BackgroundIn 2011, a large outbreak of hand, foot and mouth disease (HFMD) in Vietnam resulted in 113,121 children seeking medical attention, of whom170 died. Understanding the epidemiology of fatal HFMD may improve treatment and help targeting prevention activities for vulnerable populations. We describe epidemiological and clinical characteristics of children who died from HFMD in Vietnam in 2011.MethodsClinical data were obtained through reviewing medical records of the deaths occurring from January through December 2011 in all hospitals in Vietnam. Hospitals reported any deaths among patients with laboratory-confirmed enterovirus (EV) infection to the Ministry of Health. Data were extracted from the national database.ResultsOf the 169 deaths reviewed for whom records were available, 87% were 3-year-old or younger, 69% were male, 18% attended daycare, 89% lived in Southern Vietnam, and 85% of the deaths occurred between May-October 2011. One hundred thirty (77%) cases sought treatment in a hospital within three days of onset of illness. Symptoms at admission included fever (98%), myoclonus (66%), vomiting (53%), oral ulcers (50%) and vesicular erythema (50%). One hundred six (75%) cases had leukocytosis and 91 (54%) had hyperglycemia. One hundred three (61%) tested positive for EV, of which 84 (82%) were positive for EV71.ConclusionsDeaths associated with HFMD occurred throughout 2011 among males three years or younger who were cared for at home. The HFMD control program should focus on interventions at the household level. Clinicians should be alerted to symptoms suggestive of severe HFMD including fever, myoclonus, vomiting, oral ulcers and vesicles with high white blood cell count especially in young children.

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Recent Better Buying Power (BBP) initiative for improving DoD's effectiveness in developing complex systems includes "Owning the Technical Baseline" (OTB). This paper presents an innovative approach for the development of a "Resilient Program" Technical Baseline Framework (PTBF). The framework provides a recipe for generating the "Resilient Program 2 " Technical Baseline (PTB) components using the Integrated Program Management (IPM) approach to integrate Key Program Elements (KPEs) 3 with System Engineering (SE) process/tools, acquisition policy/process/tools, Cost and Schedule estimating tools, DOD Architecture Framework (DODAF) process/tools, Open System Architecture (OSA) process/tools, Risk Management process/tools, Critical Chain Program Management (CCPM) process, and Earned Value Management System (EVMS) process/tools. The proposed resilient framework includes a matrix that maps the required tools/processes to technical features of a comprehensive reference U.S. DOD "owned" technical baseline. Resilient PTBF employs a new Open System Approach (OSAP) combining existing OSA 4 and NOA (Naval Open Architecture) frameworks, supplemented by additional proposed OA (Open Architecture) principles. The new OSAP being recommended to SMC (Space and Missiles Systems Center) presented in this paper is referred to as SMC-OSAP 5 . Resilient PTBF and SMC-OSAP conform to U.S. DOD Acquisition System (DAS), Joint Capabilities Integration and Development System (JCIDS), and DODAF processes. The paper also extends Ref. 21 on "Program Resiliency" concept by describing how the new OSAP can be used to align SMC acquisition management with DOD BBP 3.0 and SMC's vison for resilient acquisition and sustainment efforts.