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If you’re a parent travelling with young children to Southeast Asia soon you should be aware that hand, foot and mouth disease (HFMD) is currently at or near epidemic level in some of the region’s most popular destinations.

In Asia, the risk of infection is highest during the (northern) summer, especially from April through July.
Thailand has recorded more than 14,000 cases, almost double 2013 figures, and the country’s health authorities last week warned parents that new outbreaks are set to spread during the upcoming rainy season, peaking in July.
In Vietnam, the national total has surged past 24,700 in recent weeks – most notably in the country’s southern provinces, including Ba Ria-Vung Tau, Ca Mau, Soc Trang, Binh Duong, and Bac Lieu, as well as Ho Chi Minh City. 
Activity has also spiked in Singapore, which recorded a year-high 793 infections in the last week of May. 
In Beijing, the number of HFMD cases has increased each week since the start of May, peaking last week with 2860 infections, according to a report by health authorities in China’s national capital.  

About hand, foot and mouth disease

Hand foot and mouth disease (HFMD) is a very common viral disease that mainly affects children. Outbreaks occur in kindergartens and childcare centres the world over. HMFD gets its name from the non-itchy rash and blisters that develop on the palms of the hands and soles of feet, and sometimes the throat, tongue, tonsils and mouth. The tiny ulcers have red, raw edges which can be painful when touched.
While symptoms usually are short-lived and cause mild discomfort, outbreaks of HFMD have taken on more dangerous dimensions in recent years with the emergency of human enterovirus 71 (EV71). The strain can result in more severe illness, including rare but potentially fatal cases of meningitis or encephalitis.
EV71, which was first identified in Cambodia, is now the principal strain across Asia. Epidemics have resulted in millions of cases and hundreds of deaths in recent years in China, Vietnam, Japan, Macao, Hong Kong and Singapore.
Dr Eddy Bajrovic, Medical Director of Travelvax Australia, says HFMD virus can occur anywhere, at any time.
“It’s very contagious and spreads very easily,” he said.
“For most people, HFMD is a mild disease, but EV71 infection has led to many children needing hospital treatment. In a relatively small number of some cases, it has been fatal.
“With so many outbreaks in recent years, parents travelling to Asia with small children should be mindful of good hygiene. Hand washing is particularly important to lower the risk of getting HFMD and other illnesses like travellers’ diarrhoea and flu.”
While HFMD rarely results in severe illness, it can disrupt a family holiday as it passes from one child to another. At least one vaccine1 is being developed, but the best way to protect children is with regular hand hygiene.

What parents should know

WHERE IT’S FOUND: While major epidemics occur mainly across South-East and South Asia, the virus is present in virtually every country in both hemispheres.
WHEN IT OCCURS: The peak seasons are summer and early autumn.
WHO’S AT RISK: Children under 10 are most susceptible, but adolescents and adults can also be infected.
HOW YOU CATCH IT: The virus is found in saliva or mucus and is typically spread from person-to-person. You literally pick up the virus by touching an object or surface that’s been touched by an infected person. The final link in the chain of infection occurs when virus-laden fingers go into or near their mouth, nose, or eyes. (A person infected with HFMD is most contagious during the first week of the illness, but the virus can stay in their bowl motions for weeks after symptoms disappear. People with HFMD may not show signs of infection, but can still pass on the virus to others.)
THE SYMPTOMS: Occasionally dehydration, high fever, febrile seizures, or secondary bacterial infections can occur. In rare cases, viral (aseptic) meningitis may require a child to be hospitalised. HFMD usually disappears in 5-7 days without any specific treatment and with no lasting ill effects.
TREATMENT: There is no specific treatment for HFMD. Antibiotics are ineffective and are not recommended. Adults or children can be given over-the-counter medications such as Ibuprofen or Paracetamol to relieve pain and fever, or to reduce any inflammation. (Aspirin should NOT be given to children). To soothe the throat, gargle with salt and warm water, or use a mouthwash or spray, such as Betadine or Difflam. An anti-inflammatory lozenge like Strepsils may also be an option, depending on the age of the child.
HYDRATION IS IMPORTANT: It’s important that a patient drinks plenty of liquids to maintain adequate hydration. Water and cold milk products are best – fruit juice and sodas should be avoided as they may burn throat ulcers, causing discomfort.

Our 3 prevention tips

Follow these 3 steps to minimise the risk of hand, foot and mouth disease infection:
1 – Wash your hands often. Hand hygiene is especially important after using the toilet or changing a nappy. Soap and water are best, but alcohol-based gel is handy for times when soap and water are not available. Gels don’t kill all types of germs and are less effective when hands are dirty. Ensure the product you choose contains at least 60% alcohol.
2 – Disinfect dirty surfaces and soiled items. First wash the items with soap and water; then disinfect them with a solution of chlorine bleach (made by mixing 1 tablespoon of bleach and 4 cups of water). Don’t forget to include toys.
3 – Avoid close contact. HFMD is spread by kissing, hugging, or sharing eating utensils or cups with someone with hand, foot, and mouth disease.

Find out more about the health risks and travel vaccinations for your destination by calling Travelvax Australia’s travel health advisory service on 1300 360 164.

REFERENCES:
1 - Rongcheng Li, Longding Liu, Zhaojun Mo et al. An Inactivated Enterovirus 71 Vaccine in Healthy Children. N Engl J Med 2014; 370:829-837February 27, 2014DOI: 10.1056/NEJMoa1303224. (internet) Available from: http://www.nejm.org/doi/full/10.1056/NEJMoa1303224

 

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