Epidemiological and clinical characteristics of children who died from hand, foot and mouth disease in Vietnam, 2011

Abstract

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.

Hand, Foot, and Mouth Disease in Hunan Province, China, 2009-2014: Epidemiology and Death Risk Factors

“…We also found that more boys were affected by HFMD than girls, and the gender distribution was similar to that observed in other Asian regions [29, 30]. This may indicate that boys are more susceptible to enterovirus infection.…”

Molecular epidemiology of human enterovirus 71 at the origin of an epidemic of fatal hand, foot and mouth disease cases in Cambodia

“…The CFR in Cambodia was extremely high compared with that observed in other countries such as in China, Taiwan and Vietnam, where the CFR ranged from 0.14% to 34% depending on year, age group and gender. 52, 64, 65 Subgenotype C4a, which was detected in most Cambodian cases, was already suspected to both cause more severe disease (CPF) and be associated with higher lethality. 50, 52, 66, 67, 68 We did not find any significant molecular difference, however, between EV-A71 subgenotype C4a sequences isolated from mild HFMD and severe (CNSI and CPF) cases.…”

The Epidemiology of Hand, Foot and Mouth Disease in Asia

“…However, this relationship is less clear for tropical and subtropical Asia. The extracted data on Southwest China, 15,21 South China, 2,15,22,23 Hong Kong 24,25 and Taiwan [26][27][28] show that outbreaks typically happen in late spring and fall. No distinct pattern is obvious for tropical regions as seen from data in Thailand, [29][30][31] Vietnam, 32,33 Malaysia 34 and Singapore, [35][36][37][38] where outbreaks occur sporadically throughout the year, although models have been developed for Singapore (≈1° north) that show a positive statistical relationship between maximum daily temperature above 32°C with HFMD incidence in the subsequent 1-2 weeks.…”