A joint investigation launched by the WHO, the Cambodian Health Ministry, the US Centers for Disease Control and Prevention and the Institut Pasteur du Cambodge has drawn up some conclusions on the killer disease with a very high mortality rate in Cambodia.
It has been confirmed that the severe illness affecting the majority of children taken ill in Cambodia since April and with a very high mortality rate is a very severe form of Hand, Foot and Mouth Disease (HFMD) caused by enterovirus EV-71. Most of the 31 samples tested by the Pasteur Institute in Cambodia tested positive for EV-71, others tested positive for Haemophilus Influenzae type B and Streptococcus suis.
78 cases were reported, 62 of these from the Kantha Bopha Children's Hospital in Phnom Penh and 16 from other hospitals. 61 of the cases fitted into the case definition (EV-71) and 54 of these died. The victims were mainly under three years of age, from 14 provinces, some of them with chronic underlying health issues. It was found that many of the cases had been treated with steroids during the illness, a treatment which worsens the condition of patients with EV-71.
HFMD is a common viral disease which usually affects children under 5 years of age and is rarely fatal. So far in the PR China this year there have been 890,000 cases of mild HFMD, occasioning 242 deaths, while in Vietnam there have been 58,000 cases and 29 deaths. Usually the patient recovers from the disease within ten days without medical treatment. Severe cases, and particularly those caused by EV-71, cause neurological and respiratory symptoms, such as convulsions, jerking limbs, shortness of breath, vomiting, severe abdominal pains and fever. It is spread from person-to-person through body secretions. It is particularly dangerous to treat this form of the virus with steroids.
HFMD is caused by viruses belonging to the genus Enterovirus, which includes coxsackievirus, poliovirus, echovirus and enterovirus. The most common cause is Coxsackievirus A16, however other Coxsackieviruses and Enterovirus 71 have been known to cause the disease, as is the case in Cambodia.
Recently there have been numerous outbreaks of this disease in the PR China, Japan, Hong Kong (China), Republic of Korea, Malaysia, Singapore, Taiwan, Thailand and Vietnam.
The investigation does not rule out the appearance of further cases in the near future: "It is expected that the enhanced surveillance will identify occasional new cases of the severe form of the disease in the coming months" (1).
The Cambodian Health Ministry has ordered all health centers to report cases of HFMD and to be particularly watchful for neuro-respiratory syndrome (a key symptom in patients suffering from severe HFMD caused by EV-71).
However, HFMD is not endemic only in Asia and does not always affect infants. The disease appears round the world and some forms can attack adults and teenagers. In Alabama, USA, in 2012, a sudden outbreak of an uncommon form of HFMD affected teenagers and older adults, causing some hospitalisations.
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