Guangdong Outbreak - Hand, Foot and Mouth Disease Claims

1. (U) Summary: A hand, foot and mouth disease (HFMD) outbreak has
led to three deaths in Guangdong province, and the infection of more
than 1,600 local children. Guangdong's Department of Health has
created an HFMD task force to increase local monitoring, prevention
and control efforts. Guangdong authorities anticipate more than
10,000 cases of HFMD by year's end, mostly occurring during the peak
months of June and July. According to one specialist, the disease
has occurred sporadically over the past few years; there is more
public notice of it now that it has been listed in the category of
statutory reported infections. End summary.



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The Threat to South China


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2. (SBU) HFMD, which has already claimed the lives of 22 children in
Anhui province, has led to the death of two infants in Guangdong's
Foshan city, and one infant in Maoming city, both located southwest
of Guangzhou. As of May 5, Guangdong had documented 1,692 cases of
HFMD among local children. Of cases reported, 372 were in Guangzhou,
519 were in Shenzhen, and another 373 in Foshan, the most severely
affected municipalities. According to Dr. Tang Xiaoping, well known
in Guangzhou for his work during the severe acute respiratory
syndrome (SARS) outbreak and currently serving as Deputy-Director of
Guangzhou's Public Health Bureau, all of Guangzhou's HFMD cases are
mild, and the infected infants are recovering. However, authorities
are not ruling out increased fatality rates and additional outbreaks
in the coming months. According to the Guangdong Government
Emergency Response Office, Guangdong is expected to see at least
10,000 cases of HFMD by the end of 2008.



3. (U) Hand, Foot, and Mouth Disease (HFMD), which mostly affects
infants and young children, especially those without access to
proper healthcare and facilities, is transmitted through direct
contact with saliva, feces, or mucus. Symptoms range from rash and
fever, to severe neurological damage. Various viruses can cause
HFMD, however, Enterovirus 71 (EV 71), known to attack the
intestines, is one of the more dangerous. There is no clearly
effective vaccine or anti-viral agent for treating EV 71.



4. (SBU) Of the three reported deaths in Guangdong, the two in
Foshan were confirmed to be caused by the EV 71 virus. Two cases in
Shenzhen and one other in Foshan have also been linked to EV 71.
According to Feng Shaomin, Director of the Foreign Affairs Division
of the Guangdong Department of Health, Guangdong currently does not
have the capacity to test all cases of HFMD for the EV 71 virus.
Health officials report that no Guangdong HFMD patients are
currently in critical condition, and Tang Xiaoping claimed that the
EV 71 situation is under control. According to the Guangdong Center
for Disease Control (CDC), the most significant challenges ahead are
preventing the spread of HFMD during June and July, the disease's
peak season. They are also working to prevent asymptomatic infected
adults from infecting children.



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Prevention and Control


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5. (SBU) The Ministry of Health instructed local authorities to
address HFMD outbreaks with the same vigilance as they would address
SARS. Guangdong's Department of Health has taken steps to control
the outbreaks and prevent further spreading of the disease. Under
the direction of the Department's director, an HFMD Prevention and
Control Team has been established. The team covers two areas --
disease prevention and control, and medical treatment. In addition,
the following measures have been implemented:

-- Experts have been dispatched to affected areas to provide
guidance and assistance to medical professionals and those
infected.

-- Guangdong health authorities have strengthened all monitoring and
reporting efforts, including the requirement of hospitals to report
all cases within 24 hours of detection to the Guangdong Department
of Health.

-- Authorities are increasing public awareness campaigns to outline
methods of prevention, including visits to local nurseries and
primary schools to educate teachers about proper hygiene methods.

In the coming days, the HFMD task force is planning to focus
attention on enhancing clinical care and diagnosis, and providing
immediate training for local CDC personnel for HFMD screening and
testing purposes.



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Reporting and Data


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6. (SBU) Officials disagree on how much more severe this year's HFMD
outbreaks are compared to previous years. According to Dr. Tang
Xiaoping of the Guangzhou Public Health Bureau, the number of cases
seems to have risen this year; however, the President of Guangzhou's
Children's Hospital said that the number of cases in Guangzhou is
not significantly higher than last year. The discrepancy is due in
part to a lack of consistent data. An expert from Guangdong's CDC
told us that the apparent increase in cases in Guangdong is a result
of this week's changes in reporting practices. Prior to May 2, the
Ministry of Health did not classify HFMD as an infectious disease
legally subject to reporting or requiring public notification;
therefore, only outbreaks (classified as the occurrence of more than
three cases), not sporadic cases, were reported. Because of this,
reports are now more regular, while statistical data on past
outbreaks is sparse. In 2006, Guangdong province reported 670 cases
and Fujian province reported 240 cases; statistical data for 2007 is
still unavailable. The Guangdong Department of Health's Foreign
Affairs Division Chief Feng Shaomin told us that inconsistent
reporting has made it difficult to compare this year's outbreak to
long-term trends, but it does represent a significant increase over


2006.



7. (U) Beijing Embassy ESTH has cleared this cable.

GOLDBERG