Published Date: 2007-09-23 21:00:10
Subject: PRO/EDR> Hand, foot & mouth disease - India (Calcutta)
Archive Number: 20070923.3160
HAND, FOOT & MOUTH DISEASE - INDIA (CALCUTTA)
A ProMED-mail post
ProMED-mail is a program of the
International Society for Infectious Diseases
Date: Sun 23 Sep 2007
Source: The Telegraph (Calcutta) [edited]
As of Sat 22 Sep 2007, doctors have warned of a "hand, foot and mouth
disease" epidemic that they say is infecting city children. "The
disease is spreading like an epidemic in parts of the city. Usually,
we find a few stray cases every year, but this year , the
number is huge," said Apruba Ghosh, Director of the Institute of
Child Health, Calcutta.
Nearly 300 cases have been reported across the city in the past 4
days. Children younger than 5 have been found to be vulnerable to the
coxsackievirus causing the disease. "It is highly infectious and
causes fever, ulcers in the mouth and vesicles -- small swellings
filled with liquid under the skin -- in the limb joints," Ghosh said.
A 4-year-old child had similar symptoms 4 days ago. He had high
fever, which subsided by evening, but he was unable to eat, as there
were ulcers in his mouth. "In the morning, we found vesicles in the
joints of his hands and legs," said his father, a resident of Bagha
Jatin in south Calcutta. A doctor diagnosed the patient with hand,
foot and mouth disease.
The B.C. Roy Memorial Hospital for Children has received several
patients with the disease in the past 3 or 4 days at its outpatient
department. Experts say the coxsackievirus is part of [belongs to]
the enterovirus family of viruses, which includes hepatitis A [virus]
that is found in the digestive tract. Usually, the coxsackievirus
causes mild flu-like symptoms, but sometimes the patients show high
fever. The fever usually subsides in 3 to 4 days.
Doctors said only symptomatic treatment should be done. There is no
vaccine to prevent the infection, they said. "Parents are advised not
to send children suffering from this disease to school, because the
virus, being air-borne, spreads easily," Ghosh said.
[Hand, foot and mouth disease (HFMD) can be caused by several enteric
picornaviruses: Human enterovirus 71, Human coxsackievirus A16, Human
echovirus 11 and Human echovirus 4 being the most frequent. HFMD
disease, although present worldwide, has caused most concern in
China, Japan and South-east Asia. (HFMDV is a pediatric disease
unrelated to the foot-and-mouth disease affecting ruminants and some
other animals). Echovirus 71 has been associated more than the other
viruses with cases of acute neurologic disease, including
poliomyelitis-like paralysis, encephalitis, and aseptic meningitis pathogens.
Sasiharadran et al. (Indian J . 2005 Jan;72(1):17-2) have published a
description of a previous outbreak in Calcutta and the surrounding
area which occurred in October 2003 and subsided in February 2004. A
total of 81 children were followed up on, and it was concluded that
although that outbreak was caused by echovirus 71 on that occasion,
the disease was mild, and all children recovered within 2 to 3 weeks.
Coxsackievirus A16 appears to be the cause of the current outbreak in
Calcutta. A recent analysis of the molecular phylogeny of
coxsackievirus A16 (Perera et al., Arch Virol. 2007;152(6):1201-8)
has revealed that there are 2 distinct strains (genogroups) of this
virus, one consisting of the prototype virus and the other 2 distinct
lineages. Lineage 1 viruses circulating before 2000 were later
displaced by lineage 2 viruses. This genetic heterogeneity may play a
role in the continuing occurrence of outbreaks of HFMDV in the region.
A map of the West Bengal state of India showing the location of
Calcutta (now called Kolkata) is accessible at