Guardian UK: Fear Grows Over Child Virus in China (24 dead, 5000 infected)

[marmar]

Health warning in China as fears grow over child virus
Tania Branigan in Beijing
The Guardian, Monday May 5 2008



Cases of a virus that has killed 24 young children and infected more than 5,000 may continue to rise despite efforts to contain it, the World Health Organisation (WHO) warned yesterday.

Enterovirus 71 (EV-71), which causes a severe strain of hand, foot and mouth disease, normally peaks in June and July. Experts fear that infections could increase as the weather becomes warmer.

With hundreds more cases emerging every day, China's health ministry has stepped up efforts to contain its spread, closing nurseries at the centre of the outbreak in Fuyang, eastern Anhui province, where 22 of the deaths occurred. State television showed workers spraying disinfectant around houses in rural areas.

This weekend it issued a nationwide alert, calling for heightened efforts to control the spread of infectious diseases - including hepatitis A and measles as well as hand, foot and mouth. It warned that the drive was needed "to guarantee the smooth staging of the Beijing Olympics and Paralympics and to practically preserve social stability".

But WHO China representative, Hans Troedsson, told a press conference: "I don't see it at all as a threat to the Olympics or any upcoming events."

There is no vaccine or cure for hand, foot, and mouth disease, which is characterised by fever, sores in the mouth and a rash with blisters. It is a common illness among infants and children and is not usually fatal. ......(more)

The complete piece is at: http://www.guardian.co.uk/world/2008/may/05/china.health

[uppityperson]

1. More info...

We had a hand/ft/mouth outbreak here when UPkid was a kid. I was glad I had run across it in a ped clinic situation. UPkid said mouth hurt, looked in to find it covered with what looked like canker sores. Not panicking (omg!, seriously, it looked HORRIBLE. If it were me I'd've been in the hospital) but calmly thinking, I remembered this virus going around a town where I worked in a ped clinic.

It is easily transmittable, and usually gets passed on before any symptoms show. It is a very common illness for kids, often parents don't know their kids have it as symptoms are usually slight. It is not fatal, though some kids may have more mouth sores and difficulty with food/drink for a few days.

It is odd that this many kids have died. Here is a bit more from the article:

There is no vaccine or cure for hand, foot, and mouth disease, which is characterised by fever, sores in the mouth and a rash with blisters. It is a common illness among infants and children and is not usually fatal.

However, the virus EV-71 can result in a more serious form of the illness and complications including meningitis and heart problems can prove fatal.

All of those taken ill have been under six, and most have been under two.

More about the virus and complications (from Australia but looks like good info):
http://access.health.qld.gov.au/hid/InfectionsandParasites/ViralInfections/enterovirus71Ev71NeurologicalDisease_fs.asp

Topic: Enterovirus 71 (EV71) Neurological Disease

Description

Enterovirus 71 (EV71) neurological disease is a rare but serious complication of infection with Enterovirus 71, a virus which can also cause hand, foot and mouth disease. Although Enterovirus 71 causes frequent outbreaks of hand foot and mouth disease, cases or outbreaks of Enterovirus 71 neurological disease are rare and mainly occur in 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. In 1999, Western Australia experienced an outbreak with 14 cases of meningitis and 8 cases of paralysis, 3 of which have become permanent.

Symptoms

Enterovirus 71 is one of the causes of a mild illness called hand, foot and mouth disease which usually starts with a slight fever followed by blisters or ulcers in the mouth and on the hands and feet. However, in a small number of children it may cause high fever, meningitis (inflammation of the lining of the brain), encephalitis (inflammation of the brain itself), and paralysis.

The usual time between contact with the virus and the development of the illness is approximately 3-5 days. After fever develops it usually takes 1 - 3 days before meningitis occurs, but paralysis can occur within 10 - 30 hours after symptoms begin.

Transmission

Enterovirus 71 is usually spread by respiratory droplets, through contact with the fluid in the blisters or contact with infected faeces. The virus may continue to be excreted in the faeces for many weeks.

The virus can be in the faeces for at least 2 months after symptoms develop. A person is infectious for as long as the virus is present in the faeces.

Treatment

There is no proven treatment for the virus. Treatment usually focuses on the person's symptoms.

Prevention

Good hygiene is the single most effective way of preventing the spread of the disease. Hands should be washed thoroughly in soap and water for at least 15 seconds and then dried thoroughly. It is important to wash hands after going to the toilet, touching soiled linen or articles and before preparing or eating food. Teach children to wash their hands effectively before eating or drinking and after going to the toilet.

Control

Children with hand foot and mouth disease should be excluded from child care and schools until all blisters have healed.

Children with Enterovirus 71 neurological disease should be excluded until the virus is no longer being excreted in the faeces and until a medical certificate of recovery is obtained.

From CDC, pdf link on severe cases/complications :http://www.cdc.gov/eid/content/14/5/pdfs/07-1121.pdf

Info on hand/foot/mouth disease: http://www.cdc.gov/ncidod/dvrd/revb/enterovirus/hfhf.htm

What is hand, foot, and mouth disease?

Hand, foot, and mouth disease (HFMD) is a common illness of infants and children. It is characterized by fever, sores in the mouth, and a rash with blisters. HFMD begins with a mild fever, poor appetite, malaise ("feeling sick"), and frequently a sore throat. One or 2 days after the fever begins, painful sores develop in the mouth. They begin as small red spots that blister and then often become ulcers. They are usually located on the tongue, gums, and inside of the cheeks. The skin rash develops over 1 to 2 days with flat or raised red spots, some with blisters. The rash does not itch, and it is usually located on the palms of the hands and soles of the feet. It may also appear on the buttocks. A person with HFMD may have only the rash or the mouth ulcers.

Is HFMD the same as foot-and-mouth disease?

No. HFMD is often confused with foot-and-mouth disease of cattle, sheep, and swine. Although the names are similar, the two diseases are not related at all and are caused by different viruses. For information on foot-and-mouth disease, please visit the web site of the US Department of Agriculture.

What causes HFMD?

Viruses from the group called enteroviruses cause HFMD. The most common cause is coxsackievirus A16; sometimes, HFMD is caused by enterovirus 71 or other enteroviruses. The enterovirus group includes polioviruses, coxsackieviruses, echoviruses and other enteroviruses.

Is HFMD serious?

Usually not. HFMD caused by coxsackievirus A16 infection is a mild disease and nearly all patients recover without medical treatment in 7 to 10 days. Complications are uncommon. Rarely, the patient with coxsackievirus A16 infection may also develop "aseptic" or viral meningitis, in which the person has fever, headache, stiff neck, or back pain, and may need to be hospitalized for a few days. Another cause of HFMD, EV71 may also cause viral meningitis and, rarely, more serious diseases, such as encephalitis, or a poliomyelitis-like paralysis. EV71 encephalitis may be fatal. Cases of fatal encephalitis occurred during outbreaks of HFMD in Malaysia in 1997 and in Taiwan in 1998.

Is HFMD contagious?

Yes, HFMD is moderately contagious. Infection is spread from person to person by direct contact with nose and throat discharges, saliva, fluid from blisters, or the stool of infected persons. A person is most contagious during the first week of the illness. HFMD is not transmitted to or from pets or other animals.

How soon will someone become ill after getting infected?

The usual period from infection to onset of symptoms ("incubation period") is 3 to 7 days. Fever is often the first symptom of HFMD.

Who is at risk for HFMD?

HFMD occurs mainly in children under 10 years old, but may also occur in adults too. Everyone is at risk of infection, but not everyone who is infected becomes ill. Infants, children, and adolescents are more likely to be susceptible to infection and illness from these viruses, because they are less likely than adults to have antibodies and be immune from previous exposures to them. Infection results in immunity to the specific virus, but a second episode may occur following infection with a different member of the enterovirus group.

What are the risks to pregnant women exposed to children with HFMD?

Because enteroviruses, including those causing HFMD, are very common, pregnant women are frequently exposed to them, especially during summer and fall months. As for any other adults, the risk of infection is higher for pregnant women who do not have antibodies from earlier exposures to these viruses, and who are exposed to young children - the primary spreaders of enteroviruses.
Most enterovirus infections during pregnancy cause mild or no illness in the mother. Although the available information is limited, currently there is no clear evidence that maternal enteroviral infection causes adverse outcomes of pregnancy such as abortion, stillbirth, or congenital defects. However, mothers infected shortly before delivery may pass the virus to the newborn. Babies born to mothers who have symptoms of enteroviral illness around the time of delivery are more likely to be infected. Most newborns infected with an enterovirus have mild illness, but, in rare cases, they may develop an overwhelming infection of many organs, including liver and heart, and die from the infection. The risk of this severe illness in newborns is higher during the first two weeks of life.

Strict adherence to generally recommended good hygienic practices by the pregnant woman (see "Can HFMD be prevented?" below) may help to decrease the risk of infection during pregnancy and around the time of delivery.

When and where does HFMD occur?

Individual cases and outbreaks of HFMD occur worldwide, more frequently in summer and early autumn. In the recent past, major outbreaks of HFMD attributable to enterovirus 71 have been reported in some South East Asian countries (Malaysia, 1997; Taiwan, 1998).

How is HFMD diagnosed?

HFMD is one of many infections that result in mouth sores. Another common cause is oral herpesvirus infection, which produces an inflammation of the mouth and gums (sometimes called stomatitis). Usually, the physician can distinguish between HFMD and other causes of mouth sores based on the age of the patient, the pattern of symptoms reported by the patient or parent, and the appearance of the rash and sores on examination. A throat swab or stool specimen may be sent to a laboratory to determine which enterovirus caused the illness. Since the testing often takes 2 to 4 weeks to obtain a final answer, the physician usually does not order these tests.

How is HFMD treated?

No specific treatment is available for this or other enterovirus infections. Symptomatic treatment is given to provide relief from fever, aches, or pain from the mouth ulcers.

Can HFMD be prevented?

Specific prevention for HFMD or other non-polio enterovirus infections is not available, but the risk of infection can be lowered by good hygienic practices. Preventive measures include frequent handwashing, especially after diaper changes (see "Handwashing" in: An Ounce of Prevention: Keeps the Germs Away), cleaning of contaminated surfaces and soiled items first with soap and water, and then disinfecting them by diluted solution of chlorine-containing bleach (made by mixing approximately ¼ cup of bleach with 1 gallon of water. (See more about cleaning and disinfecting in general in CDC's Prevention Resources). Avoidance of close contact (kissing, hugging, sharing utensils, etc.) with children with HFMD may also help to reduce of the risk of infection to caregivers.

HMFD in the childcare setting

HFMD outbreaks in child care facilities occur most often in the summer and fall months, and usually coincide with an increased number of cases in the community.

CDC has no specific recommendations regarding the exclusion of children with HFMD from child care programs, schools, or other group settings. Children are often excluded from group settings during the first few days of the illness, which may reduce the spread of infection, but will not completely interrupt it. Exclusion of ill persons may not prevent additional cases since the virus may be excreted for weeks after the symptoms have disappeared. Also, some persons excreting the virus, including most adults, may have no symptoms. Some benefit may be gained, however, by excluding children who have blisters in their mouths and drool or who have weeping lesions on their hands.

If an outbreak occurs in the child care setting:

* Make sure that all children and adults use good handwashing technique, especially after diaper changes.

* Thoroughly wash and disinfect contaminated items and surfaces using diluted solution of chlorine-containing bleach.

See the section “Can HFMD be prevented?” to learn more about hygienic practices which may be helpful in preventing HFMD transmission.