Situation Information

Since March 2009, a growing number of cases of hand, foot, and mouth disease (HFMD) have been reported in parts of Asia, including China, Hong Kong, Singapore, and Taiwan. HFMD is common among infants and children, and most of the recently reported cases have occurred in children.

The disease is very contagious and is spread through contact with the body fluids of an infected person — such as droplets from coughs and sneezes; saliva; blister fluid; or stool.

China

On April 10, 2009, China’s Ministry of Health Information Office reported that 54,713 cases of HFMD had been detected through the end of March.  Most of these cases were in rural areas. The provinces and regions most affected by this outbreak are the central provinces of Henan, Jiangsu, Guangxi, Anhui, Guangdong, Hebei, Hunan, Zhejiang, Hubei, and the eastern province of Shandong.  As of March 30, 2009, the Chinese Center for Disease Control and Prevention (China CDC) confirmed that at least 19 children have died from HFMD this year.

The Chinese government has enhanced its surveillance, prevention, and control activities, along with training of local medical staff to identify and report cases promptly.

Hong Kong

As of March 27, 2009, the Center for Health Protection of Hong Kong has confirmed one case of HFMD.  Nine other children who were exposed at the nursery the ill child attended also developed HFMD symptoms.  This is the seventh case reported to the Center for Health Protection of Hong Kong this year.

Singapore

As of April 11, 2009, Singapore’s Ministry of Health has reported 5,471 cases of HFMD infections this year. Typically, Singapore experiences annual peaks of HFMD from March to May.

Taiwan

As of March 31, 2009, the Taiwan Center for Disease Control and Prevention (Taiwan CDC) has reported 9 cases of HFMD with severe complications, all in children under 5 years of age. Two cases each were located in the northern and central area of Taiwan and five additional cases were located in the southern area of Taiwan.

In response to the growing number of reports of HFMD, other countries in the Western Pacific have increased surveillance for HFMD. When available, further information on this evolving situation will be posted as an update to this notice.

Advice for Travelers

No vaccine is available to prevent HFMD. There is no specific treatment for people who are sick with this disease other than treating symptoms, such as fever.

If you are sick and have fever while you are traveling, be aware that some countries treat fever with a class of medicine called pyrazolone that is banned in the United States due to harmful side effects. This medicine may even be available over-the-counter. CDC does not recommend using this class of medicine to treat fever. In general, because in some countries there is a risk that medications you buy will be counterfeit, CDC recommends that you bring with you all the medications that you think you will need during your trip. You should consider taking fever medicine with you to treat any symptoms if you plan to travel to any of these countries.

Travelers can take steps to prevent getting HFMD by practicing good personal hygiene. If you are traveling, especially to areas where HFMD has been reported, follow these tips for good health:

• Wash your hands often with soap and water, especially before you eat, after you cough or sneeze, and after you go to the bathroom. If soap and water are not available, use an alcohol-based hand gel (with at least 60% alcohol). Consider packing alcohol-based hand gel in your luggage to ensure you have it when needed.
• Do not share eating utensils, such as forks, spoons, and cups.

Adults should help child travelers to follow these recommendations. Infants, children, and adolescents are more susceptible to HFMD.

Additional Information

Hand, foot, and mouth disease

HFMD is an illness caused by certain enterovirus strains, including EV71, which are common worldwide. Outbreaks of HFMD caused by EV71 are common and have been reported by countries throughout the Asia-Pacific region in recent years. EV71 can be spread from person to person by direct contact with nose and throat secretions (e.g., by coughing or sneezing), saliva, fluid from blisters, or the stool of infected persons. People who are sick with HFMD often experience symptoms such as fever, sores in the mouth, and a rash, occasionally with blisters. HFMD caused by EV71 may sometimes lead to serious complications, including swelling of the brain (encephalitis). Most cases of HFMD occur in children under 10 years of age, but adults can also become infected.

For more information, see―

• Hand, Foot, and Mouth Disease (CDC Fact Sheet)
• Traveling with Children: Resources (CDC Travelers’ Health website)

Disease situation in Asia

China

• Chinese Center for Disease Control and Prevention
  • Health Ministry: Hand-foot-mouth disease claims 50 lives (April 10, 2009)
  • Health workers told to monitor rural China to prevent hand-foot-mouth disease (March 30, 2009)
  • Two babies killed, 4 hospitalized by hand, foot and mouth disease in east China (March 26, 2009)
  • Two babies die of hand, foot and mouth disease in east China (March 26, 2009)

Hong Kong

• Boy found infected with EV71 in HK (March 30, 2009)

Singapore

• Ministry of Health Singapore Weekly Infectious Disease Bulletin VOL 6. NO. 14 2009 (PDF) (April 11, 2009)

Taiwan

• Enterovirus Infection with Severe Complications in Taiwan (March 31, 2009)