Hand, foot and mouth disease with severe complications caused by EV71 virus

In previous years, hand, foot and mouth disease cases manifested through the skin as blisters on the palms, feet, mouth, and buttocks. However, this year's cases rarely manifest on the skin or mucous membranes, mainly manifesting in the nervous system.

Monitoring results

After recording 1 death (4 years old) suspected of hand, foot and mouth disease in La Gi on June 20, 2023, the Provincial Center for Disease Control established a monitoring team to investigate and determine the cause of death in the 4th week of June 2023.

Hand, foot and mouth disease (illustrative photo).

With epidemiological history, 2 weeks before getting sick, the patient did not contact, eat, or live with children suspected of having hand, foot, and mouth disease. Within a radius of 100m from the patient's house, no cases of hand, foot, and mouth disease were detected. On May 15, 2023, the child was bitten by a dog with 3 deep wounds on the forearm, and the child was not vaccinated against rabies.

The field monitoring team visited the household and residential area surrounding the deceased patient's house. Specifically, on May 15, 2023, the patient was bitten by a dog in the neighborhood (the child pointed out to his grandfather the dog that bit the patient). Through investigation of the two dogs suspected of biting the patient, from the time of the bite on May 15, 2023 to June 18, 2023, both neighbor dogs were still alive and showed no signs of illness. It was determined that the neighbor dog suspected of biting the patient did not have rabies.

Supervision at the hospital, through the medical records kept in the department and according to the doctor on duty. The patient showed signs of convulsions, high fever with unknown temperature, no cough, no vomiting; little moist rales in the lungs, soft abdomen; mouth ulcers... with a diagnosis of hand, foot and mouth disease level 2B. The doctor treated and then transferred the patient to another hospital. On the way to the hospital, the patient suddenly stopped breathing and returned to La Gi Regional General Hospital for treatment, but the patient did not survive. The hospital conducted a death review of the patient and diagnosed the death as suspected hand, foot and mouth disease level 4.

Through the results of the medical record consultation, clinical symptoms, and paraclinical results related to the suspected death from hand, foot, and mouth disease. And the results of field monitoring, it was determined that the neighbor's dog suspected of biting the patient did not have rabies. The monitoring team unanimously diagnosed the patient's death as suspected of hand, foot, and mouth disease.

Upward trend in June

Since the beginning of the year, Binh Thuan has recorded 117 cases of hand, foot and mouth disease, including 1 death. The number of cases of this disease tends to increase in May and June 2023. Specifically, in May 2023, the whole province recorded 13 cases, an increase of 7 cases compared to the previous month; week 25 (June 19 - June 25, 2023) had 40 cases, an increase of 73.9% compared to the previous week of 23 cases. Areas with high numbers of cases include Phan Thiet with 28 cases, La Gi with 19 cases, and Ham Thuan Bac with 23 cases.

Binh Thuan General Hospital alone admitted 21 cases of hand, foot and mouth disease for inpatient treatment in June 2023, and some severe cases were promptly transferred to higher levels and their health is now stable. However, in the first 5 months of 2023, this hospital admitted 7 cases for inpatient treatment. This shows that the number of hand, foot and mouth disease cases increased in June 2023.

Dr. Nguyen Thi Bao Van - Deputy Head of Pediatrics Department of Binh Thuan General Hospital said: In previous years, cases of hand, foot and mouth disease manifested through the skin as blisters on a erythematous base, palms, feet, mouth, and buttocks. However, this year's cases of the disease manifested less on the skin and mucous membranes, mainly manifested in the nervous system such as startle, dizziness; tremors in the limbs, staggering; some manifestations of damage to the brain stem such as rapid pulse, high blood pressure, pulmonary edema; vasomotor disorders. Within 1 day, the disease can progress from stage 1 to stage 4.

According to Dr. Van, the Coxsackievirus A16 virus strain manifests mostly on the skin, with few serious complications. The Enterovirus 71 (EV71) virus strain manifests in the nervous system, leading to high mortality. The way to prevent this disease is for caregivers and children to wash their hands regularly with soap and clean water; give children cooked food and boiled water; and clean children's utensils and toys. When a child is diagnosed with hand, foot and mouth disease, parents and caregivers use chloramine B or Javen water to clean the floor, disinfect; clean toys and utensils; and isolate the child for 7-10 days...

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