Non-polio Enteroviruses (NPEV's) - of which there are dozens - typically spread in the summer and early fall, and generally produce mild or even asymptomatic infections, mostly in children under the age of 10.
Symptomatic cases can range from a mild fever or a runny nose - to HFMD (Hand Foot Mouth Disease) - a generally mild childhood disease characterized by blisters on the hand, feet, and mouth.In North America HFMD is usually caused by the Coxsackie A16 virus, or less commonly, the Coxsackie A10 virus. In recent years, we’ve also seen the emergence of the Coxsackie A6 virus (see MMWR: Coxsackievirus A6 Notes From The Field) which has been associated with more severe illness.
For several decades - particularly in Asian and Western Pacific nations - we've monitored yearly NPEV epidemics of a much more serious nature, with the most severe illness linked to Human Enterovirus 71 (EV-71), which can cause a polio-like paralysis, and sometimes even death.
Other NPEV's, including EV-D68 and Coxsackievirus A6 are also linked to more severe disease. But in terms of the number of severe cases, EV-71 is currently the biggest threat.Yesterday Hong Kong's CHP released their latest EV Scan (Week 21, May 24, 2018), which shows a sharp uptick in the number of EV71 cases in the region during the month of May.
EVSCAN (Week 21)
As of May 24, 2018
EV SCAN is a weekly report produced by the Enteric and Vector-borne Disease Office of the Centre for Health Protection, Department of Health. It summarises the surveillance findings of local situation of hand, foot and mouth disease (HFMD) and enterovirus 71 (EV71) infection.
- The activity of hand, foot and mouth disease (HFMD) is increasing in Hong Kong
- In Hong Kong, the usual peak season for HFMD and EV71 infection is from May to July. A smaller peak may also occur from October to December.
- HFMD is a common disease in children usually caused by enteroviruses such as Coxsackieviruses and EV71. EV71 infection is of particular concern as it is more likely to be associated with severe medical complications and even death.
Today the CHP issued the following statement:
Heightened vigilance urged amid increasing activity of hand, foot and mouth disease and enterovirus 71 infectionThe Centre for Health Protection (CHP) of the Department of Health today (May 25) urged the public to maintain strict personal and environmental hygiene as the local activity of hand, foot and mouth disease (HFMD) and enterovirus (EV) 71 infection has been increasing in the past two weeks.
According to the CHP's surveillance data, the number of institutional HFMD outbreaks recorded increased from five (affecting 23 persons) to 14 (affecting 60 persons) from the week of May 6 to that of May 13. As of yesterday (May 24), 15 outbreaks involving 59 persons had been reported this week. In the last four weeks, most outbreaks occurred in kindergartens and child care centres as well as primary schools.While EV-71 continues to have its biggest impact in Asia and the Eastern Pacific, in recent years we've seen an increasing number of outbreaks in Europe (see ECDC Rapid Risk Assessment Of EV-71 Outbreak In Spain), and there are no guarantees that this virus won't become a bigger factor in Europe of North America in the years ahead.
As for EV71 infection, while only one case of infection was recorded per month in February and March this year, the number of cases increased to seven in May. As of yesterday, nine cases had been recorded this year.
"HFMD occurs throughout the year. Apart from a summer peak from May to July, a smaller peak may also occur from October to December. As young children are more susceptible, parents should stay alert to their health. Institutional outbreaks may occur where HFMD can easily spread among young children with close contact," a spokesman for the CHP said.
"We have issued letters to doctors, child care centres, kindergartens and primary and secondary schools to alert them to the latest situation. Schools are reminded to follow the Guidelines on Prevention of Communicable Diseases on preventive and control measures as well as management of outbreaks, which should be reported to the CHP for prompt follow-up," the spokesman added.
Management of venues with play facilities should pay special attention to the CHP's Public Health Advice for Play Facilities on appropriate infection control in activities involving young children under 6 during the peak season.
"We noted that HFMD activity in neighbouring areas such as Guangdong and Taiwan has also increased recently. Parents travelling with their children in the coming holidays or summer vacation should pay special attention to personal and environmental hygiene while attending play facilities or having close contact with other children," the spokesman added.
To prevent HFMD, members of the public, and especially the management of institutions, should take heed of the following preventive measures:
The CHP's weekly report, EV SCAN (www.chp.gov.hk/en/view_content/21639.html), is issued every Friday to report the latest local situation of HFMD. The public may also visit the CHP's page on HFMD and EV71 infection for more information.
- Maintain good air circulation;
- Wash hands before meals and after going to the toilet or handling diapers or other stool-soiled materials;
- Keep hands clean and wash hands properly, especially when they are dirtied by respiratory secretions, such as after sneezing;
- Cover the nose and mouth while sneezing or coughing and dispose of nasal and oral discharges properly;
- Clean children's toys and other objects thoroughly and frequently with diluted household bleach (by adding one part of household bleach containing 5.25 per cent sodium hypochlorite to 99 parts of water), followed by rinsing or wiping with clean water;
- Children who are ill should be kept out of school until their fever and rash have subsided and all the vesicles have dried and crusted;
- Avoid going to overcrowded places; and
- Parents should maintain close communication with schools to let them know the latest situation of the sick children.
Ends/Friday, May 25, 2018Issued at HKT 19:05
Among the challenges of controlling EV71 outbreaks are:
- No currently available vaccine (outside of China).
- EV-71 is a moving viral target, with new strains evolving and emerging over time
- Many children can carry (and shed) the virus asymptomatically (see Incidence Rates of Enterovirus 71 Infections in Young Children during a Nationwide Epidemic in Taiwan, 2008–09)
- Patients may shed virus for month or longer (see Long persistence of EV71 specific nucleotides in respiratory and feces samples of the patients with Hand-Foot-Mouth Disease after recovery)
For now, control and prevention are limited to promoting good hygiene, and removing children with signs of the disease from child care or school environments.