Severe hand, foot and mouth disease killed Cambodian children

News release

Severe form of hand, foot and mouth disease caused illnesses and deaths in majority of the children under recent investigation, Ministry of Health Cambodia concluded.

Severe form of hand, foot and mouth disease (HFMD) was the cause of illnesses and deaths in majority of the cases recently reported to the Ministry of Health in Cambodia, concluded the findings of a joint investigation.

the MoH, with support from WHO and partners, including Institut Pasteur du Cambodge and the US Centers for Disease Control and Prevention concluded investigation following reports from Kantha Bopha Children's Hospital of unusual numbers of illness and deaths among children hospitalised since April 2012.

The investigation included a thorough review of the hospital records of the patients from Kantha Bopha hospital as well as other hospitals, laboratory tests; active follow-up with the affected families by the local Rapid Response Teams (RRT) and evaluation of the data from national surveillance system.

Findings

Bases on the investigation, a total of 78 cases were identified. These included the initial 62 cases reported by Kantha Bopha hospital, and cases reported from other hospitals. Of these, the investigation focused on 61 cases who fitted the criteria used (the case definition), of which 54 had died.

It was not possible to test all the patients as some of them died before appropriate samples could be taken. Samples from a total of 31 patients were obtained and tested for a number of pathogens by Institut Pasteur du Cambodge. Of these, majority tested positive for Enterovirus 71 (EV-71) which causes hand, foot and mouth disease. A small proportion of sample also tested positive for other pathogens including Haemophilus Influenzae type B and Streptococcus suis.

The investigation revealed that most of the cases were under 3 years old, with some suffering with chronic conditions and malnutrition. The cases were from 14 different provinces and many of them were given steroids at some point during their illness. Steroid use has been shown to worsen the condition of patients with EV-71.

Response

In response to this event, the government, with support from WHO, has begun enhanced surveillance for neuro-respiratory syndrome, a key syndrome observed among patients with severe HFMD caused by EV-71. Health centres have also been instructed to report patients with mild HFMD. It is expected that the enhanced surveillance will identify occasional new cases of the severe form of the disease in the coming months.

In addition, MoH with support from partners is developing guidelines and training courses for management of patients with mild and severe forms of HFMD. The MoH is also working on a campaign to raise awareness on prevention, identification and care of children with HFMD.

What is HFMD?

HFMD is a common infectious disease of infants and children. It is not a new disease in Cambodia and is seen in many countries across the world. Nearly all patients recover in 7-10 days without medical treatment and complications are uncommon.

HFMD is different from foot-and-mouth disease (FMD) which affects cattle. HFMD is not transmitted to or from pets or other animals.

HFMD is caused by Enteroviruses, most commonly by Coxsackievirus which usually results in mild and self-limiting disease. HFMD can also be caused by Enterovirus 71, some of which can cause serious complications and lead to death.

Early signs of HFMD infection

The disease usually begins with a fever, poor appetite, malaise, and sore throat. Skin rash develops over 1-2 days with red spots, some with blisters on the palm, hands, soles of feet, and sometimes on buttocks or genitalia.

Severe signs of HFMD infections

In a small number of children, HFMD may cause severe disease. The signs of severe disease include shortness of breath, drowsiness, limb weakness and convulsion. It is advised that parents seek medical attention as soon as they see any of these signs in their children.

Treatment of children with HFMD

There is no specific treatment of HFMD. Patients should drink lots of water and may require treatment according to their symptoms to reduce fever and pain from ulcers.

How can HFMD be prevented?

Good hygiene practice can prevent HFMD. Frequent washing of hangs with soap and water, especially after touching any blister or sore, before preparing food and eating, before feeding young infants, after using toilets and after cleaning children.

For more information on disease, please:

MoH hotline numbers:
115 (free call), 012 488 981 or
089 669 567

Ministry of Health
Dr Sok Touch
+855 12 856 848

Dr Ly Sovann
+855 12 825 424

World Health Organization
Dr Pieter Van Maaren
+855 23 216 610

Dr Nima Asgari
+855 23 216 610

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