acsbkk advisory: Hand, foot & mouth disease

Message to U.S. Citizens: Information on Hand, Foot and Mouth Disease in Children
Thursday, July 19, 2012

Information on Hand, Foot and Mouth Disease (HFMD) in Children

This message is to provide U.S. citizens in Thailand information about Hand, Foot, and Mouth Disease in children.
The following information was compiled by medical professionals posted at the U.S. Embassy in Bangkok.

As always, if you believe that your child is ill, you should consult your regular health care provider.

The media has widely reported a severe illness claiming the lives of more than 50 children in Cambodia. Some questions remain unanswered, but the clinical and laboratory information indicates that these illnesses are caused by infection with enterovirus 71, commonly referred to as EV 71.



EV 71 is one type in the family of enteroviruses. There are over 90 types of enteroviruses that cause illness in humans. They are very common, second only to the “common cold.” Illnesses range from mild cold or flu-like symptoms to the syndrome called hand, foot and mouth disease (HFMD). Rarely, these infections may infect the brain (meningitis and/or encephalitis) or the heart (myocarditis).

EV 71 has been associated with numerous outbreaks of HFMD in the Asia Pacific region since 1997. In some cases, these outbreaks have been complicated by severe neurologic disease. This is clinically and epidemiologically consistent with the information we have about the outbreak in Cambodia. In addition, there are large EV 71 outbreaks in China and Vietnam. These countries have reported small numbers of children with severe disease and some deaths.

Can we expect to see the outbreak currently impacting Cambodia, Vietnam and China spreading here to Thailand? It is more certain to say that we can expect to see a rise in EV 71 infection along with HFMD cases as is typical for this time of year in Thailand. It is possible that some cases of the severe form of EV 71 infection will turn up, though, given Thailand’s relatively good medical capabilities, we anticipate there will be less delay in diagnosis and better outcomes.

HFMD usually starts with a fever, loss of appetite, and may involve a sore throat. Within a day or two, painful sores develop in the mouth, starting as small red spots that form blisters and which can pop and then form small ulcers. These occur over the tongue, gums and inside the mouth. Also during this time period, a rash occurs, occasionally with blisters, over the palms and soles. If your child becomes ill with these symptoms, we recommend conferring with your usual medical provider.

There is no specific treatment for either HFMD or other EV 71 disease manifestations. There are things that can help you child feel better that you can discuss with your healthcare provider. The illness usually resolves in a week’s time. If your child appears more seriously ill, seek care immediately. At present, there is no vaccine available to prevent HFMD or other EV 71 manifestations.

How about your child and group settings? With regard to HFMD, the American Academy of Pediatrics does not recommend excluding children from school or other group situations, unless obviously ill. Exclusions are not thought to reduce disease transmission because some children shed the virus without obvious illness, and others who were ill may shed the virus for weeks. Hand washing and cleaning surfaces may offer some protection if done immediately following exposure, if you know that you have been exposed. There have been some school closures in Thailand. Although the international schools are not currently in their normal session, it would be unusual to see wholesale closures for HFMD, using past history as a guide.

For more information regarding enterovirus infections: http://www.cdc.gov/ncidod/dvrd/revb/enterovirus/non-polio_entero.htm

The American Citizen Services Unit of the U.S. Embassy (http://bangkok.usembassy.gov/service.html) is located at 95 Wireless Road in Bangkok, and can be reached by calling 66-2-205-4049, or by e-mailing acsbkk@state.gov. The Embassy’s after-hours emergency telephone number is 66-2-205-4000. The U.S. Consulate General in Chiang Mai (http://chiangmai.usconsulate.gov/service.html) is located at 387 Wichayanond Road in Chiang Mai. The American Citizen Services Unit of the Consulate General can be reached by calling 66-53-107-777 and by e-mail at acschn@state.gov. The after-hours emergency telephone number is 66-81-881-1878.
For the latest security information, you should regularly monitor the Department’s Bureau of Consular Affairs Internet website (http://travel.state.gov/), where current Worldwide Cautions, Travel Alerts, Travel Warnings and health-information resources can be found. You can also obtain up-to-date information on security by calling 1-888-407-4747 (toll free) in the U.S. and Canada or, for callers in other areas, by calling a regular toll line at 1-202-501-4444. These numbers are available from 8:00 a.m. to 8:00 p.m. (Eastern Time), Monday through Friday (except U.S. federal holidays).
We encourage you notify us of your presence in Thailand by enrolling in the Department of State’s Smart Traveler Enrollment Program (STEP), available at https://travelregistration.state.gov/ibrs/ui/.
Sincerely,

American Citizen Services

U.S. Embassy Bangkok