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Published Date: 2012-04-20 23:43:57
Subject: PRO/EDR> Hand, foot & mouth disease - Viet Nam (07)
Archive Number: 20120420.1108616

HAND, FOOT AND MOUTH DISEASE - VIET NAM: (07)
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Date: Thu 19 Apr 2012
Source: Examiner.com [edited]
http://www.examiner.com/article/red-cross-vietnam-hfmd-outbreak-now-at-28-000-cases-18-dead

Viet Nam HFMD outbreak now at 28 000 cases, 18 dead, according to Red Cross
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The virulent strain of the childhood disease, hand, foot and mouth disease (HFMD) called [i.e., caused by] EV-71 [Enterovirus-71] continues to spread in Viet Nam and fears of record childhood fatalities are concerning public health officials. According to a statement from a senior official from the International Federation of Red Cross and Red Crescent Societies (IFRC) in AlertNet Wednesday [18 Apr 2012], the disease has already infected over 28 000 children in the Southeast Asian country this year, killing 18. This is up from the 21 000 cases and 16 deaths reported a week ago. The IFRC reports 80 percent of the children who died from HFMD are under 3 years of age; 16 of the children are from the south of the country.

In a large scale outbreak in Viet Nam in 2011, more than 100 000 people were sickened by HFMD) with nearly 200 children dying from this common childhood infection. HFMD is typically a benign and self-limiting disease. Most common in young children, it presents as fever, oral lesions and rash on the hands, feet and buttocks. The oral lesions consist of rapidly-ulcerating vesicles on the buccal mucosa, tongue, palate and gums. The rash consists of papulovesicular lesions on the palms, fingers and soles, which generally persist for 7 to 10 days, and maculopapular lesions on the buttocks.

The [virus causing this outbreak] of HFMD in the Viet Nam epidemic, EV71, can be fatal [in rare cases] and is spreading among children under 5 according to the World Health Organization. EV-71 has been implicated in HFMD outbreaks in Southeast Asia over several years. EV-71 is a non-polio enterovirus. Complications associated with HFMD caused by the more pathogenic EV-71 include encephalitis, aseptic meningitis, acute flaccid paralysis, pulmonary edema or haemorrhage and myocarditis. Most deaths in HFMD occur as a result of pulmonary edema or haemorrhage.

[Byline: Robert Herriman]

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[The epidemic of HFMD in Viet Nam shows no sign of slowing. Since 1st described in California in 1969, EV-71 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 "Hand, foot & mouth disease - Viet Nam (05) 20120408.1093926," the epidemiology of EV71 infection in South East Asia is likely to be complex. The EV-71 viruses have been classified into 3 independent lineages, A, B, and C, based on the structural VP1 gene sequence; each group has at least 15 percent divergence from the others. For example, a recent study of EV-71 strains from severe and mild disease patients in North-eastern China identified 7 circulating EV-71 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 EV-71 viruses contained genetic recombination events between 4 distinct EV-71 strains.

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

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