Cambodia has begun nationwide surveillance for a severe form of hand,
foot and mouth disease since the deaths of more than 50 children from an April
2012 outbreak.
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 five years
old and is rarely life-threatening, health officials confirmed on July 13.
Since April more than 50 children
have reportedly died from the “mysterious” disease which was first diagnosed on
July 9. 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 centers 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 centers 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.
——
Source: IRIN
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