Cambodian Children’s Deaths Linked to Hand, Foot and Mouth Disease

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The mysterious illness that has killed dozens of Cambodian children may be a deadly strain of hand, foot and mouth disease, a common childhood illness. Lab tests have confirmed that a virulent strain of the disease called EV-71 was responsible for some of the 59 cases of illness reviewed in Cambodia since April, including 52 deaths, according to the World Health Organization (WHO) and Cambodian Health Ministry.

The numbers of cases and deaths have been scaled down since an initial report put the caseload at 62. Epidemiologists are now interviewing parents and still trying to determine a cause for all the cases; in many, relevant medical information may have been omitted and not all the children were tested before they died. “As far as I’m aware, EV-71 was not identified as a virus in Cambodia before,” Dr. Nima Asgari, who is leading the WHO investigation, told the Associated Press.

The Institut Pasteur in Cambodia tested samples taken from 24 patients and found that 15 came back positive for EV-71.

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EV-71 has been reported in other regions of Asia, including Vietnam and China. This strain of the disease can cause paralysis, brain swelling and death. In Cambodia, most affected children were under age 3, and many experienced severe respiratory symptoms that escalated quickly; some also developed neurological symptoms.

Hand, foot and mouth disease gets its name from a rash that appears on infected persons’ palms and soles (sometimes with blisters), along with painful, red, blister-like lesions on the tongue, gums and inside of the cheeks. Asgari told the AP that blistering was reported in only some of the Cambodian cases, but that steroids administered by doctors could have masked the symptom.

Early symptoms of hand, foot and mouth disease include fever, followed by sore throat and sometimes a poor appetite and malaise. One or two days after the fever begins, painful sores may develop in the mouth or throat, and rashes may then appear within one or two days after that. The usual incubation period — the time from infection to first symptoms — is about three to seven days.

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The disease, which is caused by enteroviruses — the same family as polio — is moderately contagious and is spread through sneezing, coughing and contact with blisters or infected fecal material. Although no vaccine or specific treatment exists, the disease is typically mild and most children recover in 7 to 10 days without medical treatment, according to the Centers for Disease Control and Prevention (CDC).

The CDC notes also that children with hand, foot and mouth disease are most contagious during the first week of illness, but can continue to spread the disease long after symptoms have disappeared because the viruses that cause it can remain in the feces for weeks. Also, infected people who show no symptoms of the disease can still spread the viruses to others.

Hand, foot and mouth disease should not be confused with foot-and-mouth disease which affects cattle, sheep and swine.

Although the U.S. is not experiencing a similar outbreak, hand, foot and mouth disease can be contracted by anyone. Between November 2011 and February 2012, the CDC received reports of 63 people with symptoms of hand, foot, and mouth disease in Alabama, California, Connecticut and Nevada.

To prevent the disease, the CDC recommends:

  • Washing your hands often, especially after changing diapers
  • Thoroughly cleaning objects and surfaces (toys, doorknobs, etc.) that may be contaminated with a virus that causes the disease
  • Avoiding close contact (like kissing and hugging) with people who are infected

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42 comments
stockbuy44
stockbuy44

The kids probably got of dose of Bill Gates new Eugenic depopulation vaccine. Seriously.

onLI
onLI

Pediatricians are doing us a diservice for not reporting this outbreak to the CDC. This isn't the normal coxsackie. It's a nastier strain than usual. It's in the NY metro area as well. For my family, it started as a 100-102 fever for 3 days with extreme malaise, diarhea, appetite loss, and headaches, and then progressed to 3-5 days of lesions in the mouth (and for me laryngitis), and an extremely bad cough.

onLI
onLI

Pediatricians are doing us a diservice for not reporting this outbreak to the CDC. This isn't the normal coxsackie. It's a nastier strain than usual. It's in the NY metro area as well. For my family, it started as a 100-102 fever for 3 days with extreme malaise, diarhea, appetite loss, and headaches, and then progressed to 3-5 days of lesions in the mouth (and for me laryngitis), and an extremely bad cough.

onLI
onLI

Pediatricians are doing us a diservice for not reporting this outbreak to the CDC.  This isn't the normal coxsackie.  It's a nastier strain than usual.  It's in the NY metro area as well.  For my family, it started as a 100-102 fever for 3 days with extreme malaise, diarhea, appetite loss, and headaches, and then progressed to 3-5 days of lesions in the mouth (and for me laryngitis), and an extremely bad cough.

onLI
onLI

It's in the NY metro area too.  My son caught it in pre-school and gave it to me and my husband.  100-102 fever for about 3 days, no appetite, malaise... then progressed to oral lesions, laryngitis (for me),  and coughing fits for days

onLI
onLI

It's also in the NY metro area.  My son caught it... then I did.  100-102 fever for days, appetite loss, malaise...  We had no blisters on the hands/feet, but DO have awful lesions in the throat (and some on my scalp).  I was stuck in bed for 5 days and still have laryngitis.  This is NOT the normal strain going around.  Much nastier.

Skegee
Skegee

So, why is this particular strain so deadly I wonder? Wow...scary. Do they have any proposals on how to treat the poor children that catch it?

Danforth
Danforth

 The treating doctor, (who unfortunately is not referenced here),  has asked that medications used in the Cambodia  be investigated to see if there is a tainted or counterfeit batch circulating that could be causing the lung damage.   EV71 rarely causes severe neurological outcomes and even more rarely has been associated with the fatal lung syndrome in Asian countries.   Also, all the fatal cases that were brought to his hospital had been treated at other hospitals first.

More here on that:

http://edition.cnn.com/2012/07... 

Virologists, on the other hand,  have been considering that co-infection with a new adenovirus or other pathogen may be behind the lung symptoms.

Perni79
Perni79

I disagree with the article. There IS a current outbreak of HFM in Maryland.  My children contracted it from their school - which has reported a similar outbreak.  My husband also contracted it, and had a very severe reaction.  Apparently, he contracted a different more virulent strain. This disease MUST be elevated to the CDC.  

Danforth
Danforth

CDC is aware and has found a strain associated with some reports of more severe disease in the US that they have identified as  Coxsackievirus A6.  Note that is NOT the strain EV71 found in some of the much more severe cases in Cambodia.

There is no need for panic or outrage. 

http://www.cdc.gov/mmwr/previe...

Perni79
Perni79

There is an outbreak of HFM currently here in Maryland.  The school at which my children attend have reported outbreaks. My children had a mild to moderate reaction, but my husband, who contracted it from the children, had a severe reaction. Apparently, my husband contracted a different strain. This disease MUST BE elevated to the CDC. 

IrishMomma
IrishMomma

There is a US epidemic.  Our son was covered in blisters from the shoulder to finger tips, hips to bottoms of feet and in and around his mouth.  Fever of 102 for days.  Also hands and feet peeled like he had been burnt.  Large patches of skin at a time.  This is really scarey to witness.  

cmeboxu
cmeboxu

Went to Mexico about 4 weeks ago with my kids 3 and 2. When we got back they were covered in lesions. Went to the doc and he said he didnt know what it was, but it resembled a severe case of hand, foot amp; mouth disease. They recovered within 7 to 10 days with the use of benedryl and calimine lotion. But now they have scars all over their body. Just glad they didn't die from it.

suefran
suefran

tickborne????  babesia form????  coinfection?????  don't just sit there research and find out what the baseline issue is derived from

suefran
suefran

tickborn?????  babesia???????   coinfection??????? 

Valeri Kastoff
Valeri Kastoff

Why do they show a Japanese child at the dentist in the photo. Very confused.

Elisa
Elisa

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Elisa
Elisa

my neighbor's step-mother's base pay is $80/HR 0n the c0mputer .She has been out of work for 5 months but last month her paycheck was $7597 just working on the laptop for a few hours. Here's the site to read more.   CashLazy.com

ObrienLouis
ObrienLouis

my neighbor's step-mother's base pay is $80/HR

0n the c0mputer .She has been out of work for 5 months but last month her

paycheck was $7597 just working on the laptop for a few hours. Here's the site

to read more, CAshLazy.com

ObrienLouis
ObrienLouis

Perni79 my roomate's mother-in-law makes $76/hr on the laptop. She has been unemployed for 8 months but last month her income was $15315 just working on the laptop for a few hours. Here's the site to read more CAshLazy.com

ObrienLouis
ObrienLouis

my best friend's mom makes $80 hourly on the internet. She has been fired for 9 months but last month her check was $16629 just working on the internet for a few hours. Read more on this site http://ufil.ms/h1L12

ObrienLouis
ObrienLouis

my friend's aunt makes $72/hour on the laptop. She has been out of work for ten months but last month her payment was $16769 just working on the laptop for a few hours. Here's the site to read more http://nirl.eu/4B

ObrienLouis
ObrienLouis

my neighbor's step-mother's base pay is $80/HR 0n the c0mputer .She has been out of work for 5 months but last month her paycheck was $7597 just working on the laptop for a few hours. Here's the site to read more,     CashLazy.com

cmeboxu
cmeboxu

You obviously have no clue where cambodia is, or that hand foot and mouth disease leaves lesions all over your mouth. Cambodians are asian and he is looking at the lesions in his mouth genious.

Marlee C.
Marlee C.

There are Japanese people who live in Cambodia so yeah the child could be Japanese.

ObrienLouis
ObrienLouis

Perni79 my roomate's mother-in-law makes $76/hr on the laptop. She has been unemployed for 8 months but last month her income was $15315 just working on the laptop for a few hours. Here's the site to read more  CAshLazy.com

AgentUtah
AgentUtah

There IS currently an outbreak of HFMD though pediatricians do not report incidents to the CDC as they do not believe it necessary or too serious. This strain causes more blistering on hands, feet, mouth and also arms, legs, torso and face with high fever. I have not seen any nail loss as of yet but have read it is possible many weeks later. I have seen skin loss around fingers and toes weeks after illness... similar to blisters without any fluid (you can see the spots coming to surface days before they surface as, what I'd call "dry skin blisters"). San Francisco amp; Portland (OR)...

Spencer Hawkyard
Spencer Hawkyard

Agree.  Less than 2 weeks ago, my 5 month old had it.  Then gave it to me to enjoy for 10 days.  I'm 35.  Childhood desease my ___.

cmeboxu
cmeboxu

Got back from Mexico 4 weeks ago and both my kids had what the doctor said looked like a severe case of HFMD, but said the lesions were in some spots not typical for the disease. He made me take off of work until they healed and sanatized his entire office. He also took pictures and called a bunch of different doctors, never did find out what it was. Kids are fine now except for the scars all over their bodies.

JohnOBX
JohnOBX

I agree.  We're seeing the same thing here in my neck of the woods in North Carolina.  Lots of kids getting it, some adults too.  Our pediatrician said its the worst outbreak he's seen in 10 years.  No nail loss, but massive peeling around the areas where blistering occurred.  

Cold compresses, soaking in baking soda baths (lukewarm), Benadryl creams, and ocean water seem to help the little ones when the itching and discomfort is most unbearable.  Good luck to any parents going through it...thankfully it isn't as severe as what the Cambodians are experiencing, but it is a miserable time.

Valeri Kastoff
Valeri Kastoff

 Yes, there was an HFMD outbreak in the DC area as well. Same side effects.

Nicole Fisher
Nicole Fisher

Here in Oregon I know of 6 kids personally that have had it. My son is 7 so its not just the smaller kids. His case was normal but he later was admitted to the ER with symptoms of an Appendicitis. It was not severe enough to take out but was .6 cm over the normal high range and there was swollen lymph nodes and free fluid. I would say this is def a outbreak. If I know 6 of my CLOSE friends kids. We live in Salem, 1 lives in WA, 2 live in Woodburn and more in Eugene. None of them gave it to each other so that means there are how many more in their neighborhoods. I think the large problem is the stigma attached to having to tell people your kids have hand, foot mouth as well why you don't hear about it as much and it gets contracted easier.

cmeboxu
cmeboxu

My 2 kids came back with it from Mexico about 4 weeks ago. Doc said it was very severe and wasnt sure if it was HFMD because the lesions were in places not usually associated with HFMD. They're ok now, just have scars everywhere.

carflin1
carflin1

In New Jersey too (about 2-3 months ago)...daughter did end up losing a few finger nails about 6 weeks after blisters

Concernedadult77
Concernedadult77

Georgia Also...how scary ...both my kids got it only in the mouth though...

Concernedadult77
Concernedadult77

Georgia also ...both my kids got it only in the mouth ...scary to think it could escalate to this level...