MANILA, 13 July 2009 - Hand, foot and mouth disease (HFMD) is typically a mild illness in economically developed nations, and most patients usually recover quickly. It is, however, emerging as a serious threat to public health in some parts of the Western Pacific Region.
The disease has caused 155 deaths this year in China, where health authorities reported 436 221 infections between 1 March and 31 May. HFMD infections in Malaysia have almost tripled from last year to 9653, but with no deaths so far this year. Brunei Darussalam has documented 447 cases, 15% more than the same period last year. Though last year’s outbreaks were more severe, the disease has nevertheless killed two people in Taiwan (China) and one in Hong Kong (China) this year.
Establishing a solid count of numbers for HFMD in the Western Pacific Region is difficult because some Member States do not conduct surveillance for the illness, or use differing standards to measure its impact on communities. China added HFMD to its list of reportable diseases last year and established a national surveillance system to track case numbers and improve public health responses.
There is no vaccine or antiviral treatment specifically for HFMD. As with influenza viruses such as the new Pandemic H1N1 2009 however, the risk of infection can be minimized by good hygiene practices, including:
- Washing hands frequently and thoroughly with soap, especially after changing a child's diaper and after using the toilet
- Cleaning dirty surfaces and soiled items, including toys, first with soap and water and then disinfecting them with a solution of chlorine bleach (made by adding 1 tablespoon of bleach to 4 cups of water; larger quantities can be made by adding ¼ cup of bleach to 1 gallon [16 cups] of water)
- Avoiding close contact (such as kissing and hugging) with persons with HFMD
- Not sharing personal items such as spoons, cups and other utensils, and properly washing them with detergent after use.
HFMD occurs globally, and in temperate climates spreads more easily in summer and early autumn. It is common among infants and children but can also occur in adults. HFMD symptoms can include fever, blisters in the mouth, and rashes on the hands, wrists and feet.
It is moderately contagious, spreading 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 should not be confused with foot-and-mouth disease, which affects only animals.
The disease is caused by viruses belonging to the enterovirus group, which includes polioviruses, coxsackieviruses, echoviruses, and enteroviruses. The most common cause of HFMD is Coxsackievirus A16, which usually results in a mild illness from which patients recover within one week to 10 days.
Outbreaks and individual cases are however sometimes caused by enterovirus 71 (EV71). This pathogen can cause more severe illness as it can attack the nervous system leading to viral meningitis and more serious diseases such as encephalitis (swelling of the brain) and polio-like paralysis.
Complications from EV71 can be fatal and are considered responsible for the majority of fatalities. Early symptoms are similar to mild HFMD, but can progress to headache, irritability, and acute limb weakness. If the central nervous system is attacked, potentially life-threatening encephalitis, polio-like paralysis, and cardiopulmonary failure can follow.
Recent years have seen several HFMD epidemics throughout the Asia-Pacific. In 1998 outbreaks occurred in Singapore and Taiwan, the latter infecting 100,000 people and causing 78 deaths. Surveillance for this disease is improving throughout the Western Pacific, and this is expected to result in more cases of HFMD being reported in the future.