EID Journal: New Introductions Of EV-71 Subtype C4 To France – 2012

Photo Credit University of Iowa

 

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Human Enterovirus 71 (EV-71) – which is most often reported in Asia and the Western Pacific region - is one of more than 60 non-polio enteroviruses (NPEVs) known to cause cause human illness, and that primarily affect children under the age of 10.

 

While EV-71 is most frequently linked to severe outbreaks of HFMD (Hand, Foot, & Mouth Disease), it is also capable of producing serious neurological illnesses – including poliomyelitis-like paralysis (AFD or Acute Flaccid Paralysis), encephalitis, and sometimes death.

 

It should be noted that HFMD can be caused by a variety of viruses, and most of the time, it is generally mild and only rarely requires medical attention.  It is, however, highly contagious and spreads via close personal contact, droplets (through coughing or sneezing), the fecal-oral route, or contact with contaminated objects and surfaces (fomites).

 

The most common cause of HFMD in North America and Europe is the Coxsackie A16 virus, and more rarely the Coxsackie A10 virus. In recent years, we’ve also seen the emergence of the Coxsackie A6 virus which has been linked to somewhat more severe HFMD cases (see MMWR: Coxsackievirus A6 Notes From The Field).

But it is Enterovirus 71 that has been linked to the most severe cases of HFMD – particularly across Asia - with serious outbreaks recorded over the past 18 years in places like China, Taiwan, Malaysia, Hong Kong and Cambodia. 

 

Like other RNA viruses we monitor, EV71 is constantly evolving, creating new strains or lineages, and as a result we’ve seen repeated outbreaks over the years. During the late 1990s and early 2000s, genotypes C1, C2, B3, and B4 were most commonly reported as sparking outbreaks in Malaysia, Singapore, and Taiwan.

 

But by 2005, emerging genotype C4 had replaced B4 in Taiwan, while in China C4 (which had split into 2 distinct lineages, C4a and C4b) caused major HFMD outbreaks in 2007–2009 (see Phylogenetic analysis of Enterovirus 71 circulating in Beijing, China from 2007 to 2009.)

The spread and diversity of EV71 – Credit WHO

 

As shown in the chart above, the more aggressive C4 genotype – which first appeared in China in 1998 - has made significant inroads across much of Asia and the Western Pacific over the past 15 years. 

In 2012, we saw an outbreak of EV-71 in Cambodia that claimed the lives of dozens of children (see Updating The Cambodian EV71 Story), while last year, in Australia: Acute Flaccid Paralysis & EV71, we looked at a report that described 5 recent cases of acute flaccid paralysis (AFP) in children who tested positive for the EV71 virus.

 

Although EV-71 was first described in a California infection in 1969, and outbreaks of EV-71 associated HFMD were recorded in Europe, North America, and Australia back in the 1970s (see BMJ article on Challenges of EV-71) the genotypes circulating in Asia today have evolved to become more virulent than those of 40 years ago.

 

As with many other infectious diseases, there are genuine concerns that EV-71 may, through repeated introductions via international travel, spread beyond Asia and the Pacific to get a foothold in Europe and North America. While large outbreaks have not occurred outside of Asia yet, there is no good reason known why they couldn’t in the future.

 

All of which serves as prelude to a new Dispatch from the EID Journal, which documents recent introductions of the EV-71 C4 subtype to France.  The bottom line – which comes from the author’s conclusions – reads: The phylogenetic data are consistent with 3 independent virus introductions, presumably from China, and are compatible with a more global circulation of subgenogroup C4 enteroviruses

 

 

Volume 20, Number 8—August 2014

Dispatch

New Introductions of Enterovirus 71 Subgenogroup C4 Strains, France, 2012

Abstract

In France during 2012, human enterovirus 71 (EV-A71) subgenogroup C4 strains were detected in 4 children hospitalized for neonatal fever or meningitis. Phylogenetic analysis showed novel and independent EV-A71 introductions, presumably from China, and suggested circulation of C4 strains throughout France. This observation emphasizes the need for monitoring EV-A71 infections in Europe.

Conclusions

In 2012, EV-A71 C4 strains were detected in France in 4 children hospitalized for neonatal fever or meningitis. Although EV-A71 C4 strains have circulated extensively in China since 2008, this virus has rarely been detected in Europe. In France, 133 cases of EV-A71 infections were reported during January 2000–May 2013 (9) (I. Schuffenecker, unpub. data). EV-A71 C2 infections have been predominant since 2007; however, only 5 cases of EV-A71 C4 infection have been identified in the country since 2004. Our Bayesian analyses excluded a direct evolution of the 2012 EV-A71 C4 strains from the earlier 2004 European virus lineage. The phylogenetic data are consistent with 3 independent virus introductions, presumably from China, and are compatible with a more global circulation of subgenogroup C4 enteroviruses. In 2013, the C4 subgenogroup also emerged in Russia, where it was associated with an outbreak of 78 reported cases, including 1 fatal case of meningoencephalitis (14).

Many cases of fatal encephalitis have been associated with EV-A71 C4 infection outbreaks in China (6), which highlights the neurovirulence of EV-A71 strains. Rare acute flaccid paralysis cases have also been reported in Australia through the national poliomyelitis surveillance program (15).

Although the prevalence of neurologic cases associated with EV-A71 infection is currently low in Europe, the recent circulation of EV-A71 C4 in France and in Rostov, Russia (along the eastern border with Europe), underscores the need for improved surveillance of neurologic manifestations associated with EV infection and of the incidence of HFMD within communities. In addition, careful monitoring for the possible introduction and circulation of new EV-A71 genogroups and subgenogroups should be conducted.

 

 

Among the challenges of controlling EV71 outbreaks are:

• Although at least three vaccine candidates have recently completed Phase III trials, none are currently commercially available.
• 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.  For more on HFMD, including the more severe Enterovirus-71 (EV-71), you may wish to revisit the following blogs:

 

The Emerging Threat Of EV71

China: A Recombinant EV-71

HFMD Rising In China

China Sounds Alert Over EV-71 Virus

WHO/Cambodian MOH Announcement On HFMD Outbreak

 

 

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My thanks go to Ronan Kelly on FluTrackers for finding and  posting the joint announcement between the World Health Organization, and the Cambodian Ministry of Health regarding the recent outbreak of severe HFMD in that country.

 

The announcement is in a PDF FILE, which makes cutting and pasting here problematic.  You can click this link, or the image below, to read the 2 page report.

 

 

Essentially, this report finds that the EV71 virus was the prime cause of the outbreak; with only a small percentage of cases testing positive for other pathogens (Strep suis, Haemophilus Influenzae type B, etc.). 

 

The report suggests the use of steroids may have worsened the outcome in some cases.

 

The Cambodian government, in conjunction with the World Health Organization, will conduct enhanced surveillance for neuro-respiratory syndrome which may accompany severe HFMD due to EV71.

 

This report appears to assign a minor role, if any, to the other infectious agents which have been widely mentioned in the media.

Updating The Cambodian EV71 Story

 

 

 

# 6430

 

Over the past several days we’ve seen some confusing (and conflicting) reports on the `mystery illness’ in Cambodia which has claimed the lives of more than 50 children over the past few months (see EV71: Cambodia’s Prime Suspect).

 

Complicating the investigation, these children were treated by a variety of doctors in different clinics across 14 provinces, and many died and were buried before proper testing could be done.

 

Overnight  ProMed Mail posted (see Undiagnosed illness, fatal, child - Cambodia (06): pathogen mix) a CNN  report that a combination of pathogens – including enterovirus 71, Streptococcus suis and dengue fever – will be named responsible for these child deaths, and that the inappropriate use of steroids in their treatment exacerbated their illnesses.

 

An official announcement from the World Health Organization is expected shortly, but as of this writing has not yet been published.

 

But we do have some tweets this morning from the WHO twitter account that continue to highlight the EV71 virus as the major cause of the outbreak.

 

 

 

And this morning Xinhua News is reporting that:

 

HFMD causes child deaths in Cambodia: WHO

English.news.cn   2012-07-12 19:55:37

The severe form of hand, foot and mouth disease (HFMD) was the cause of illnesses and deaths of 54 Cambodian children since April, concluded the findings of a joint investigation on Thursday.

(Continue . . . )

 

Whatever other contributing factors might be involved, the EV71 virus is perfectly capable of producing serious – even fatal – illness on its own. 

 

The classic symptoms of a blistering rash on the hands, feet, and mouth associated with HFMD are not always present. Sometimes the patient only presents with severe neurological symptoms.

 

 

Outbreaks of EV71 are neither new, nor rare, although the mortality rate in this Cambodian outbreak does appear unusually high (admittedly difficult to know, since we don’t know how many mild cases went uncounted).

 

The past decade has seen numerous outbreaks of EV71, resulting in the deaths of hundreds of children across Asia (see China: EV71 Claims 28th Victim, Authorities Warn of Possible `Mass Outbreak', FMD Outbreak In China Spreads To 25,000 Children).

 

 

We have also seen signs that the virus continues to evolve (see China: A Recombinant EV-71).

 

While no new cases have been reported in the past several days, with no vaccine and no effective antiviral treatment available, fears continue to run high in Cambodia. The following report from Bangkok Post indicates that some Cambodians with small children are attempting to enter Thailand to escape the outbreak.

 

   Cambodians flee to Sa Kaeo

Published: 12/07/2012 at 08:07 AM

The hand, foot and mouth disease (HFMD) scare has resulted in a mass exodus of Cambodian parents with young children into Sa Kaeo province.

 

The Aranyaprathet immigration checkpoint was yesterday crowded with Cambodian travellers, most of them with young children, eager to enter Thailand.

 

The Cambodian parents were mainly workers and vendors at the Rong Kleau border market in Thailand.

 

(Continue . . . )

 

 

When we get an official announcement from the WHO, or the CDC, as to the cause of these deaths, I’ll post it.  For now, however, the EV71 virus still appears to be the prime suspect in this outbreak.

EV71: Cambodia’s Prime Suspect

 

Photo Credit University of Iowa

 

# 6427

 

 

Although normally a mild childhood disease, HFMD (Hand, Foot, & Mouth Disease) has taken center stage in the media these past few days as one of the viruses (EV71) associated with that illness has been tentatively linked to dozens of deaths of Cambodian children over the past three months.

 

The epidemiological investigation is ongoing, with researchers looking for any possible complicating factors (or changes to the virus) that might explain the unusually high mortality rate being reported with this outbreak. 

 

We should know more in a few days, but as you’ll see, the EV71 virus doesn’t need any help to be deadly. 

 

HFMD can be caused by a variety of viruses, and most of the time, it is mild and only rarely requires medical attention.

 

The most common cause of the illness is the Coxsackie A16 virus, and more rarely the Coxsackie A10 virus. In recent years, we’ve also seen the emergence of the Coxsackie A6 virus which has been linked to somewhat more severe HFMD cases (see MMWR: Coxsackievirus A6 Notes From The Field).

 

But it is Enterovirus 71 that has been linked to the most severe cases of HFMD – particularly across Asia - with serious outbreaks recorded over the past dozen years in places like China, Taiwan, Malaysia, Hong Kong and most recently, Vietnam.

 

In addition to the classic HFMD symptoms, this virus has been known to produce serious neurological illness, including life threatening encephalitis. 

 

You can find more details on HFMD, and EV71, in the World Health Organization’s Hand, Foot and Mouth Disease Information Sheet, from which I’ve excerpted the following:

 

• HFMD is usually a mild disease, and nearly all patients recover in 7 to 10 days without medical treatment and complications are uncommon.
  • Dehydration is the most common complication of HFMD infection caused by coxsackieviruses; it can occur if intake of liquids is limited due to painful sores in the mouth.
  • Rarely, patients develop "aseptic" or viral meningitis, in which the person has fever, headache, stiff neck, or back pain, and may need to be hospitalized for a few days.
• HFMD caused by EV71 has been associated with meningitis and encephalitis, and on occasion can cause severe complications, including neurological, cardiovascular and respiratory problems. Cases of fatal EV71 encephalitis have occurred during outbreaks.

 

While the recent outbreak in Cambodia has raised alarms around the world, deadly outbreaks of EV71 are nothing new.  Last May, in CDC Issues HFMD Travel Notice For Vietnam, we looked at an outbreak that had claimed more than 20 lives.

 

In the News
Hand, Foot, and Mouth Disease in Vietnam

Released: May 25, 2012

What Is the Current Situation?

As of April 29, 2012, the Vietnam Ministry of Health has confirmed nearly 40,000 cases of hand, foot, and mouth disease (HFMD) since the beginning of 2012. Cases have occurred in 63 provinces, and 20 deaths (all in children under 5) have occurred in 10 provinces.

(Continue . . .)

 

The CDC also provides several  multimedia products related to hand, foot, and mouth disease.

 

• CDC Feature: Hand, Foot, & Mouth Disease
  An article that provides the basics about hand, foot, and mouth disease, who is commonly affected, symptoms, how it spreads, and ways to prevent it.
• Podcast: Hand, Foot, and Mouth Disease
  A CDC pediatrician and dad talks about hand, foot, and mouth disease, its symptoms, and tips to prevent your family from getting this disease.

 

Similarly, we’ve seen reports this week indicating that Hand, foot, mouth disease kills 240 in China.

 

We are seeing reaction to the Cambodian outbreak from several health departments across Asia, including Hong Kong, Thailand, and the Philippines.

 

First, Hong Kong’s CHP (Centre for Health Protection) which sent out this Update on An Unknown Disease in Cambodia letter to doctors in the region on July 9th, which asks that doctors notify the CHP of any suspected cases with recent travel history to Cambodia.

 

Possibly related, the CHP is reporting on Two cases of severe paediatric enterovirus infection, although the causative virus is not indentified.

 

In Thailand, The Nation newspaper is reporting that the MOH has instructed schools to close if an unusual number of HFMD cases are reported.

 

Disease warning for schools

The Nation July 10, 2012 5:47 pm

The Public Health Ministry on Tuesday instructed schools and nurseries nationwide to close if they find that students in five classes or more have contracted hand, foot and mouth disease.

(Continue . . . )

 

And perhaps the most proactive of all is the Philippines, where the Department of Health has ordered increased surveillance at airports, and has declared  EV-71 to be a notifiable disease. 

 

Here is the official press release:

 

DOH MAKES ENTEROVIRUS-71 INFECTION AS A NOTIFIABLE DISEASE

July 10, 2012

(Press Release – 10 July 2012)

Health Secretary Enrique T. Ona instructed today the Department of Health (DOH) National Epidemiology Center to include Enterovirus-71 (EV-71) infection as a notifiable disease in the country. This will compel all health providers especially physicians to report individual cases or even outbreaks.

 

“Mandatory notification will improve monitoring of EV-71 infections and ensure that necessary measures are in place to guarantee that the Philippines is free from the highly fatal severe form of EV-71 infections that have claimed the lives of at least 60 children in Cambodia since April this year,” Ona said.

 

Also, the DOH and the World Health Organization (WHO) clarified today that the Cambodian EV-71 was of the encephalitis type and not hand foot and mouth disease (HFMD) as earlier reported. Affected Cambodian children generally presented with fever followed by rapid respiratory deterioration and impaired consciousness. Death occurred 24 hours from hospital confinement.

 

EV-71 causes different diseases of varying intensity. These include the often mild hand, foot and mouth disease (HFMD), acute respiratory disease, acute flaccid paralysis (polio-like) and the deadly brainstem encephalitis. HFMD is characterized as a self-limiting illness presenting with fever and accompanied by skin lesions or rashes.

 

EV-71 infections do occur in the country but are reported with irregularity. Fatal EV-71 infection is still very rare in the Philippines.

 

Proper disposal of baby diapers or human waste, strict personal hygiene and regular hand washing prevent viral spread. The virus is known to be excreted in the feces since it is found in human intestines.

 

 

The DOH urges parents and day-care personnel to clean and disinfect toys and teaching tools that are easily shared with other children. This can prevent EV-71 infections, as there are no known effective drugs or vaccines.

 

 

‘There is still no travel restriction to and from Cambodia and incoming passengers will be subjected to thermal screening upon arrival in all international airports as a routine quarantine procedure,” the health chief concluded.

 

The statement above, that the `(WHO) clarified today that the Cambodian EV-71 was of the encephalitis type and not hand foot and mouth disease (HFMD)’ is something I’ve not been able to locate on the WHO site yet.  

 

And last, but certainly not least, Lisa Schnirring of CIDRAP NEWS wrote a detailed report last night on the Cambodian outbreak, which you can read at:

 

Enterovirus 71 cited in puzzling Cambodian infections

Lisa Schnirring Staff Writer

Jul 9, 2012 (CIDRAP New) – Lab analysis in the mysterious recent illnesses and deaths of dozens of Cambodian children pointed to enterovirus 71 (EV-71), a virus that causes hand, foot, and mouth disease (HFMD) and can lead to severe complications in some patients, the World Health Organization (WHO) announced today.

(Continue . . .)

 

 

The peak season for HFMD is summer and fall, which suggests that we will be hearing about outbreaks of EV71, and other HFMD viruses, for months to come.

EV71 Linked To Cambodian `Mystery’ Virus

 

 

 
# 6424

 

 

Doctors may be closer today to identifying the `mystery disease’ that has killed – at last report – more than 60 children in Cambodia over the past couple of months (See Updating The Cambodian `Mystery’ Illness).

 

According to multiple media reports this morning (CNN, Bloomberg, RTHK) the Institut Pasteur in Cambodia has found Enterovirus-71 (EV71) in 15 out of 24 samples taken from victims of this disease.

 

While more testing is needed, and there may be other factors involved, the signs and symptoms being reported in this outbreak are consistent with severe cases of EV71 infection.

 

EV71 is one of more than 60 non-polio enteroviruses  that have thus far been identified, and while it is most frequently linked to severe outbreaks of HFMD (Hand, Foot, & Mouth Disease), it is capable of producing other serious neurological illnesses as well.

 

Credit - CDC EID Journal

The classic rash & lesions associated with HFMD does not always manifest with EV71 infections, making diagnosis far more difficult.  Additionally, HFMD is normally a mild illness, particularly when caused by the Coxsackie A16 virus.

 

An article that appeared in early 2001 in Clinical Infectious Diseases (cite Neurological Manifestations of Enterovirus 71 Infection in Children during an Outbreak of Hand, Foot, and Mouth Disease in Western Australia Peter McMinn, Ivan Stratov, Lakshmi Nagarajan, and Stephen Davis) describes its impact this way:

 

Children <4 years of age are particularly susceptible to the most severe forms of EV71-associated neurological disease, including meningitis, brain-stem and/or cerebellar encephalitis, and poliomyelitis-like paralysis.

 

The neurological complications of EV71 infection may occasionally cause permanent paralysis or death. Several large epidemics of severe EV71 infection in young children, including numerous cases of fatal brain-stem encephalitis, have recently been reported in Southeast Asia [10–12].

 

A 2007 study appearing in the American Journal of Tropical Medicine & Hygiene, looked at mortality rates among severe HFMD involving EV71 infection during an outbreak in Taiwan.  Researchers found a crude mortality rate of roughly 16%, although that number varied considerably over the 8 year study.

 

And in recent years, we’ve seen increasing evidence of severe EV71 outbreaks - particularly across Asia.  China, and most recently Vietnam, have been hard hit – as evidenced last May when the CDC Issues HFMD Travel Notice For Vietnam.

 

 

Two major genotypes of EV-71, EV-71 B and EV-71 C, have been identified as being responsible for a number of severe outbreaks in Australia, Japan, China, Malaysia, and Taiwan since 1997.

 

A couple of years ago, the Virology Journal, published an analysis of an EV-71 HFMD virus that caused a major disease outbreak in Fuyang City, China in 2008 that showed it was due to an emerging recombinant virus (see China: A Recombinant EV-71).

 

A reminder that viruses are always evolving, looking for an evolutionary advantage.

 

Researchers will no doubt be looking for any signs of change to the EV71 virus that has now been isolated from these Cambodian children.

 

For now there is no vaccine to prevent EV71 infection, although several pharmaceutical companies are working on one. There are no effective antivirals available to treat EV71 at this time, either (cite).

 

The PHAC (Public Health Agency of Canada) describes enterovirus 71 transmission:

 

EV 71 is transmitted through direct contact with discharge from the nose and throat, saliva, fluid from blisters or the stools of an infected person. Cases are most infectious during the first week of acute illness but may continue to shed virus in stool for weeks. The incubation period is three to five days. The epidemiological pattern varies by geographical region and climate, but the incidence of infection is higher in the summer and autumn months in temperate climates while remaining prevalent year-round in tropical climates.

 

There is increasing evidence, however, suggesting respiratory transmission of the virus as well.  This was recently highlighted in a BMC Infectious Diseases article called:

 

Long persistence of EV71 specific nucleotides in respiratory and feces samples of the patients with Hand-Foot-Mouth Disease after recovery

Jun Han, Xue-Jun Ma, Jun-Feng Wan, Ying-Hui Liu, Yan-Ling Han, Cao Chen, Chan Tian, Chen Gao, Miao Wang and Xiao-Ping Dong

HFMD has been an important public health concern worldwide, especially in the Asia-Pacific region. Up to now, more than 900,000 HFMD cases have been reported in mainland of China. Enteroviruses can be isolated from both the lower and upper alimentary tract and can be transmitted by both fecal-oral and respiratory routes. Fecal-oral transmission may predominate in areas with poor sanitary conditions, whereas respiratory transmission may be important in more developed areas. The relative importance of the different modes of transmission probably varies with the particular EV and environmental setting.

 

Despite its discovery more than 40 years ago during an outbreak in California, EV71 remains a sometimes elusive diagnosis – particularly when atypical symptoms that are not consistent with HFMD are present.

 

While we are seeing outbreaks of EV71 primarily in Southeast Asia, an article published in Clinical Infectious Diseases back in 2007 warns that EV71 may be a largely unrecognized and potentially emerging disease here in the United States as well.

 

Outbreak of Neurologic Enterovirus Type 71 Disease: A Diagnostic Challenge

Carlos M. Pérez-Vélez,Marsha S. Anderson, Christine C. Robinson, Elizabeth J. McFarland, W. Allan Nix, Mark A. Pallansch, M. Steven Oberste, and Mary P. Glodé

An outbreak of neurologic EV71 disease occurred in Denver, Colorado, during 2003 and 2005. Likely, EV71 disease remains unrecognized in other parts of the United States, because EV-PCR of cerebrospinal fluid frequently yields negative results. EV-PCR of specimens from the respiratory and gastrointestinal tracts had higher diagnostic yields than did EV-PCR of cerebrospinal fluid. EV71 infection should be considered in young children presenting with aseptic meningitis, encephalitis, acute flaccid paralysis, or acute cardiopulmonary collapse. EV71 infection may be an underrecognized emerging disease in the United States.

 

 

We will have to await further laboratory tests over the coming days to see if any other factors may be involved in this outbreak in Cambodia. 

 

Of particular interest will any evidence of genetic changes in the EV71 virus that might help explain the unusually high mortality rate that been attributed to this particular outbreak.

 

Stay tuned.

Vietnam’s HFMD Outbreak

 

 

# 5768

 

 

Photo Credit University of Iowa

HFMD (Hand Foot Mouth Disease) is a relatively common, and usually mild, viral illness seen mainly in children under the age of 10 (although adults are vulnerable as well) and may be caused by several of the non-polio enteroviruses.

 

The 60+ non-polio enteroviruses identified to date are among the most prevalent viral infections in the world, probably only second to the myriad and ubiquitous variants of Rhinovirus (`common cold’) that circulate every year.

 

The two most common causes of HFMD are the Coxsackie A16 virus, and the Enterovirus-71 (EV-71).

 

The disease caused by the Coxsackie A16 virus is generally the milder of the two, rarely causes serious illness, and outbreaks are not uncommon in childcare facilities. 

 

EV-71 HFMD is most commonly found in the Asia, with serious outbreaks recorded over the past dozen years in places like China, Malaysia, Hong Kong and most recently, Vietnam.

 

This version of the HFMD can sometimes be quite serious, with viral meningitis - and less commonly, encephalitis – complicating matters.

 

This summer Vietnam has seen an explosion of HFMD cases, and has recorded more than 80 deaths. Although the headline in the following story from Than Nien News uses the term `pandemic’, this outbreak would be better described as an `epidemic’.

 

Hand, foot and mouth disease spreads to pandemic levels

Last updated: 8/19/2011

Official re-classifies the outbreak as death toll reaches 81

The Ministry of Health is considering declaring hand, foot and mouth disease (HFMD) a pandemic, as more than 32,000 cases of the illness have killed 81 across the country so far this year.

 

According to the ministry, the disease has hit 52 of 62 cities and provinces, mostly in the southern and central regions. Some 96 percent of the fatalities have been children under the age of five.

(Continue . . . )

 

According to a recent VOA Vietnamese news report, about 1/3rd of the cases reported in Vietnam have been due to the more serious virus; EV-71.

 

For more on HFMD, we turn to the CDC’s webpage, which offers advice on prevention, and treatment, focusing primarily on the mild version more likely to be encountered outside of Asia.

 

 

Hand, Foot, and Mouth Disease

 

Hand, foot, and mouth disease is a contagious viral illness that commonly affects infants and children. While there is no vaccine to prevent the disease, there are simple steps you and your family can take to reduce the risk of getting sick.

 

Hand, foot, and mouth disease (HFMD) is a contagious viral illness that commonly affects infants and children in the U.S. and abroad. In the U.S. and other countries with temperate climates, HFMD occurs most often in summer and early autumn. While there is no vaccine to prevent the disease, there are simple steps you and your family can take to reduce the risk of getting sick.

HFMD

• Usually causes fever, sores in the mouth, and a rash with blisters.
• Is moderately contagious.
• Mostly affects children younger than 10 years of age, but people of any age can be infected.
• Has no specific treatment.
• Infection risk can be reduced by practicing good hygiene, such as washing hands frequently.
• Is not the same as foot-and-mouth disease.

(Continue . . . )

 

The CDC also offers a short (4 minute) audio podcast on HFMD, which may be listened to HERE.

 

 

Two major genotypes of EV-71, EV-71 B and EV-71 C, have been identified as being responsible for a number of severe outbreaks in Australia, Japan, China, Malaysia, and Taiwan since 1997.

 

Last year, the Virology Journal, published an analysis of an EV-71 HFMD virus that caused a major disease outbreak in Fuyang City, China in 2008 that showed it was due to an emerging recombinant virus (see China: A Recombinant EV-71).

 

Viruses are always changing.

 

Normally mild viral diseases like HFMD can sometimes mutate or pick up genetic material from other viruses and become more virulent or more transmissible as a result.

 

While serious cases are uncommon in Europe or the United States at this time, there is no reason to believe we are immune to an importation of a more severe version of HFMD.

 

More than enough reason to pay close attention to what is happening in Asia today.