Hand, Foot and Mouth disease

Trying to make sense of it all?
Me too.
As a parent I worry of cause.
Nevertheless I do not want too loose my self in speculations.
The things I found looking for info regarding HMFD confused me.

Now, I’m not a Doctor, neither am I a rocket scientist.
But I am sure that the whole thing might bite me in my behind when I decide to just go with things like:

“This can be a very painful and bothersome illness, but it is not dangerous”.

While peoples who seem to know what they talk about tell me things like:

Hand-foot-and-mouth disease is most contagious during the first week of illness. However, the coxsackievirus may spread for weeks after signs and symptoms have disappeared. Some people excreting the virus, especially most adults, may have no signs or symptoms of hand-foot-and-mouth disease.
Source: mayoclinic.com Mayo Foundation for Medical Education and Research (MFMER)

Epidemic HFMD viral infections are usually caused by members of the Enterovirus genus, namely, coxsackievirus A16 or enterovirus 71. In addition, sporadic cases with coxsackievirus types A4-A7, A9, A10, B1-B3, and B5 have been reported. Infections usually occur as isolated events, but epidemics occur regularly.

• Recently, a large outbreak of HFMD in Taiwan caused by enterovirus 71 had a high mortality rate of 19.3% in the severe cases; the deaths resulted from pulmonary hemorrhage. During this outbreak, mortality rates were highest in children younger than 3 years.
• In a large epidermic (138 cases) of HFMD related to enterovirus 71 in Singapore, 7 fatalities occurred, most from interstitial pneumonitis or brainstem encephalitis. The report's conclusions were that in general, HFMD is a benign disease but the presence of unusual physical findings, elevated total white blood cell count, and vomiting and the absence of oral ulcers may signify a patient with higher risk of a fatal outcome.
• A later study of an HFMD epidermic (14 children) in Australia, again with enterovirus 71, reported that 9 (64%) developed severe neurologic disease in which the host immune response seemed to cause most of the neurologic manifestations.
  
  Source: Brad S Graham, MD, Consulting Staff, Dermatology Associates of Tyler, East Texas Medical Center; Trinity Mother Francis Hospital
  

Anyways . . . I’ve collected some stuff a headache to read but interesting . . .

As a start Here a distilation of articles posted in the Nation, on the link page you'll find some more.

November 27, 2007

More than 90 per cent of the victims were children younger than five years old.
"Bangkok has the highest number of HFMD patients with 2,567 people being infected," Morakot said.
The total number of patients this year was already two times higher than last year, he said, because the disease continued to spread in the cool season despite the fact it usually only spreads during the wet season.
Morakot said outbreaks of HFMD were usually found among children at nurseries or kindergartens. "To reduce HFMD risks, children should wash their hands with soap after using the toilet and playing in the playground," he said.
He also encouraged parents to take children to the doctor when they have blisters around their mouth, hands or feet.
"Don't just buy medicines from pharmacies and separate the children with symptoms from others to prevent the spread of the disease," he said.
Disease Control Department director general Thawat Suntrajarn said HFMD was caused by enterro-viruses.
"Although infected children can recover within about one week, serious complications may arise and cause deaths," he warned.

The Nation

November 15, 2007

Contagious disease strikes 30 children

Nearly 30 children have contracted hand, foot and mouth disease (HFMD) after it spread through nurseries in Angthong, Lamphun and Nan provinces, the Public Health Ministry revealed yesterday.

In Angthong province, six children were struck by the disease at the Wat Mongkol Thamnimit Nursery in Sam Ko district, and three children were affected at Wat Yeung Khongkharam Nursery in Chaiyo district. Both nurseries have been closed for two weeks.
Seven children were hit with the disease at a nursery in Muang Lamphun and 13 children contracted the disease at nurseries in Nan province. None of the cases were considered severe.
Angthong provincial health official Thawal Poblarp said about 50 cases of HFMD were detected in the province every year. Most patients suffer from a less severe strain of HMFD, called coxsackie virus, and the fatal enterivirus strain had not yet been detected.
Thawal said he dispatched officials to schools and nurseries in the province to alert teachers to watch out for HMFD. Officials were instructed to shut down schools if more than two cases of the disease were detected in one place.
Dr Khamnuan Ungchusak, director of the Disease Control Department's Epidemiology Bureau, said 6,775 HFMD cases had been detected this year (up to November 10) - double the 3,300 cases detected last year.
He said the increase was partly due to intensified controls, which allowed more cases to be detected.
HFMD typically affects children in nurseries and kindergartens from September to November, but the illness usually goes away by itself. It is characterised by mild fever, poor appetite, mouth sores, and a rash with blisters. It can spread from person to person by direct contact and sufferers are most contagious during the first week of the illness.
Children should be taken to a doctor if they have a high fever and seizures.
Khamnuan said the public should also watch out for dengue hemorrhagic fever, which had killed 72 people this year and affected 56,000 people overall.

 The Nation

3 April 2007

Over 1,000 cases of hand, foot and mouth disease detected in Thailand this year

A total of 1,009 cases of hand, foot, and mouth disease (HFMD) have been detected in Thailand this year, the director-general of the Disease Control Department said Saturday.

Doctor Thawat Sunthajan, the director-general, said the cases were reported by public health clinics nationwide from January until the end of July.

Thawat said four children died of the disease and most of the patients were between two to five years old.

The Nation

15 Sep 2006

HEALTH ALERT
30 schools closed by disease threat

259 students have symptoms of hand, foot and mouth virus; Sai Mai worst-hit
Thirty schools in Bangkok have been closed for 15 days following an outbreak of hand, foot and mouth disease, a source at the city's Health Department said yesterday.
Symptoms of the disease - high fever, a rash and blisters on hands, feet and mouth - were found in 259 pupils at 30 schools in 20 districts, the source said.
Sai Mai district was the worst affected, with 60 cases.
The schools would be disinfected to kill the communicable disease's viral species, which includes Coxsackie virus type A and B and Anterovirus 71.
The sick students had been placed under medical supervision, the source said.
Hand, foot and mouth disease can be passed on via direct contact with contaminated saliva, excrement or nasal discharge and there is no cure; doctors only provide treatments according to symptoms. In worst cases the disease can lead to fatal lung or brain infection and heart failure.
Between January and the end of July, some 1,009 cases were found, mostly in children aged between two and five, with four children dying of the disease, the head of the Disease Control Department, Thawat Sunthajan, said.
The Public Health Ministry has been urging childcare centers to dispose of faeces properly and to take children with symptoms to a doctor immediately. Teachers were asked to thoroughly wash their hands after changing nappies and before preparing meals.
Related agencies were also asked to regularly check the amount of chlorine in tap water and swimming pools to ensure it was at least 1 milligram per liter.
Meanwhile, caretaker Public Health Minister Pinij Charusombat said nearly 14 million Thais had diabetes and high-blood pressure - but nine million of them did not know.
Pinij said the ministry would implement a policy next year of using health stations and volunteers to help prevent and cut the amount of people stricken with cardiovascular disease, HIV/Aids, cancer, diabetes, and emphysema. Altogether, these diseases killed nearly 100,000 Thais a year, he said.
The ministry also aims to employ more staff over the next three years for its 9,765 health stations so that each has five workers, instead of the current three per station, permanent secretary for Health Prat Boonyawongwirot said.

16 Sep 2006

Doctors fear hand, foot and mouth outbreak could be a mutated strain

Experts fear the virus that has caused the outbreak of hand, foot and mouth disease in several Bangkok schools might be a mutated strain because it appears to be particularly virulent.
"We cannot say for sure the virus has mutated, but we suspect it is the cause of the considerably more-severe symptoms seen in some patients," said Dr Tawee Chotpitayasunondh, director of Queen Sirikit National Institute of Child Health. The ministry is studying the enterovirus 71, which causes hand, foot and mouth disease, to determine whether it is a mutated form or not, said Dr Kumnuan Ungchusak, the head of the Bureau of Epidemiology.
The ministry will have to compare the genetic profile of the strain found in recently infected Thai victims with those from cases in countries like Taiwan, Singapore and Malaysia, said the doctor.
"It is not just in Thailand. Enterovirus 71 seems to be becoming more virulent in those countries," Kumnuan said.
For example, during a 1998 outbreak of hand, foot and mouth disease in Taiwan, up to 300,000 people were infected, and 78 died, Kumnuan said.
He added that medical officials suspected then a mutation was to blame for the severity, but they were unable to confirm it.
"It was still the same subtype B and C, but the clade [a group of biological species that comes from a common ancestor] of these subtypes may have changed. Further study is needed to be sure," said Kumnuan.
Four people died in Thailand this year of common hand, foot and mouth disease.
Nine people died of the severe type of the disease. In these cases the patients' symptoms were unclear. They suffered and died of complications, said Kumnuan.
Most of these cases were children younger than five years old, said the doctor. If the ministry's study confirms that the enterovirus 71 has mutated, the government will have to revise its disease-control measures, its method of diagnosis and the treatment, said Tawee.
Public Health Minister Pinij Charusombat said that 1,360 cases of hand, foot and mouth disease had been reported this year.
Four people have died of the disease. There were close to 300 cases of the disease reported in Bangkok in the past year.
In the past week, at least nine schools in Bangkok have been temporarily shut down because of the outbreak, said Pinij. He said a rapid response unit is on call around the clock to control the disease.
If someone is infected, he or she must not go to school. If more than five cases of the disease are reported at the same school, that school would be shut down until the disease was contained, said Pinij.
Arthit Khwankhom
The Nation

19 Sep 2006

Authorities move to stop HFMD outbreak

In a bid to prevent an outbreak of hand, foot and mouth disease (HFMD), caretaker Public Health Minister Pinij Charusombat ordered on Tuesday relevant authorities to check the hygienic conditions of swimming pools frequented by children.
Meanwhile, the Bangkok Metropolitan Administration (BMA) was preparing to issue guidelines on how to guard against HFMD.
The guidelines will be distributed among schools, nurseries and public places with a large number of child visitors, Bangkok Governor Apirak Kosayodhin said.
In Bangkok, two schools, including the Bangkok Christian College (BCC), were closed yesterday for disinfecting. Lab tests are being carried out to determine whether a six-yearold BCC student who died on Saturday contracted HFMD.
As of press time on Tuesday, Medical Sciences Department director general Dr Paijit Warachit said the boy did not contract the Enterovirus 71, which was mainly responsible for the virulent form of the HFMD.
"But we are checking whether other virus causes the HFMD in this case," Paijit said.
Meanwhile Apirak inspected the BCC, which will be closed until September 21.
"We were informed of the boy's death only on Monday," BCC director Woranuch Triwijitkasem said. She added that no other parents have reported that their children were ill.
Caretaker Deputy Public Health Minister Anutin Charnveerakul and the Disease Control Department's directorgeneral Thawat Suntrajarn also inspected BCC yesterday.
HFMD is a common illness among infants and children, and is characterised by fever, sores in the mouth, and a rash with blisters. In serious cases, HFMD can be fatal.
This year, HFMD has infected 1,360 children, with five of them having died from a virulent strain of the disease, Enterovirus 71. Also, nine other child victims have succumbed to symptoms associated with the disease.

The Nation

26 Sep 2006

Disease check for 7 from Nonthaburi

Up to seven students at a Nonthaburi kindergarten have developed symptoms of hand, foot and mouth disease (HFMD).
Nonthaburi public-health chief Dr Sompong Boonsuebchart said yesterday he had received a report that seven students were being treated for suspected HFMD. He also warned the disease could be fatal in some serious cases.
"We are waiting for lab tests to conclude whether these students have contracted HFMD," he said.
Sompong inspected the Denlah Kindergarten in Rama V straight after parents said the school was still open yesterday morning despite an official recommendation it should remain closed.
Following the inspection, Bang Kruay district chief Kamon Sanpha-arsa said the kindergarten would stay closed until October 9.
Kindergarten director Arn Pandejpong said he was initially told that only one student had contracted the disease.
District chief Kamon said the school had good hygiene standards.
Anupong Kanpum, who chairs the Tambon Bang Khun Krong Administrative Organisation, sent out cautionary letters to schools, advising them to alert relevant authorities if they suspected any students had the illness.
Meanwhile, it will take five more days to determine if a Bangkok Christian College student, who passed away on Sept 16, died of a virulent strain of HFMD, Medical Sciences Department chief Dr Paijit Warachit said.