Tuesday, 6 May 2008

Enterovirus 71 (EV-71) reaches Beijing

A week ago I read about that strange virus in Anhui province that affects young children. At that time around 700 were reported sick, many in serious conditions, around 20 have died. I read about a kindergarten that told stuff to keep quiet or be fired ... But then it could no longer kept secret.

I thought Anhui is quiet far away. 17 hours by train. My ayi comes from there. I asked if her son (9 years) is okay. Yes. It seemed she had not heard yet of anything serious. I thought about the poor children living in poor conditions with low hygienic level. It seemed so far away.

Yesterday, a friend told me the virus has reached Beijing. And anxious Grandmothers from Europe started to call anxious Mums in Beijing. The info that the virus definitely had reached Beijing reached me only today - online.

And indeed. The virus has reached Beijing. All 18 districts of Beijing have reported outbreaks of hand, foot and mouth disease (HFMD), caused by the enterovirus 71 (EV-71) (reported yesterday by Chinese media Xinhua).

Via Danwei I read further that Xinhua report says that a total of 1,482 infections have been reported in Beijing. 818 of them were found in kindergartens, 583 at home. All people infected are younger than 5.

Another source (Yahoo News) quotes Beijing Evening News reporting that Beijing city health officials on Monday said the number of cases in the capital had reached 1,482 as of the day before, jumping from 1,010 five days earlier.

Reading this, I am a bit confused. They compare figures from Sunday evening with figures from five days earlier, Tuesday evening, April 29!? - And only on Sunday, May 4 was a national public alert - but it was not saying that it has reached Beijing yet, although they already counted the cases? How many kids have been running around in parks and public places during the May holiday without the parents being aware of the risk?

Maybe I did not read the newspapers well, or the online news. I was not aware of a risk in Beijing (although I know how fast a virus can travel by plane...) My son was in a public park (Chaoyang) yesterday as the school still had a day off.

So this afternoon, I tried to google more info and followed all my Chinese links.

I talked to friends and neighbours, on the street and on the phone. We discussed what we should do. So far we heard that washing hands is a good prevention. Well, that is something you do in Beijing all day long, as everything you touch is dusty. My friend and neighbour said she will keep her child inside the compound. No more trips to the park, no shopping mall, no restaurant.

One friend got an email from her employing company. We didn't (so far). But I got an email from our kindergarten instead, saying that they will prepare an information by tomorrow.

For now they forwarded an information from the SOS Clinic which says:

- Wash your hands frequently and thoroughly with soap and water.
- Don't share food, drinks or eating utensils.
- Avoid close contact such as kissing and hugging.
- Disinfect contaminated surfaces and items by washing with a diluted chlorine-containing product (well, how do we know something is contaminated?)

One of my friends just called me and said the she will not send her child to kindergarten tomorrow. She just want to wait a day or two to see how the disease is spreading.

Apparently two Chinese kindergarten in Beijing are already closed. One in Chaoyang district (or near Chaoyang Park) and one in Haidan district (near university). Regarding the figures above ... 818 cases in kindergartens... I believe more then two kindergartens are closed.

And finally I went to the WHO website. I am just quoting two paragraphs with information about the Enterovirus in China :

All fatal cases died of serious complications such as neurogenic pulmonary oedema due to EV-71 infection. The overall case fatality rate has decreased from 11% during March 10-31 to 0.2% during April 17-29.
Non-polio enteroviruses are common and distributed worldwide. Although infection often has no symptoms and goes unnoticed, these viruses are also associated with occasional outbreaks in which a larger-than-usual number of patients develop clinical disease, sometimes with fatal consequences. No specific anti-viral therapy is available and treatment focuses on prevention of complications. As there is no vaccine for this virus, control measures during outbreaks are focused on classical hygiene measures including frequent hand-washing and disinfection of soiled clothing and surfaces. In certain situations, it may be advisable to close child-care facilities and schools to reduce the intensity of transmission. It is not necessary to restrict travel or trade.

Currently many countries in the Western Pacific region have implemented heightened surveillance for hand, foot and mouth disease and for severe complications in children."

Oh, yes, I forgot to mention, Singapore and Hong Kong also has cases.


How can your child (or you) get the disease? And what are the symptoms?
Here a short summary from what I found so far:

EV71, which can cause hand, foot and mouth disease, is highly contagious and spreads through direct contact with the mucus, saliva or faeces of an infected person.
Young children are most susceptible because of lower immune systems.

In milder cases, EV71 can cause cold like symptoms, diarrhea and sores on the hands, feet and mouth, according to the journal Genetic Vaccines and Therapy.

But more severe cases can cause fluid to accumulate on the brain, resulting in polio-like paralysis and death, according to the journal.

Another source (SOS Clinic):
Infected people generally develop an illness that includes fever, painful ulcers in the mouth, and a non-itchy rash that causes small blisters to appear on the hands, feet and buttocks. Children usually recover without specific treatment in 7 to 10 days. Occasionally, the E71 virus can cause a severe illness in which patients may develop meningitis or encephalitis (inflammation of the brain). The encephalitis may be fatal.

There is no effective antiviral treatment for severe EV71 infections, and no vaccine is available.

And the peak of the outbreak is expected in June - July, when it gets warmer...

For more info follow the links:
WHO on EV71 in China
Danwei about HFMD in Beijing
Yahoo News on China on alert
CNN on China on alert

UPDATE, Beijing May 7 :
I sent my son to school today and so did most other parents. The teacher I talked to had the information status like me yesterday - he thought there are no cases in Beijing yet. Well, now he knows. But the school was prepared. A nurse (she is employed by the school and is present every day all year long) measures the temperature of each child arriving in the morning and again at noon.
Furthermore, we will keep our son inside the compound. No visits to the park or other public areas. We ensure he washes his hands whenever he comes home and before eating (as well as everybody else in the house). I am going to wash his clothes and shampoo his hair every evening.


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