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Published Date: 2012-04-08 13:20:06
Subject: PRO/EDR> Hand, foot & mouth disease - Viet Nam (05)
Archive Number: 20120408.1093926

HAND, FOOT AND MOUTH DISEASE - VIET NAM (05)
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Date: Thu 5 Apr 2012
Source: IRIN Asia [edited]
http://www.irinnews.org/Report/95244/VIETNAM-Mild-disease-turns-deadly-for=

Viet nam: Mild disease turns deadly for children
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BANGKOK: A dangerous strain of the typically non-lethal hand-foot-and-mouth disease (HFMD) [virus] has affected more than 21 000 persons -- mostly children younger than five -- killing 16 thus far in Viet Nam, according to the Ministry of Health.

"Despite being a benign viral infection in developed countries, the strain EV71 [Human enterovirus 71] of HFMD is causing multiple deaths of children under five here in Asia. We are especially worried about South Viet Nnam, where lots of children are in informal [hygienically unregulated] crèches while their parents work," Bhupinder Tomar, representative of the International Federation of Red Cross and Red Crescent Societies (IFRC) in Viet Nam, told IRIN.

HFMD’s symptoms are fever, sores in the mouth and blisters on the hands and feet. The disease spreads by direct contact with fluids from infected persons and there is no specific treatment. Most of the viruses that cause HFMD are benign, but EV71 can be fatal. The new strain appeared in Viet Nam over the past year and since then it has become a serious public health issue for children, according to the World Health Organization.

The risk of catching HFMD is greatly reduced by improving hygiene, which IFRC is trying to promote through an existing public education campaign.

In 2011 there were 110 000 reported infections and 169 deaths linked to EV71, mostly in the south of the country. The disease is active year-round and peaks between April-May and then again in September-October. In March 2012 there were twice as many deaths and seven times as many infections as in the same period last year.

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Communicated by:
ProMED-mail Rapporteur Mary Marshall

[HFMD is a common, mild and self-limiting rash-associated illness in most children, with Coxsackievirus A16 (CA16) or Enterovirus 71 (EV71) the predominant causative agents. Since first described in California in 1969, EV71 has been reported to be responsible for many large outbreaks all over the world, including outbreaks that occurred in South and East Asia from 1997 onwards. Generally, these outbreaks were accompanied by a small number of cases with severe neurologic disease such as acute flaccid paralysis, pulmonary edema, myocarditis, and fatal encephalitis. The EV71 viruses have been classified into three independent lineages, A, B, and C, based on the structural VP1 gene; each group has at least 15% divergence from the others. Consequently the epidemiology of EV71-associated HFMD in South and East Asia is proving to be very complex. For example a recent study of Enterovirus 71 strains from severe and mild disease patients in North-eastern China identified seven circulating EV71 viruses (see: Xiaomei Wang et al., PLoS ONE 7(3): e32405. doi:10.1371/journal.pone.0032405, 29 Mar 2012 http://www.plosone.org/article/info:doi/10.1371/journal.pone.0032405). These EV71 viruses contained genetic recombination events between four distinct EV71 strains. Most of the structural protein region (P1) of these viruses resembled that of the prototype EV71 C1 strain. The non-structural protein domains (P2 and P3) showed a high degree of similarity with Coxsackieviruses A4 and A5. The 5′UTR (untranslated region) showed a high degree of similarity to Coxsackievirus A16. However, irrespective of genotype no correlation was observed between genotype and virulence. In the immediate future education and control of hygiene and sanitation may remain the best options for containment of HFMD, rather than vaccine development.

The interactive HealthMap of Vet Nam can be accessed at: http://healthmap.org/r/008c. - Mod.CP]

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