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Hygiene Important for Protection Against Hand Foot and Mouth Disease, Doctor Says

People with their small children are waiting out side Kuntha Bopha hospital in Phnom Penh, Cambodia.

A reported 54 children, most under the age of three, have died from the disease, which is caused by a virus known as Enterovirus 71.

WASHINGTON DC - As Cambodia announced the closing of the elementary schools two weeks ahead of the summer break to help control the spread of Hand, Foot, and Mouth Disease, the virus that causes it seems to be spreading in Cambodia, a US-based doctor told “Hello VOA” Thursday.

Taing Tek Hong of Jacksonville, Florida stressed the importance of frequent hand washing to prevent the disease and said that while the disease is new to Cambodia, it’s not new in Asia, he said.

A reported 54 children, most under the age of three, have died from the disease, which is caused by a virus known as Enterovirus 71. The outbreak has alarmed health workers, who are working to contain the spread of the disease.

“HFMD virus is contagious and infection is spread from person to person by contact with nose or throat discharge, saliva, fluid from blisters, or stool of infected person,” the doctor said. “The risk of getting the disease can be reduced by: washing hands often, especially after changing diapers; thoroughly cleaning objects and surfaces (toys, doorknobs, etc.) that may be contaminated with the virus; avoiding close contact (like kissing or hugging) with people who are infected.”

About 63,000 cases of EV-71 infection have been reported in Vietnam this year, he said. China reported 115,000 cases with 50 deaths in 2009 and 70,756 cases with 537 deaths in 2010.

“The disease begins with fever, poor appetite, malaise and sore throat,” he said. “Painful sores develop in the mouth one to two days later. They begin as small red spots that blister and become ulcers. They are usually located on the tongue, gums and inside the cheeks. They can also be seen on the palms of the hands and soles of the feet, sometimes on the buttocks and or genitalia.”

Most patients are treated for the symptoms of the virus, but aspirin and antipyrine should be avoided, because they can make the disease worse, Taing Tek Hong said.

“Fever and pain can be managed with acetaminophen or ibuprofen,” he said. “Anesthetic mouthwashes or sprays can be applied directly to the oral cavity. Ensure adequate fluid intake to prevent dehydration. Cold liquid are preferred. Intravenous hydration may be needed if the patient has severe dehydration or if discomfort precludes oral intake.”

There are currently no specific antivirals for EV-71, and there is no vaccine.

The disease can be deadly, he said, but research in China has shown ways to reduce the number of children who die.

“In a report from China, Chinese physicians were able to significantly reduce the mortality rate by the use of mechanical ventilation, administration of mannitol to decrease brain swelling, Milrinone and other vasoactive drugs to help the heart contraction and the use of IV fluid volume resuscitation,” the doctor said. “Intravenous immunoglobulin and Methylprednisolone are also used.”

Treatments with corticosteriod use should be avoided, he said.

“Some scientists believe that corticosteroid may help by reducing the capillary leakage, hence alleviating the edema of the lungs and brain,” he said. “On the other hand, a review of cases from China indicate increased mortality with the use of corticosteroid. All children who died from HFMD in Cambodia were given corticosteroid at some point. Chinese scientists believe that the severe respiratory complications are caused by vocal cord paralysis, which causes negative intrapulmonary pressure leading to pulmonary edema. The vocal cord paralysis is caused by the damage of the central nervous system from sudden increased intracranial pressure.”