CAMBODIA: “Mystery disease” not so mysterious
HFMD usually strikes children under five
PHNOM PENH, 13 July 2012 (IRIN) - Cambodia has begun nationwide surveillance for a severe form of hand, foot and mouth disease (HFMD), a common viral illness that usually affects infants and children younger than 5 years old and is rarely life-threatening, health officials confirmed on 13 July.
Since April more than 50 children have reportedly died from the “mysterious” disease which was first diagnosed on 9 July. Health experts cite Enterovirus 71 (EV-71), one of a group of enteroviruses that results in the disease, as the cause.
"The surveillance system had not been geared up to detect hand, foot and mouth disease, and the country lacked the capacity for testing for its severe form," Dr Nima Asgari, head of the emerging disease surveillance and response unit of the World Health Organization (WHO) in Phnom Penh, the capital, told IRIN.
Sentinel sites for severe HFMD have been established at five hospitals and health centres have been instructed to inform the Cambodian Ministry of Health about mild cases of HFMD, ministry officials said of the effort which began earlier this week.
Asgari noted that it was likely more cases of the disease would be detected in the coming weeks as surveillance increased in Cambodia. So far in 2012, there have been 890,000 cases of mild and severe HFMD in China, with 242 deaths, and Vietnam has recorded 58,000 cases and 29 deaths, WHO reported.
“EV71 seems to be rising and causing a number of situations where there are a lot of deaths,” Asgari said. In Cambodia the cases occurred in 14 of the country’s 23 provinces, which did not add up to an "outbreak" because they were not linked, health ministry officials said.
In its mild form HFMD mainly affects children, causing fever, sores in the mouth, and rashes with blisters on the feet, hands and buttocks. Children generally recover from the disease within seven to 10 days without medical treatment.
But in severe cases, especially those with the presence of EV-71, patients can have neurological and respiratory symptoms, including convulsions, jerking of the hands and feet and shortness of breath.
HFMD virus is contagious and is spread from person to person by direct contact with nose and throat discharges, saliva, fluid from blisters, or the stool of infected persons.
Infected individuals are most contagious during the first week of the illness, but the period of communicability can last for several weeks, as the virus persists in stool, said a WHO fact sheet
In nearly all of the most severe cases reported in Cambodia, the children died within one day of hospitalization and within four days of the onset of symptoms, an investigation by the health ministry and WHO revealed.
About 80 percent of the cases had been treated with steroids, most at privately run clinics, before they were hospitalized, the investigation found. Treating severe cases of HFMD with steroids increases the likelihood of fatality in patients, health officials said.
To address this issue, along with enhanced surveillance, health officials are launching a public awareness campaign about the disease and the need to avoid using steroids to treat it. However, the surveillance system covers only the public sector and does not include private clinics and practitioners.
Cambodia’s fledgling healthcare system comprises a poorly funded state-run system of health centres and hospitals, and privately run clinics which, though unregulated, are often the first choice of many people.
Public health experts have long urged the government and its international donors to strengthen healthcare services to offset the rise of unregulated clinics, where staff are often untrained and poorly equipped to diagnose illness and provide the correct treatment.
According to WHO, outbreaks of HFMD occur every few years in different parts of the world, but in recent years these have occurred more frequently in Asia, including China, Japan, Hong Kong (China), Republic of Korea, Malaysia, Singapore, Thailand, Taiwan, and Viet Nam.