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HAND, FOOT & MOUTH DISEASE - CHINA (ANHUI), SINGAPORE
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A ProMED-mail post
<http://www.promedmail.org>
ProMED-mail is a program of the
International Society for Infectious Diseases
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[1] China (Anhui)
[2] Singapore: background
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[1] China (Anhui)
Date: Sun 27 Apr 2008
Source: China View, Xinhua News Agency report [edited]
<http://news.xinhuanet.com/english/2008-04/27/content_8061094.htm>
A total of 19 children have died and more than 700 others fallen ill
in an outbreak of a lethal intestinal virus in Fuyang City, east
China's Anhui Province, since March [2008]. "Experts from the
Ministry of Health, Anhui Province, and Fuyang City confirmed the
virus is enterovirus 71 or EV-71 based on epidemiological surveys,
clinical diagnosis, and lab work," said the city's health department.
Hospitals in Fuyang, in northwest Anhui, started to take in children
with fever, along with blisters, ulcers in the mouth, or rashes on
the hands and feet, in early March [2008]. Some of the victims were
diagnosed with brain, heart, and lung damage. Most of the victims
were aged between 2 and 6. By Saturday [26 Apr 2008], there were 789
cases of infections, of which, 19 were fatal. A total of 204 children
remain in hospital for further medical observation, of whom, 4 are
said to be in critical condition.
The Ministry of Health sent a team in mid-April [2008], and they have
been working with health workers to find the cause of the infection.
Chen Zhu, minister of health, on Saturday [26 Apr 2008] visited
Fuyang to oversee work. Fuyang has set up a leading group for control
and prevention of the lethal virus, backed with 3 million yuan (about
USD 428 571) from Anhui Province and Fuyang City. Other efforts to
stop the infection spreading include improved disease monitoring,
more epidemiological surveys, and lab tests. Schools, kindergartens,
and villages are being inspected for hygiene.
Enterovirus 71 can cause hand-foot-mouth disease, which usually
starts with a slight fever followed by blisters of ulcers in the
mouth and on the hands and feet. It may cause high fever, meningitis,
encephalitis, pulmonary edema and paralysis in a small number of
children. Paralysis is more common in children under 2 years of age
and meningitis is more common in children from 2-5 years of age, said
Yang Weizhong, deputy chief of Chinese Center for Disease Control and
Prevention. Infections could lead to high mortalities in serious
cases and neither vaccine nor therapeutic treatment is available.
[Editor: An Lu]
--
Communicated by:
ProMED-mail
<promed@promedmail.org>
[Hand-foot-mouth disease (HFMD) is a common illness of infants and
children, which has tended to be more severe and to occur in more
pronounced outbreaks in South Asia. HFMD is a consequence of
infection by an enterovirus and is particularly associated with
infection by human coxsackievirus A16 (and less commonly A4, A5, A9,
A10, B2, or B5). Human echovirus 19 was responsible for an outbreak
of HFMD in Shandong province of China in 2003. Beginning in the 1970s
human enterovirus 71 has been associated with outbreaks exhibiting
some neural involvement (meningitis and encephalitis). Cases of fatal
encephalitis occurred during outbreaks of HFMD due to human
enterovirus 71 infection in Malaysia in 1997 and in Taiwan in 1998.
Despite their distinctive names, human coxsackievirus A16 and human
enterovirus 71 are similar viruses now classified together as members
of the same virus species _Human enterovirus A_. Human enterovirus 71
has been the predominant cause of HFMD in south China. The strains
isolated from Mainland China are closely related to most isolates
from Taiwan, but different from most strains isolated elsewhere. The
symptoms of human enterovirus 71 infection in Mainland China were not
as severe as those described in Taiwan's outbreak. Recent molecular
data indicate that human enterovirus 71 and human coxsackievirus A16
are genetically diverse rapidly evolving viruses, which may be one
reason why HFMD outbreaks are more severe in some parts of Asia.
A map of the provinces of China showing the location of Anhui
province is available at
<http://www.mapsofworld.com/china/china-political-map.html>, and a
map of Anhui province showing the location of the city of Fuyang in
the northwest of the province is available at
<http://www.mapsofworld.com/china/provinces/anhui/map-of-anhui.html>. - Mod.CP]
******
[2] Singapore: background
Date: Mon 28 Apr 2008
Source: GIDEON (Global Infectious Disease & Epidemiology Network) [edited]
<http://www.gideononline.com/>
Recent outbreaks highlight the fact that Hand-foot-mouth disease
(HFMD) is the 2nd most commonly reported viral disease in Singapore.
In fact, since 2001 rates of HFMD have approached those of varicella.
See graph at
<http://exhibit.gideononline.com/HFM-Singapore.jpg>.
The following data regarding enteroviral infection in Singapore are
extracted from Gideon
<http://www.gideononline.com/blog/2008/04/28/enterovirus-infections-in-singapore/>.
Enteroviruses are responsible for 0.2 percent of lower respiratory
infection in the age group 0 to 20 years (1990 to 1994).
During 1996 to 1997, 44 percent of school children ages 5 to 12, and
50 percent of their mothers were found to be seropositive toward
enterovirus 71.
- Enterovirus 71 accounted for 71 percent of enteroviral isolates in
2000; 44.3 percent in 2001; 3.5 percent in 2002.
Epidemics of hemorrhagic conjunctivitis due to enterovirus 70 were
reported in 1971 and 1980.
- Epidemics of hemorrhagic conjunctivitis due to coxsackie 24 were
reported in 1975; 1985; 1992; and 2002.
HFMD has been a notifiable disease in Singapore since October 2000.
- Over 81 percent of patients with HFMD are below age 5 (1998 to 1999).
- Enterovirus 71 was identified in all fatal cases reported during
2000 to 2001.
Notable outbreaks
-----------------
1970 - an outbreak of HFMD (agent not identified) was reported -- the
1st in Singapore.
1970 - an outbreak (60 000 cases) of acute hemorrhagic conjunctivitis
was caused by coxsackievirus A24.
1972 - an outbreak (104 cases) of HFMD due to coxsackievirus A16 was reported.
1974 - an outbreak (53 cases) of 'Bornholm disease' due to coxsackie
B3 was reported.
1975 - an outbreak (40 000 cases) of hemorrhagic conjunctivitis due
to coxsackie 24 was reported.
1981 - an outbreak (742 cases) of HFMD due to coxsackievirus A16 was reported.
1997 - an outbreak (8 cases) of echovirus 30 meningitis was reported
in a nursery -- the 1st reports of this strain in Singapore.
2000 - an outbreak (3790 cases) of HFMD was reported --
coxsackievirus and enterovirus 71 were implicated.
2002 - an outbreak (16 228 cases) of HFMD was reported --
coxsackievirus A16 was implicated in 76.9 percent of cases.
--
Steve Berger
Geographic Medicine
Tel Aviv Medical Center
<mberger@post.tau.ac.il>
[ProMED-mail thanks Professor Berger for compiling these data. The
primary reference is available from him on request. - Mod.CP]
[see also:
Hand, foot & mouth disease - Singapore, Brunei 20080427.1456
2007
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Hand, foot & mouth disease - China (Beijing) 20070713.2253
Hand, foot & mouth disease - China (Hong Kong) 20070530.1741
Hand, foot & mouth disease - China (Shandong)(04) 20070524.1667
Hand, foot & mouth disease - China (Shandong) (03) 20070520.1604
Hand, foot & mouth disease - China (Shandong) (02) 20070516.1560
Hand, foot & mouth disease - China (Shandong) 20070514.1540
2006
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Hand, foot & mouth disease - China (HK), Malaysia (Sarawak) 20060711.1909
2004
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Hand, foot & mouth disease, children - China (HK) (02) 20040528.1452
Hand, foot & mouth disease, children - China (HK) 20040521.1370
Hand, foot & mouth disease - China (HK SAR) 20040427.1177
Hand, foot & mouth disease - China (Hong Kong) 20040315.0722
2003
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Hand, foot & mouth disease - China (Beijing) 20031118.2865
Hand, foot & mouth disease - China (Hong Kong) (02): Background 20031116.2848
Hand, foot & mouth disease - China (Hong Kong) 20031115.2839
2002
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Hand, foot & mouth disease - China (Hong Kong) (02) 20020619.4537
Hand, foot & mouth disease - China (Hong Kong) 20020618.4528
2000
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Hand, foot & mouth disease - China (Hong Kong) (02) 20001123.2032
Hand, foot & mouth disease - China (Hong Kong) 20000818.1374
1998
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Hand, foot & mouth disease - China (Hong Kong) (02) 19980729.1438
Hand, foot & mouth disease - China (Hong Kong) 19980716.1341]
...................................cp/mj/mpp
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