Giuseppe
Emeritus
[In this post: (1) European Centre of Diseases Prevention and Control, Situation Update, Hand Foot and Mouth Disease outbreaks in Asia; (2) HFMD Facts Sheet. See original texts at the source sites. EDITED.]
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(1) [ECDC, UPDATES, HAND_FOOT_MOUTH DISEASE, ENTEROVIRUS] Outbreak of hand, foot and mouth disease in Asia
06 May 2008
* Such outbreaks frequently last months and can spread widely.
* The virus is mainly transmitted through direct contact with cases.
* HFMD is a common illness in children, and is usually mild, starting with fever, followed by a sore throat with sores on the tongue, gums and cheeks, and skin rash on the palms of the hands and the soles of the feet.
* EV71 may, however, cause severe neurological disease, including meningitis and encephalitis, which may result in death. There is currently no vaccine or curative treatment for cases.
* There are, however, effective public health measures to prevent the spread of the disease, such as sanitation and general hygiene.
* Cases are currently being reported from six provinces in China: Anhui (the most affected), Zhejiang, Henan, Hubei, Jiangxi and Guangdong.
* Singapore and Vietnam are also experiencing outbreaks, but for Vietnam no further details are available on the geographical spread.
* Anyone traveling to an affected area should observe strict personal hygiene measures to avoid infection ? please see our fact sheet on EV71 for more information.
* ECDC, in collaboration with the European Commission, is closely following the situation, and will provide additional information and analysis as needed.
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(2) [ECDC, UPDATES, HAND_FOOT_MOUTH DISEASE, ENTEROVIRUS] HAND, FOOT AND MOUTH DISEASE FACTS SHEET - Latest update 6 May 2008
? Infectious agent: Enterovirus 71 is one of the more than 90 enterovirus serotypes that have been identified up to date.
It belongs to the family of the Picornaviridae, genus Enteroviridae.
Poliovirus belongs to the same family and genus.
? Reservoir: Humans function as the reservoir.
? Clinical presentation: After an incubation period of 3 to 7 days, symptoms start with fever, and general malaise.
After 2 days, this is followed by the development of sores (blisters, ulcers) on the tongue, gums and inside the cheeks and a skin rash on the palms of the hands and the soles of the feet.
Symptoms usually disappear after a week to 10 days.
Young children are the most affected. A large proportion, more than two thirds of enterovirus 71 infected cases remain asymptomatic.
While enterovirus 71 infections are most frequently self-limited febrile diseases, they may cause severe neurological disease, including viral (aseptic) meningitis, encephalitis or acute flaccid paralysis.
As illustrated during a recent large outbreak in Taiwan, death may occur, mainly in children below three years, as well as long-term neurological sequelae.
? Transmission modes: Enterovirus 71 is mainly transmitted through direct contact with nose and throat discharges, fluid from the blisters, saliva or through faeco-oral route.
In case of respiratory illness, transmission through droplets may also occur.
There is no evidence of food- or water-borne transmission.
? Epidemiology: Enterovirus 71 was first isolated in the United States in 1969, and is distributed worldwide.
Related outbreaks may be small, with occasional fatalities, or more severe with a high case-fatality ratio.
In Europe, such severe outbreaks have been reported in Bulgaria in 1975 with 44 deaths and in Hungary in 1978 with 45 deaths. More recently, severe outbreaks were reported from Malaysia (1997), Taiwan (1998, 1999, 2001) and Singapore (2000). In the 1998 outbreak in Taiwan, at least 130,000 cases were reported, with 78 deaths.
It is not known why the virulence and communicability of enterovirus 71 infections vary. It may be linked to decreased population immunity or mutations affecting the virus? virulence.
? Treatment: There is no antiviral treatment or vaccine for enterovirus 71. Only supportive treatment is possible in case of severe complications.
Prevention and control: Sanitation and personal hygiene are the most important and effective preventive measures, in particular when in direct contact with infected cases.
These measures include hand washing, especially after going to the toilet or changing babies? nappies. Contaminated surfaces and soiled clothing should also be disinfected.
? Links:
1) Enteroviruses ? non polio. World Health Organization. Available from: http://www.who.int/mediacentre/factsheets/fs174/en/index.html
2) Hand, foot and mouth disease. Centres for Disease Prevention and Control. Available from: http://www.cdc.gov/ncidod/dvrd/revb/enterovirus/hfhf.htm
3) Guideline on Hand-foot-mouth Disease (HFMD) Management. Centre for Health Protection, Hong Kong, China. 23 May 2007. Available from: http://www.dh.gov.hk/english/useful/useful_ld/files/ltod20070523.pdf
4) Lin T-Y, Twu S-J, Ho M-S, Chang L-Y, Lee C-Y. (2003) Enterovirus 71 outbreaks, Taiwan: occurrence and recognition. Emerg Infect Dis [serial online]. Available from: URL: http://www.cdc.gov/ncidod/EID/vol9no3/02-0285.htm
5) Modlin JF. (2007) Enterovirus D?j? vu. N Engl J Med ; 356 : 1204-5.
6( Chang LY, King CC, Hsu KH, et al. (2002) Risk factors of enterovirus 71 infection and associated hand, foot, and mouth disease/herpangina in children during an epidemic in Taiwan. Pediatrics; 109: e88.
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(1) [ECDC, UPDATES, HAND_FOOT_MOUTH DISEASE, ENTEROVIRUS] Outbreak of hand, foot and mouth disease in Asia
06 May 2008
Health authorities in Singapore, China and Vietnam are tackling several thousand cases of hand, foot and mouth disease (HFMD), with at least 26 fatalities reported in China. Infants and young children are most affected, which is as expected.
* These outbreaks of HFMD are caused by enterovirus 71 (EV71), an intestinal virus found worldwide.
* Such outbreaks frequently last months and can spread widely.
* The virus is mainly transmitted through direct contact with cases.
* HFMD is a common illness in children, and is usually mild, starting with fever, followed by a sore throat with sores on the tongue, gums and cheeks, and skin rash on the palms of the hands and the soles of the feet.
* EV71 may, however, cause severe neurological disease, including meningitis and encephalitis, which may result in death. There is currently no vaccine or curative treatment for cases.
* There are, however, effective public health measures to prevent the spread of the disease, such as sanitation and general hygiene.
* Cases are currently being reported from six provinces in China: Anhui (the most affected), Zhejiang, Henan, Hubei, Jiangxi and Guangdong.
* Singapore and Vietnam are also experiencing outbreaks, but for Vietnam no further details are available on the geographical spread.
* Anyone traveling to an affected area should observe strict personal hygiene measures to avoid infection ? please see our fact sheet on EV71 for more information.
* ECDC, in collaboration with the European Commission, is closely following the situation, and will provide additional information and analysis as needed.
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(2) [ECDC, UPDATES, HAND_FOOT_MOUTH DISEASE, ENTEROVIRUS] HAND, FOOT AND MOUTH DISEASE FACTS SHEET - Latest update 6 May 2008
? Infectious agent: Enterovirus 71 is one of the more than 90 enterovirus serotypes that have been identified up to date.
It belongs to the family of the Picornaviridae, genus Enteroviridae.
Poliovirus belongs to the same family and genus.
? Reservoir: Humans function as the reservoir.
? Clinical presentation: After an incubation period of 3 to 7 days, symptoms start with fever, and general malaise.
After 2 days, this is followed by the development of sores (blisters, ulcers) on the tongue, gums and inside the cheeks and a skin rash on the palms of the hands and the soles of the feet.
Symptoms usually disappear after a week to 10 days.
Young children are the most affected. A large proportion, more than two thirds of enterovirus 71 infected cases remain asymptomatic.
While enterovirus 71 infections are most frequently self-limited febrile diseases, they may cause severe neurological disease, including viral (aseptic) meningitis, encephalitis or acute flaccid paralysis.
As illustrated during a recent large outbreak in Taiwan, death may occur, mainly in children below three years, as well as long-term neurological sequelae.
? Transmission modes: Enterovirus 71 is mainly transmitted through direct contact with nose and throat discharges, fluid from the blisters, saliva or through faeco-oral route.
In case of respiratory illness, transmission through droplets may also occur.
There is no evidence of food- or water-borne transmission.
? Epidemiology: Enterovirus 71 was first isolated in the United States in 1969, and is distributed worldwide.
Related outbreaks may be small, with occasional fatalities, or more severe with a high case-fatality ratio.
In Europe, such severe outbreaks have been reported in Bulgaria in 1975 with 44 deaths and in Hungary in 1978 with 45 deaths. More recently, severe outbreaks were reported from Malaysia (1997), Taiwan (1998, 1999, 2001) and Singapore (2000). In the 1998 outbreak in Taiwan, at least 130,000 cases were reported, with 78 deaths.
It is not known why the virulence and communicability of enterovirus 71 infections vary. It may be linked to decreased population immunity or mutations affecting the virus? virulence.
? Treatment: There is no antiviral treatment or vaccine for enterovirus 71. Only supportive treatment is possible in case of severe complications.
Prevention and control: Sanitation and personal hygiene are the most important and effective preventive measures, in particular when in direct contact with infected cases.
These measures include hand washing, especially after going to the toilet or changing babies? nappies. Contaminated surfaces and soiled clothing should also be disinfected.
? Links:
1) Enteroviruses ? non polio. World Health Organization. Available from: http://www.who.int/mediacentre/factsheets/fs174/en/index.html
2) Hand, foot and mouth disease. Centres for Disease Prevention and Control. Available from: http://www.cdc.gov/ncidod/dvrd/revb/enterovirus/hfhf.htm
3) Guideline on Hand-foot-mouth Disease (HFMD) Management. Centre for Health Protection, Hong Kong, China. 23 May 2007. Available from: http://www.dh.gov.hk/english/useful/useful_ld/files/ltod20070523.pdf
4) Lin T-Y, Twu S-J, Ho M-S, Chang L-Y, Lee C-Y. (2003) Enterovirus 71 outbreaks, Taiwan: occurrence and recognition. Emerg Infect Dis [serial online]. Available from: URL: http://www.cdc.gov/ncidod/EID/vol9no3/02-0285.htm
5) Modlin JF. (2007) Enterovirus D?j? vu. N Engl J Med ; 356 : 1204-5.
6( Chang LY, King CC, Hsu KH, et al. (2002) Risk factors of enterovirus 71 infection and associated hand, foot, and mouth disease/herpangina in children during an epidemic in Taiwan. Pediatrics; 109: e88.
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