Asia’s Outbreak Of Hand, Foot, and Mouth Disease on the Decline

After a seemingly unremitting increase in the number of cases of Hand, Foot, and Mouth Disease (HFMD) throughout several areas of Asia since March, the CDC has now published an update reporting that the outbreak situation appears to have peaked and begun its decline.

Enterovirus 71 (EV71) appears to be the main culprit for causing a large number of the current outbreak cases, although other strains of enterovirus can also cause HFMD. Outbreaks caused by EV71 are not out of the ordinary and have recently been most commonly reported by countries across the Asia-Pacific region.

According to the update from the CDC, the decline of the outbreak of HFMD in China has been confirmed by the Chinese Center for Disease Control and Prevention (China CDC) with the number of daily reported cases decreasing from 11,501 during the outbreak's peak in May to 3,922 by June 5, 2008. The provinces which have been most affected are Guangdong, Zhejiang, Hebei, Shandong, and Hunan with other cases having been reported in Anhui, Hebei, Hubei, Henan, Jiangsu, Jiangxi, Shaanxi, Sichuan, Yunnan, Beijing, Chongqing, and Macau. Most reported cases were in children 5 years of age and younger with the majority of cases tested being caused by EV71. The Chinese government has implemented a public awareness campaign and is also monitoring water quality to aid in the prevention of HFMD.

In Hong Kong, a total of 100 cases of HFMD have been reported with 66 percent of the cases caused by EV71 and in Taiwan, the Taiwan CDC confirmed a total of 272 cases this year with 9 deaths but is now reporting that the outbreak is in decline. Good hygiene as well as prompt medical attention for children with severe symptoms is being encouraged.

In Singapore, the Ministry of Health has reported a total of 15,776 cases, but since the end of May the number of reported cases has been decreasing each week. 32 percent of cases tested were positive for EV71. The Ministry is working with preschools and child-care centers to limit the spread of HFMD and has stressed the importance of good hygiene.

The outbreak had the greatest impact on children as HFMD is common among infants and children under 10 years of age, however, adults can also be affected. The disease is highly contagious and spreads through direct contact with the nose and throat secretions (coughing and sneezing), saliva, blister fluid, or stool of an infected person.

The CDC encourages prevention measures for travelers and urges the practice of good personal hygiene and following safe food and water practices:

• Wash your hands frequently with soap and water for 20 seconds, especially before you eat, after you cough or sneeze, and after you go to the bathroom. If soap and water are not available, use an alcohol-based hand gel (with at least 60% alcohol). Consider packing alcohol-based hand gel in your luggage to ensure you have it when needed.
• Eat foods that are fully cooked and served hot.
• Drink beverages that have been properly bottled and sealed (water, carbonated drinks, or sports drinks).
• Do not put ice in drinks.
• Eat only fruits and vegetables that you can wash (with boiled or bottled water) and peel yourself.
• Do not share eating utensils, such as forks, spoons, and cups.

Hand-foot-and-mouth disease has the typical characteristics of sores in the mouth and a rash on the hands and feet. It spreads from person to person, most often through unwashed hands or contaminated surfaces. There is no precise treatment for the disease but practicing good hygiene, such as washing your hands often and thoroughly, can lessen the risk of infection.

The signs and symptoms of HFMD include:

• Fever
• Sore throat
• Painful red blister-like lesions on the tongue, mouth, palms of the hands or soles of the feet
• Headache
• Fatigue
• Irritability in infants and toddlers

The usual incubation period from initial infection until an infected person begins to exhibit signs and symptoms of HFMD is three to seven days. Fever is most often the first sign of the disease, followed by a sore throat, with the possibility of having a poor appetite and the feeling of malaise. A day or two after the onset of fever, painful sores may begin developing in the mouth or throat, followed by a rash on the hands, feet and possibly the buttocks within another couple of days. Signs and symptoms vary among those infected.
Rarely, HFMD caused by EV71 can lead to serious complications, such as encephalitis (swelling of the brain).

Remember, there is no vaccine to prevent HFMD and no specific treatment for the disease. Safe practices are your best defense against infection.