer months. Outbreaks are usually associated with kindergarten and school settings, where the virus is easily spread among children.
HFMD is usually a mild infection although in rare cases, meningitis and brain stem complications can occur sometimes resulting in death.
Further information about the transmission and clinical symptoms of HFMD can be found in the NaTHNaC News item of 7 May 2008.
References
1. ProMED-Mail. Hand, foot, and mouth disease – Asia (11), 17 May 2008 [accessed 4 June 2008]. Available at: http://apex.oracle.com/pls/otn/f?p=2400:1202:354069417305023
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2. ProMED-Mail. Hand, foot, and mouth disease – Asia (14), 23 May 2008 [accessed 4 June 2008]. Available at: http://apex.oracle.com/pls/otn/f?p=2400:1001:354069417305023
0::NO::F2400_P1001_BACK_PAGE,F2400_P1001_PUB_MAIL_I
3. Chinese Centre for Disease Control and Prevention. Hand, foot, and mouth disease declining in China’s Anhui Province, 26 May 2008 [accessed 4 June 2008]. Available at: http://www.chinacdc.net.cn/n272562/n276003/24335.html
4. Chinese Centre for Disease Control and Prevention and Office of the World Health Organization in China. Report on the Hand, foot, and mouth disease outbreak in Fuyang City, Anhui Province and prevention and control in China, May 2008 [accessed 5 June 2008]. Available at: http://www.wpro.who.int/NR/rdonlyres/591D6A7B-FB15-4E94-A1E9-1D3381847D60/0/HFMDCCDC20080515ENG.pdf
5. Chinese Centre for Disease Control and Prevention. Viral epidemic retains grip on China with 3 more deaths, 14 May 2008 [accessed 4 June 2008]. Available at: http://www.chinacdc.net.cn/n272562/n276003/23791.html
6. Chinese Centre for Disease Control and Prevention. Macao’s enterovirus cases rise to 283, 2 June 2008 [accessed 4 June 2008]. Available at: http://www.chinacdc.net.cn/n272562/n276003/24784.html
7. World Health Organization. Enterovirus in China. Disease Outbreak News, 1 May 2008 [accessed 6 May 2008]. Available at http://www.who.int/csr/don/2008_05_01/en/index.html
8. Hong Kong Centre for Health Protection. Hand, foot, and mouth disease and enterovirus 71 daily situation update. 4 June 2008 [accessed 4 June 2008]. Available at: http://www.chp.gov.hk/files/pdf/HFMD_EV_Daily_Update_08060
9. Ministry of Health, Singapore. Update on hand, foot, and mouth disease (HFMD) situation in Singapore, 3 June 2008 [accessed 4 June 2008]. Available at: http://www.moh.gov.sg/mohcorp/pressreleases.aspx?id=19204
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