Published Date: 2005-05-23 23:50:00
Subject: PRO/EDR> Hand, foot and mouth disease - Taiwan (Central)
Archive Number: 20050523.1417
HAND, FOOT & MOUTH DISEASE - TAIWAN (CENTRAL)
A ProMED-mail post
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International Society for Infectious Diseases
Date: Sun 22 May 2005
From: ProMED-mail <firstname.lastname@example.org>
Source: Taiwan News, 22 May 2005 [edited]
CDC issues warning against outbreak of Enterovirus 71
Officials, advising members of the public to wash their hands
frequently, have revealed that the disease has already claimed the
lives of 3 young children.
Parents were warned again yesterday [21 May 2005] by Taiwan's health
authorities to guard against an Enterovirus epidemic that has already
taken the lives of 3 young children in central Taiwan so far this
year , 2 of whom died in the past week [2nd week May]. The
disease is especially dangerous when contracted by children under the
age of 3.
"The next 2 weeks might be the peak of the infections," said Wu Ping-hui, an
official from the [Taiwan] Center for Disease Control. "As the virus is
spread by physical contact, before parents and older children touch younger
children, they are advised to take showers or wash their hands when coming
home from the outdoors," he said. Wu also suggested that parents avoid
exposing their young children to public places.
The symptoms of the disease include continuous high fever, excessive
sleepiness, continuous vomiting, unusual inactivity, numbness in the
limbs, and shortness of breath, Wu said. He suggested that "parents
should pay more attention to these symptoms, as they are quite
similar to those of common colds and are easily disregarded." The
children with these symptoms should be taken to see a doctor quickly
to prevent any delay in obtaining treatment for the potentially
lethal disease, Wu said.
According to CDC statistics, 3 children have died of the virus this
year , one in February in Taichung County, and the other 2 last
week [2nd week May 2005] in Yunlin and Changhua counties.
According to the CDC, the 3 young children all died of [pnfection with]
Enterovirus 71, which often presents like other enterovirus infections and
can have no symptoms, or the patient may show signs of hand, foot & mouth
disease, rashes, meningitis, encephalitis or some combination of these. But
it may also come with unusual symptoms, such as hemorrhage and acute flaccid
Enterovirus 71, which hits Taiwan every summer, caused a large
outbreak in Taiwan in 1998, with 78 deaths, and smaller outbreaks
recurred in 2000 and 2001.
There are still 29 children with severe Enterovirus infections, 3 in
northern Taiwan, 18 in central Taiwan, 7 in southern Taiwan, and one
in eastern Taiwan. 15 of the 29 cases are infected by EV71 virus.
The child who died in Chunghua was one year and 7 months old. He was
found infected on 16 May 2005 and died just 4 days later. After his
death, his brother was also found infected with the same virus, CDC
said, adding that his parents must not have thought their older child
was infected, and missed the opportunity to send their younger child
to see the doctor before the disease became serious. "Normally, the
2nd child to be infected by the virus is more serious than the 1st
child in one family, as the magnitude of the virus will increase as
time goes by," Wu said. Because of this, Wu added, if one child has
become infected with the virus, the parents should be watchful for
any possibility that it will be transmitted to other children.
Health officials say there is no known vaccine for the intestinal bug.
Enterovirus 71 was 1st isolated in 1969 and has since been associated
with sporadic outbreaks in various parts of world, including the
USA, Brazil, Europe, Australia and Malaysia.
[Byline: Shih Hsiu-chuan]
[Taiwan is currently facing the annual outbreak season for hand, foot &
mouth disease (HFMD). Viruses from the group called enteroviruses cause
HFMD. The most common cause is coxsackievirus A16; sometimes, HFMD is caused
by enterovirus 71 or other enteroviruses. The enterovirus group includes
polioviruses, coxsackieviruses, echoviruses and other enteroviruses. HFMD
caused by coxsackievirus A16 infection is a mild disease, and nearly all
patients recover without medical treatment in 7 to 10 days. Complications
are uncommon. Rarely, the patient with coxsackievirus A16 infection may also
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. Another cause of HFMD, EV71 virus may also produce viral
meningitis and, rarely, more serious diseases, such as encephalitis, or a
poliomyelitis-like paralysis. EV71 encephalitis may be fatal. Cases of fatal
encephalitis occurred during outbreaks of HFMD in Malaysia in 1997 and in
Taiwan in 1998.
Hand, foot & mouth disease is usually characterized by tiny blisters
on the inside of the mouth and the palms of the hands, fingers, and
soles of the feet. Young children are primarily affected, but it may
be seen in adults. Most cases occur in the summer and early fall.
Outbreaks may occur among groups of children, especially in child
care centers or nursery schools. Symptoms usually appear 3 to 5 days
Hand, foot & mouth disease is usually spread through person-to-person
contact. People can spread the disease when they are shedding the virus in
their feces. It is also spread by the respiratory tract from mouth or
respiratory secretions (such as from saliva on hands or toys). The virus has
also been found in the fluid from the skin blisters. The infection is spread
most easily during the acute phase/stage of illness when people are feeling
ill, but the virus can be spread for several weeks after the onset of
The symptoms are much like a common cold with a rash The rash appears
as blisters or ulcers in the mouth, on the inner cheeks, gums, sides
of the tongue, and as bumps or blisters on the hands, feet, and
sometimes other parts of the skin. The skin rash may last for 7 to 10
There is no specific treatment for the virus that causes HFMD. Help prevent
and control its spread by:
- Washing hands well, especially after going to the bathroom,
changing diapers and/or handling diapers or other stool-soiled
- Covering the mouth and nose when coughing or sneezing.
- Washing toys and other surfaces that have saliva on them.
- Excluding children from child care or school settings if there is
a fever, or ulcers in the mouth and the child is drooling.
For reviews, please see refs: [Taiwan] CDC HFMD Fact sheet:
Epidemiology and Disease Control Program (EDCP) Fact sheet:
With annual timely public awareness campaigns by the Taiwan CDC and
the island-wide public health network, the frequency of reporting
outbreaks of Enterovirus 71 or HFMD has been chronologically reduced.
ProMED welcomes further information from Taiwan health authorities. -