Published Date: 2006-07-30 00:00:00
Subject: PRO/EDR> Hand, foot & mouth disease - Malaysia (Sarawak)(07)
Archive Number: 20060730.2103
HAND, FOOT & MOUTH DISEASE - MALAYSIA (SARAWAK) (07)
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Date: Sun 30 Jul 2006
From: Jane Cardosa <janecardosa@yahoo.co.uk>
Sarawak: An Explanation of the 2nd Wave Phenomenon in Outbreaks of HFMD
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[The Moderator, commenting on the current outbreak of Hand, Foot and
Mouth Disease (HFMD) in Sarawak reported in the ProMED-mail post
entitled "Hand, foot & mouth disease - Malaysia (Sarawak) (06),"
asked for clarification of "the 2nd wave" phenomenon described in
that post. Dr. Jane Cardosa has sent the following explanation.
ProMED-mail and the Moderator appreciate Dr. Cardosa's prompt and
informative response. - Mod.CP]
My laboratory has been investigating HFMD outbreaks in Sarawak since
the initial enterovirus 71 (EV71) outbreak in Sarawak in 1997, and
our data shows that in Sarawak, EV71 outbreaks occur in a regular
cyclical pattern every 3 years. In an outbreak year, we start seeing
cases in early February. The outbreaks have peaked between March and
May. In 2000 and in 2003, we did not have many fatal cases, but in
this year's [2006] outbreak, we have seen more than in the previous 2
outbreaks. All outbreaks we have documented (1997, 2000, 2003 and
2006) have been predominantly caused by EV71 of genogroup B. Our
surveillance findings have recently been published in BMC Public
Health (see: Sentinel surveillance for human enterovirus 71 in
Sarawak, Malaysia: Lessons from the first 7 years. Podin, Y., et al.,
BMC Public Health. 2006 Jul 7;6(1):180; Epub ahead of print at
<http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&dopt=AbstractPlus&list_uids=16827926&query_hl=11&itool=pubmed_docsum>.
Early in the year, we posted preliminary data on the likelihood of an
outbreak occurring this year [2006], and Dr. Peter McMinn wrote to
ProMED pointing to our study website URL
<http://www.ichr.uwa.edu.au/apnet/> in the hope that early warning
would encourage early public health intervention.
Sarawak is a large state on the island of Borneo, and it must be
appreciated that public health coverage of the entire state poses
considerable logistical problems, especially since many communities
live in remote areas. As our reporting system is rather
comprehensive, we get to hear of and investigate cases throughout the
state. As ProMED-mail has reported, we have seen a resurgence of HFMD
cases in the period after epidemiological week 20, and our
virological investigations confirm that these cases are predominantly
due to EV71 still, and the virus continues to circulate in the
northern part of the state, particularly in the more remote areas of
the interior, and these numbers contribute towards the "2nd wave"
described in the popular press. You will appreciate that what we are
seeing is simply a shift in the geographical location of the current
hot-spots and not a 2nd peak in areas where the outbreak has already
peaked. You will also appreciate that our efforts to keep this
outbreak investigation transparent also leads to difficulties with
sensationalistic or inaccurate lay reporting, but it is important to
keep the community at risk informed and in doing so, enlist their
participation in controlling the spread of the virus.
I shall be happy to provide further details to anyone who may need them.
--
Jane Cardosa
<janecardosa@yahoo.co.uk>
See Also
Hand, foot & mouth disease - China (HK), Malaysia (Sarawak) 20060711.1909Hand, foot & mouth disease - South East Asia 20060330.0960
Hand, foot & mouth disease - Southeast Asia (02) 20060406.1035
Hand, foot & mouth disease - South East Asia (03) 20060606.1573
Hand, foot & mouth disease - South East Asia (04) 20060628.1794
Hand, foot and mouth disease - Brunei 20060308.0744
Hand, foot and mouth disease - Malaysia (Sarawak) 20060303.0671
Hand, foot and mouth disease - Malaysia (Sarawak)(02) 20060305.0712
Hand, foot and mouth disease - Malaysia (Sarawak)(03) 20060313.0792
Hand, foot and mouth disease - Malaysia (Sarawak)(04) 20060319.0854
Hand, foot & mouth disease - Malaysia (Sarawak) (05) 20060714.1946
Hand, foot & mouth disease - Malaysia (Sarawak) (06) 20060725.2050
2005
----
Hand, foot & mouth disease - Malaysia (Penang) 20050115.0127
Hand, foot & mouth disease - Malaysia (Penang)(02) 20050223.0579
Hand, foot & mouth disease - Taiwan (Central)(03) 20050605.1567
Hand, foot & mouth disease - Taiwan (Central) (04) 20050611.1623
Hand, foot and mouth disease - Taiwan (Central) 20050523.1417
Hand, foot and mouth disease - Taiwan (central) (02) 20050531.1503
2004
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Hand, foot & mouth disease, children - China (HK) 20040521.1370
Hand, foot & mouth disease, children - China (HK) (02) 20040528.1452
Hand, foot & mouth disease - China (HK SAR) 20040427.1177
Hand, foot & mouth disease - China (Hong Kong) 20040315.0722
Hand, foot & mouth disease - Indonesia 20040528.1443
Hand, foot & mouth disease - USA (OH) 20040526.1416
Hand foot & mouth disease, pre-schools - UK (England) 20041109.3028
..........................cp/msp/mpp
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