Hand, Foot and Mouth Disease

The widely publicised hand, foot and mouth disease (HFMD) epidemic in Taiwan largely dissipated by mid July, said the Minister of Health of the Republic of China (Taiwan). No travellers are known to have been infected.

Outbreaks of HFMD are common in Taiwan, albeit past outbreaks were far smaller and involved fewer deaths, than the recent one. These outbreaks do present some risk to international travellers, particularly to small children. But the risk of serious illness and death is extremely small, says the US Centers for Disease Control (CDC). The greatest risk, especially of death, is for Taiwanese children younger than 3 years old. No adult deaths have been reported during the present outbreak.

As of July 3, 1998, various estimates put the total number of cases, nearly all of them children under the age of 3 years, at between 60,000 and 300,000 with 55 deaths. A total of 271 children had been hospitalised with aspetic meningitis and encephalitis. Enteroviruses, in particular enterovirus 71 (EV-71) have been isolated from fatal and non-fatal cases, including from brain and spinal fluid samples.

Hong Kong Department of Health. As of August 8, there were 44 cases and 9 suspected cases of EV71 HFMD. As of that date only 1 patient (an adult) remained in the hospital, and he is expected to recover. No deaths have been reported. It is unclear whether these cases are related to the outbreak of HFMD in Taiwan.

The most common cause of HFMD is not enterovirus but coxsackie virus A16, which very rarely causes meningitis or other serious illness. Infection with the EV71 enterovirus is a far less common cause of HFMD, but is more likely to cause viral meningitis and encephalitis. The spectrum of clinical illness varies considerably among outbreaks of infection reported from different locations.

HFMD occurs worldwide, in individual cases and in outbreaks. The illness usually begins with a mild fever and malaise or fussiness in infants. One or 2 days later, sores develop in the mouth. The skin rash develops over 1 to 2 days, with flat or raised red spots, some with blisters. The rash is usually located on the palms of the hands and soles of the feet, and rarely on the buttocks.

A person with HFMD may have only the rash or the mouth ulcers. The most contagious period is the first week of the illness. There is no treatment.

Transmission of enteroviruses is predominantly from person to person by direct contact, via nose and throat secretions when respiratory symptoms are present, or from the stool of infected persons. Poor hygiene and overcrowded living conditions favour spread. Airborne transmission or spread by contaminated food or water is unlikely.

Families travelling with small children to infected areas should observe strict personal hygiene: thorough hand washing after changing diapers; cleaning shared toys; disinfecting contaminated surfaces with household disinfectants (bleach or rubbing alcohol); avoiding direct contact with infected persons.

Additional information about the outbreak is available from the CDC Fax Information Service at 1-888-232-3299 (document number 3000005) or the CDC Website at www.cdc.gov. Select: Travellers' Health.

Information regarding the status of the outbreak in Hong Kong Department of Health web page at www.info.gov.hk/dh/new/index.htm.

Reproduced from and with acknowledgement to Traveling Healthy, Volume 11, No 5, Sept/Oct 1998