H5N1

Vietnam: Southern delta reports unseasonal HFMD deaths

Via Thanh Nien Daily, worrying news: Vietnam's southern delta reports unseasonal HFMD deaths. Excerpt:

Hand, foot and mouth disease in the Mekong Delta has suddenly become more severe and fatal recently, causing overloads at many hospitals in the region. 

Reports from hospitals showed a rising number of deaths and more than 2,000 new infections in October at many provinces, figures three and four times higher compared to a year earlier. 

Can Tho Children’s Hospital received 2,300 new cases in October, including 448 severe cases in need of hospitalization and five deaths. 

The hospital had to have four children share a sickbed, with seven or eight beds arranged in each room of 12 square meters. 

An Giang and Dong Thap Province recorded 15 deaths. An Giang, which has topped the death toll from the disease this year with 12 cases, reported 2,600 new cases while Dong Thap recorded more than 2,200, similar to figures from Long An Province. 

Tien Giang reported more than 2,800 new cases including one death. Some infections came from local kindergartens, where the threat of spreading the disease is greatest. 

Infections are in children under five years old, and many of the fatalities were caused by EV71, the most virulent strain of the Entovirus that causes the disease, also the most common one in Vietnam. 

Doctor Vo Huy Danh, director of the An Giang Preventive Health Center, told Phu Nu magazine “the increases are worrying.” 

Danh said this time of year used to see few infections and almost no deaths. 

He warned that cooler weather the rest of the year could further facilitate the spread of the disease.

Vietnam: HFMD on the rise in Hau Giang

Via VietNam News: Disease on the rise in Hau Giang. Excerpt:

Nearly 13,000 people have been infected with hand, foot and mouth disease (HFMD) this year in the southern province of Hau Giang, the provincial Department of Health have said. 

This is three times more the number of cases recorded at the same time last year. It is reported that more than 80 per cent of the 13,000 are children from three to five years old. All communes have patients. 

The disease is a human syndrome caused by intestinal viruses of the picornaviridae family. The most common strains causing the disease are the coxsackie A virus and enterovirus 71 (EV-71). 

Of 15 samples taken in the province, all were positive with EV-71, which can cause serious illness and death. 

The health department has said that local people's awareness of the steps needed to prevent disease remains weak. Only 36 per cent of people usually wash their hands with soap. 

The department has made efforts to control the spread of the disease, including disinfecting outbreak spots and further disseminating the importance of using soap, especially for children.

Taiwan: Still not past dengue, influenza and EV71 high-risk period: CDC

Via The China Post: Still not past Dengue, influenza and EV71 high-risk period: CDC. Excerpt:

Dengue fever cases increased by 67 in the past week, with 30 new cases in Tainan and 36 cases in Kaohsiung, the Centers for Disease Control (CDC, 疫病管制局) said yesterday. 

Due to suitable incubation temperatures for the virus during October and November, the disease is still in its high risk infection period, according to the CDC. Dengue fever is now prevalent in Tainan and Kaohsiung, with patients middle aged or older more vulnerable to infection, said CDC Disease Prevention Doctor Luo Yi-jun (羅一鈞). 

Included in the 36 new cases of dengue fever in Kaohsiung this past week were two cases of dengue hemorrhagic fever which a 49-year-old woman and a 75-year-old man both contracted. Both have shown symptoms such as high fever, bleeding, pain in muscles and joints, low levels of blood platelets, and blood plasma leakage. Both have received suitable medical treatment and have successfully been discharged from the hospital, according to the CDC. 

This year there have been a total of 605 recorded cases of dengue fever, including 12 cases of dengue hemorrhagic fever, resulting in two deaths, according to CDC statistics. 

The CDC reminds the public to watch out for containers or ditches around residential areas where water can collect to create the perfect breeding grounds for dengue fever carriers – mosquitoes. 

Enterovirus risks still lingers 

A 6-year-old boy contracted a new strain of enterovirus 71 (EV71) in Hualien, the CDC announced in a Taipei conference yesterday. 

On Sept. 29, the 6-year-old boy showed a wide variety of symptoms including mild respiratory illness, hand rash breakout, muscle seizures and so on. Doctors diagnosed him as being critically ill with a severe case of enterovirus. After intensive care and close medical attention, the patient fully recovered and has been discharged from the hospital. Other family members, classmates, and friends exposed to the patient have all been screened for the virus, all of whom remain clear and healthy. 

The CDC Deputy Director Zhou Zhi-hao (周志浩) said that up to Oct.8 of this year there has been a total of 147 enterovirus cases recorded, with 144 cases of EV71 type virus. There have been two recorded deaths.

Hong Kong: EV71 case probed

Via the Hong Kong government website: EV71 case probed.

The Centre for Health Protection is investigating a case of Enterovirus-71 infection, with a meningitis complication, involving an 11-year-old boy.   

He fell ill on August 27 and was admitted to United Christian Hospital on September 2, and diagnosed with meningitis. He was discharged on September 8.   

He tested positive for EV71.   

He travelled to the Mainland with family members in mid August. His four-year-old sister has mouth ulcers, while other home contacts are asymptomatic.

Cambodia: Enterovirus EV71 genotype C4

Via the Institut Pasteur du Cambodge in Phnom Penh: Enterovirus EV71 genotype C4. Excerpt:

Enterovirus EV71 genotype C4 identified at Institut Pasteur du Cambodge as the major cause of neurorespiratory syndrome in young children in Cambodia reported since April 2012. 

The Virology Unit at Institut pasteur du Cambodge headed by Dr Philippe Buchy has identified the human enterovirus 71 (EV71), genotype C4 as the principal etiologic agent responsible for the outbreak of hand, foot and mouth disease (HFMD) currently affecting children in Cambodia and Thailand, and other countries in Southeast Asia. 

“Following an initial report by the clinicians of the Kantha Bopha hospital that, despite their best efforts, dozens of deaths had occurred in young children presenting with encephalitis associated with pulmonary edema, human enterovirus serotype 71 (EV71) was identified by the Institut Pasteur in Cambodia. 

"The virus was then also detected in mild or severe hand, foot and mouth disease (HFMD) cases in many hospitals throughout the country through a surveillance system established by the Ministry of Health, WHO, National Institute of Public Health with the support of many partners like US CDC. 

"We analyzed 3 isolates randomly selected from patients originating from different Cambodian provinces over a 4-week period [this analysis was since completed with over 20 new strains]. 

Approximately 841 base pairs of the VP1 gene (positions 2268 to 3109) were sequenced and aligned with sequences of strains isolated in Viet Nam in 2011 and 2012 (data kindly provided by Thanh Tran Tan, Jeremy Farrar, Rogier van Doorn; Oxford University Clinical Research Unit — Ho Chi Minh City — Viet Nam/Wellcome Trust Major Overseas Programme), in Shanghai in 2011 and 2012 (data provided by Ralf Altmeyer and Ke Lan; Institut Pasteur of Shanghai), and with various sequences available in GenBank and originating from other Asian countries (e.g., Singapore, Malaysia). 

The phylogenetic analysis shows that the EV71 sequences from Cambodia cluster with those of the EV71 strains genotype C4 isolated in Viet Nam in 2011 and 2012 (homology at the nucleotide level: 98.78-99.39 percent; homology at the amino acid level: 98.78-100 percent) [and] are closely related to the sequences of the C4 genotype viruses detected in 2010-2012 in China (homology at the nucleotide level: 98.17-99.39 percent; homology at the amino acid level: 98.17-100 percent). 

Further genomic characterization is still ongoing. These preliminary data, however, suggest that strains in Cambodia are part of the ongoing outbreak of EV71 that is proceeding across Asia and involves strains similar to those observed in other countries in the region.

Hand-foot-and-mouth disease kills 8 in central China

Via China Daily, a Xinhua report: Hand-foot-and-mouth disease kills 8 in C China. Excerpt:

CHANGSHA - Hand-foot-and-mouth disease (HFMD) sickened 17,058 people and killed 8 in July in Central China's Hunan province, the provincial health authorities said Monday. 

The disease incidence rate in July was much lower than that of previous months, the department said. 

The province has witnessed an increase in the disease incidence rate since March this year, with the peak period running from April to June due to the high temperatures that hit the province this summer.

 In June, 34,768 cases of HFMD were reported and 17 people died of the disease, and 20,078 cases of HFMD infections were reported in April, according to statistics from Hunan's provincial health department. 

The disease incidence rate in August and September will decrease as cool weather sets in, according to the Hunan Provincial Center for Disease Control and Prevention.

Cambodia: July report from Kantha Bopha Hospitals

Via the website of the Kantha Bopha Hospitals, an August 2 report on Facts & Figures - July 2012. Excerpt (Dr. Beat Richner's bolding):

The Patients during July 2012 in our Hospitals:

Outpatients:  74 006  

Inpatients, severely sick children to be admitted for Hospitalization:  15 326   

Severe cases of the Hemorrhagic Dengue Fever to be admitted for Hospitalization: 5061 

Hand/Foot/Mouth treated ambulant: 434

Hand/Foot/Mouth being hospitalized   260

Among the 260 hospitalized cases there were 97 suffering from Encephalitis.

In most of these cases of H/F/M/ Diseases the Virus “E71” was found, identified by the Institute Pasteur on our demand. 

In July only 12 cases, without the lesions H/F/M, but where we found the Virus E71, have developed in the last hours of their life a destruction of the lungs. (In June 34 cases). Still it is not clear what is causing the destruction of the lungs. Compare my declaration under the title: The grave failure of the WHO in Cambodia (on my facebook, 25th July 2012). 

We still think, that the application of toxic and wrong medicine by private clinics or Tuberculosis may be a significant factor, or both. Most of these children are passing away one or two or three hours after arrival in our Hospitals, but all were treated in private clinics before during two days.

In the press release of July 12th the WHO and the Ministry of Health mentioned malnutrition as a factor. Not a single case was malnourished. And it was told that the use of Steroid has worsening the state of the patients finally leading to death!! Again, that is absolute nonsense.

The figures mentioned above are showing that Dengue is actually the great problem in Cambodia. Children are arriving in shock day and night in our Hospitals. But the mortality rate in July was only 0,5% (24 children died). All children who have died were first treated in private clinics. At arrival they show already significant signs of drug intoxication. They died from drug intoxication!

HFMD eases in Vietnam, dengue and H5N1 take stage

Via Thanh Nien Daily: HFMD eases in Vietnam, dengue and H5N1 take stage.

Vietnam’s Health Ministry said the spread of hand, foot, and mouth disease is cooling its heels as dengue infects more people and bird flu threaten to recur. 

The number of new HFMD cases has dropped and caused six deaths in July. 

The ministry’s Preventive Health Department reported 7,461 infections in July, a 49.2 percent drop from June. The death rate meanwhile is nearly six times lower than the same period last year, news website VietNamNet reported Monday. 

Local governments were asked to stay vigilant to contain any new outbreaks and the spread of current ones. 

Vietnam recorded 57,900 cases of hand, foot and mouth disease over the first half of this year, including 29 casualties, the department said in a report. Last year, 110,000 people were infected including 169 deaths. 

Most of the patients are children under five years old, falling sick first with mouth sores and blisters on the hands and feet. 

The disease, which has no vaccine or specific medication, is caused by the Enterovirus, but health officials said HFMD in Vietnam is plagued by the most dangerous strain EV-71, which has caused all the fatalities and around 80 percent of the infections this year. 

Meanwhile, the department warned about dengue fever outbreaks in southern Vietnam, where monsoon season has just begun. 

A report from the Pasteur Institute in Ho Chi Minh City listed 11 deaths out of 21,215 dengue fever cases in the south this year, a 20 percent increase year-on-year, according to a Nhan Dan report July 2. Three of the deaths and nearly 5,000 of the infections were from Ho Chi Minh City. 

The bird flu outbreak is also likely to recur as sick fowl were reported in northern Vietnam in recent months. Four people were infected with the virus in February and March, including two fatal cases from the Mekong Delta, one from Binh Duong Province outside Ho Chi Minh City and another from the Central Highlands’ Dak Lak Province.

Hand, foot and mouth disease under control in Cambodia: Health Minister

Via Xinhua: Hand, foot and mouth disease under control in Cambodia: Health Minister. Excerpt:

The outbreak of hand, foot and mouth disease (HFMD), which is caused by enterovirus 71 (EV-71), is under control in Cambodia, Minister of Health Mam Bunheng said Thursday. 

"It is controllable now," he told reporters before a health seminar. 

He said to prevent further outbreak, all public health facilities have been instructed to report mild and severe cases of HFMD among children to the ministry. 

Cambodia has been plagued with HFMD since April. The severe form of the disease has killed at least 57 Cambodian children since then, according to the latest joint statement by the Ministry of Health and the World Health Organization last Friday.

Meanwhile, Dr. Beat Richner of Kantha Bopha Hospital has posted an update on his Facebook page. He still thinks something more was at work in some of the HFMD cases he saw, and some of the EV71 cases that didn't show HFMD symptoms.

Cambodia’s EV71 virus scare demystified

Via The Phnom Penh Post, a Q&A with doctors from the International SOS Clinic: Ask the doctor: Cambodia’s virus scare demystified. Excerpt:

What exactly is EV71? A new virus? 

The Enterovirus 71(EV71) is not a new virus. It actually belongs to the second most common type of virus after common cold and causes a more severe form of Hand, Foot and Mouth Disease (HFMD). EV71 is transmitted through any direct contact with saliva, discharge from the nose and throat, fluid from blisters or stools of an infected person. 

Cases are most infectious during the first week of acute illness. It is a very transmissible illness that has drawn attention from all over the world with the recent outbreak in Cambodia. Outbreaks occur every year in Southeast Asia and over the past 15 years outbreaks have been reported in Malaysia, Singapore, Taiwan, Japan, Korea, Thailand, Vietnam, Australia, China and now in Cambodia. 

More than 90 per cent of the infections occur in children under the age of five and the incidence of infection is higher in the summer and autumn months in temperate climates while remaining prevalent year-round in tropical climates. 

I am living in Phnom Penh with my two young children; do I have to worry about HFMD? 

Most cases of HFMD are mild and have no complications but certainly HFMD (hand foot mouth disease) nowadays is something to worry about, especially living in Cambodia, where recently numerous fatal cases has been linked to this disease. It is important for parents and child-minders to keep children away from public places, like playgrounds. As we know the disease spreads easily by direct contact from contaminated objects. 

ISOS Clinic has taken precaution by removing toys from the waiting area to prevent any likely transmission of the disease. Consult immediately with your trusted doctor should your child suddenly develop any fever with small skin lesions on hands or feet. 

What measures can I take for my child to avoid HFMD? Is there a vaccine? 

The actions we can take as parents, teachers, community leaders, health care providers, etc, are to provide basic but important information about safety and hygiene, careful and regular washing of hands, the use of sanitisers, cleaning and disinfecting toys, avoiding close contact to possible carriers as well as avoidance of public places, and even schools in times of outbreak. 

Presently there is no vaccine to prevent EV71 infection, although much research is being done to develop one. As viruses are constantly evolving in their quest for survival, researchers will definitely be looking for any signs of change to the EV71 virus that has now been isolated from these Cambodian children.