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Published Date: 2012-04-17 22:53:10
Subject: PRO/EDR> Hand, foot & mouth disease - Viet Nam (06), Mekong Delta
Archive Number: 20120417.1104577

HAND, FOOT AND MOUTH DISEASE - VIET NAM (06), MEKONG DELTA
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Date: Tue 17 Apr 2012
Source: Viet Nam News [edited]
http://vietnamnews.vnagency.com.vn/social-issues/223572/outbreak-of-hand-foot-mouth-disease-strikes-mekong-delta.html

Outbreak of hand-foot-mouth disease strikes Mekong Delta
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Poor public awareness about prevention of hand-foot-mouth (HFM) disease as well as lack of basic equipment and inappropriate medical care have led to an outbreak of the disease in the Cuu Long (Mekong) Delta. Can Tho Children's Hospital, the only children's hospital in the Mekong Delta, has been overloaded with hundreds of HFM-infected patients over the last few days. 2 to 3 children have had to share a bed. During the first 3 months of the year, the hospital received nearly 4500 children with the disease, 3 times higher than that of the same period last year.

Half of the patients were from other provinces in the Mekong Delta. More than 1000 people were hospitalised for treatment. 2 of them died. Le Hoang Son, director of the hospital, said 20 standby beds had been set up in anticipation of a likely increase until the end of June [2012]. Children contracting HFM in the earliest stages had been treated at home to ease the overload at the hospital. In many cases, HFM-infected children have been wrongly diagnosed as having pneumonia, dengue fever or meningitis by primary-care physicians. When they were later transferred to the hospital, the patients had already reached an advanced stage of the illness.

Most hospitals in the provinces of Mekong Delta do not have proper equipment, including respirators, drop counters, syringe pumps and blood purification machines. Vo Huy Danh, director of An Giang Province's Preventive Medicine Centre, said that it had asked the provincial People's Committee to provide VND10 billion (USD 475 000) to purchase necessary equipment as well as chemicals for the prevention and treatment of the disease. This would reduce the number of fatalities as well as the number of patients transferred to hospitals in Can Tho and HCM City, Danh said.

The province has reported 5 deaths caused by HFM disease, the country's highest fatality rate. More than 700 children have contracted the disease, according to the province's Preventive Medicine Centre. More than 1000 cases, including 2 fatalities, have been recorded in Dong Thap Province this year [2012]. Ca Mau and Tien Giang provinces have each reported around 500 cases.

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[The HFMD outbreak has now spread country-wide to embrace all of Viet Nam. The Mekong Delta (the "Nine Dragon river delta") is the region in southwestern Viet Nam where the Mekong River approaches and empties into the sea through a network of tributaries. The Mekong delta region encompasses a large portion of southwestern Viet Nam of 39 000 square kilometres (15 000 square miles). The size of the area covered by water depends on the season. The Mekong Delta is Viet Nam's southernmost region, and contains 12 mostly small but populous provinces in the delta of the Mekong, plus the independent municipality of Cáº§n.

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.

As discussed in the preceding post, the epidemiology of EV71 infection is likely to be very complex (see: Hand, foot & mouth disease - Viet Nam (05) 20120408.1093926). In the immediate future education and control of hygiene and sanitation may remain the best options for containment of HFMD.

A map showing the locations of the Mekong Delta provinces can be accessed at:
http://en.wikipedia.org/wiki/Provinces_of_Vietnam, and an interactive HealthMap of Vet Nam can be accessed at:
http://healthmap.org/r/008c. - Mod.CP]

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