Serious Hand Foot and Mouth - Enterovirus 71

[Shiloh]

Re: Serious Hand Foot and Mouth - Enterovirus 71

Source: http://news.163.com/09/0420/19/57C91I52000120GU.html

Google translation:

Study shows that: hand, foot and mouth disease is not pathogenic virus mutates EV71
2009-04-20 19:30:05
Source: Xinhuanet

Xinhua Beijing April 20 (Xinhua) China's CDC researcher virus XU Wen-bo on the 20th during the online interview, said that from 1998 to 2009, China carried out pathogen detection and analysis showed that the hand, foot and mouth EV71 virus disease the main cause of variation is not significant, did not increase virulence.

According to him, in 2008, China's 31 provinces in the country established a network of hand, foot and mouth disease laboratories, carrying out pathogen monitoring, virus isolation and gene sequencing analysis. The results showed that my hand, foot and mouth disease to the major pathogen and the EV71 intestinal virus CoxA16 mainly caused by severe and mortality for EV71, laboratory confirmed cases accounted for 90%.

It is understood that the hand, foot and mouth disease vaccine EV71 has not now successfully developed the world, China and the international community has already begun in some countries EV71 vaccine development. However, vaccine development needs of 3-5 year cycle is applied to people, and now also without the approval of the international community to prevent the vaccine.

Hand, foot and mouth disease mainly mainly fecal-oral route of transmission, but also through direct contact and respiratory droplets spread, therefore, XU Wen-bo pointed out that strengthening personal hygiene, sanitation, food hygiene, especially hand-foot-mouth disease to prevent contact with children and their excreta secretions and respiratory secretions is the main preventive measure.

XU Wen-bo pointed out that hand, foot and mouth disease is caused by a variety of intestinal virus diseases of children, is not a new emerging infectious diseases, people are unfamiliar with it mainly due to Hand, Foot and Mouth 2008 non-statutory reporting of infectious disease, the lack of the disease laboratory testing data and data integrity of the epidemic. May 2008, my hand, foot and mouth has been incorporated into the statutory reporting of infectious disease.

Prevention from the national level, XU Wen-bo suggested that the state should be gradually incorporated into the normal hand, foot and mouth disease management, increase training for medical personnel on the grass-roots efforts, particularly in children with severe to raise the point where treated the capacity of hospitals. At the same time, the speedy setting up of hand, foot and mouth disease in China pathogenic biological information base and strengthen scientific and technological, as soon as possible to provide effective prevention and treatment products.

Beijing Ditan Hospital Dr Lu said the joint, hand, foot and mouth disease for more than 50% of the early symptoms, parents should pay attention to the spirit of good kids, good to eat, sleep any jitter, and whether there will be such a headache. In addition, if the child appeared cold extremities, skin color green, and so on to speed up breathing than usual, we must go to hospital.

According to statistics, the main hand, foot and mouth disease to the incidence under 5 years of age-based groups (91% -95%), incidence of very few young people and adults. Severe hand-foot-mouth disease mortality is about 3 thousandths, most to the success of the rescue. (This article Source: Xinhua) netease

[Shiloh]

Re: Serious Hand Foot and Mouth - Enterovirus 71

Source: http://www.nature.com/news/2009/0904...l/458554a.html

Viral outbreak in China tests government efforts
Researchers call for greater focus on surveillance and genomics.
Jane Qiu

An outbreak of hand, foot and mouth disease in China, which since January has killed 19 children and made nearly 42,000 ill, has researchers calling for a better surveillance system to detect the disease and for action to speed up vaccine development.

"The situation of preventing and containing hand, foot and mouth disease is very serious at the moment," Deng Haihua, spokesman for China's health ministry, said last week. More cases are expected, as the disease normally peaks between May and July. In the absence of a drug treatment, the ministry is focusing on prevention and containment.

The outbreak is the latest in a series to have hit China in recent years, caused by a fast-spreading virus called enterovirus 71. "The persistence of enterovirus 71 outbreaks in China is a wake-up call," says Jane Cardosa, a virologist at the University Malaysia Sarawak in Kota Samarahan. In 1997, Sarawak saw the first outbreak of hand, foot and mouth disease in the Asia-Pacific region.

The disease causes flu-like symptoms, along with rashes on the hands and feet, and mouth ulcers. It can be caused by many types of human enterovirus belonging to the Picornaviridae family, which are mainly transmitted through faecal or oral routes. Although normally mild, the disease can be life-threatening: some viruses, particularly enterovirus 71, can cause inflammation of the brain stem, resulting in heart failure and fluid accumulation in the lungs.

In 1997 in Sarawak, more than 2,600 cases of the disease were reported and 29 people died. The next year in Taiwan, there were 129,000 reported cases and 78 deaths. In mainland China, the first reported case was in Shenzhen, Guangdong province, in 1999. At first, outbreaks were local and there were no reported fatalities (L. Li et al. J. Clin. Microbiol. 43, 3835?3839; 2005).
But since 2004, the outbreaks have become more severe and widespread, says Xu Wenbo, an infectious-disease expert at the Beijing-based China Center for Disease Control and Prevention.

In May 2008, the country's health ministry added hand, foot and mouth to its category 'C' of notifiable diseases, meaning that all diagnosed cases must be reported through a national web-based system for disease surveillance, and took measures to streamline reporting requirements. The ministry also vowed to take a tough stance against cover-ups and last month sacked four health officials in Henan province for concealing the number of infections and deaths.

This year, enterovirus 71 has caused nearly all of the laboratory-confirmed cases in two hot-spots, the provinces of Henan and Shandong. Xu suspects that the disease's increasing virulence may be due to a genetic change in the circulating virus strain. Before 2004, the predominant strain was called C4b; since then, a different strain, C4a, has been most common (Y. Zhang et al. J. Clin. Virol. 44, 262?267; 2009).

What caused this switch isn't clear, says Xu, as little is known about the genetics and transmission trends of the fast-mutating virus. Most studies have been clinical, aimed at, for example, identifying the strains behind a given outbreak and the disease's clinical features, especially when there are neurological complications. Many researchers say it is time to step up efforts to understand the basic biology of enterovirus 71 to speed vaccine development.

In a major push financed by the Chinese health ministry and the Center for Disease Control and Prevention, Xu and his colleagues measured the infection rate in adults and children during last year's outbreak and analysed stool samples and throat swabs taken from more than 18,000 patients. Preliminary results suggest that the infection rate is alarmingly high, meaning that there are large populations of virus carriers who do not show any symptoms of the disease.

Experts are divided as to how worried the world should be about the virus. Tom Solomon, a neurologist at the University of Liverpool, UK, argues that enterovirus 71 infection is underappreciated on a global scale and may pose a bigger risk to public health than is currently thought. But Hans Troedsson, the World Health Organization's representative in China, says "there is no cause for alarm". The public-health impact of hand, foot and mouth disease, including cases caused by enterovirus 71, is no more serious than other common childhood diseases, he says.

Troedsson thinks that the recent apparent increase in enterovirus 71 infection might be due to higher reporting rates rather than an increase in disease prevalence. "We will closely monitor the situation and decide polices accordingly," he says.

[Sally Furniss]

Enterovirus 71 Infection

Causative agent
Enterovirus 71 (EV71) is a single stranded, RNA virus and one of the causative agents for hand, foot and mouth disease (HFMD). The disease occurs commonly in Southeast Asian areas, especially in summer and early autumn. Large outbreaks have been reported in Taiwan and Malaysia in 1990s.


Clinical features
EV71 infection is usually found among young children. It most commonly presents with symptoms of HFMD, characterised by fever, sores in the mouth, and a rash with blisters. Usually it begins with fever, poor appetite, malaise and sore throat. One to two days later, painful sores develop in the mouth. The sores are characterised by small red spots with blisters which then often become ulcers. They are usually located on the tongue, gums, and inside of the cheeks. The non-itchy skin rash manifests as flat or raised red spots. The rash is usually found on the palms of the hands and soles of the feet. Asymptomatic infections can occur. Rarely, EV71 may cause more serious diseases, such as viral (aseptic) meningitis, encephalitis, poliomyelitis-like paralysis and myocarditis.


Mode of transmission
EV71 infection is transmitted from person to person by direct contact with nose and throat discharges, saliva, fluid from blisters, or the stool of infected persons. The illness is contagious during the acute stage and perhaps longer, as faecal shedding of virus can be detected for several weeks.


Incubation period
The incubation period ranges from 3 to 7 days.


Management
Currently, no specific treatment is available for EV71 infection. Some symptomatic treatments can relief fever and pain from the ulcers. In most cases, the illness is self-limiting. Symptoms including fever, rash and ulcers subside spontaneously in one week. Parents should pay attention to the health of their children and seek medical advice if their children having HFMD developing the following symptoms:

• Persistent and high fever;
• Repeated vomiting;
• Persistent sleepiness or drowsiness;
• Myoclonic jerks or sudden limb weakness.

Infected children should refrain from schools or group activities such as parties, interest classes, swimming until two weeks after fever has subsided and all the vesicular lesions have dried and crusted to prevent the spread of disease. Protect other family members, especially children, from getting the infection through strict personal and environmental hygiene (see advice on prevention below).


Prevention
Vaccine is not available at the moment. Good personal and environmental hygienic are the most important measures to prevent EV71 infection. While in Hong Kong or during travel, members of the public are advised to:--

• Wash hands before eating and after going to toilet, managing vomitus or changing diapers;
• Cover nose and mouth while sneezing or coughing, and proper disposal of nasal and mouth discharge;
• Never share personal items such as towels and eating utensils;
• Maintain good ventilation;
• Clean and disinfect frequently touched surface, furniture and toilets regularly with diluted bleach of 1:99 concentration (mixing 1 part of 5.25% household bleach with 99 parts of water);
• Disinfect toys/places which are contaminated by secretions or excreta with diluted household bleach of 1:49 concentration;
• Avoid close contact with HFMD patients.

http://www.chp.gov.hk/content.asp?lang=en&info_id=12431&id=24&pid=9