Chinese health authorities are grappling with a virus that has killed 28 children and is set to claim more lives, with reports of a preliminary cover-up of the highly contagious disease echoing the Sars epidemic of 2003.
The disease is hand, foot and mouth, a relatively common childhood illness, but what is unusual is that the current outbreak is at its worst when caused by enterovirus 71 (EV71). There is no vaccine or antiviral agent available to treat or prevent EV71, which is spread mostly through contact with infected blisters or faeces and can cause high fever, paralysis and swelling of the brain. It is unrelated to foot-and-mouth disease, which affects cattle, sheep and swine.
The illness is particularly virulent among the under-fives: a two-year-old girl in the central province of Hunan and a three-year-old boy in the south-western region of Guangxi became the latest to die from infection by the EV71 virus, the Xinhua news agency reported.
Disease-control specialists have called on local health authorities to step up public education about the illness and to gear up for more cases. "There is no indication of a change or a more virulent virus," Hans Troedsson, the World Health Organisation's China representative, told a news conference held with the Chinese Health Ministry yesterday.
Cases of hand, foot and mouth first emerged in large numbers in eastern China in early March, but were not made public until last week, prompting state press to accuse local officials of being too slow in reporting the outbreak. Prominent medical professionals insisted that the outbreak was not a repeat of the Sars virus, whose reporting Chinese authorities muzzled in 2003, leading to the sacking of the health minister and Beijing's mayor.
Officials are puzzled as to why there were so many cases in Fuyang, in Anhui province in the east, and why the symptoms did not make it easy to identify the illness. As China and the WHO sought to calm fears about the epidemic, saying there was little cause for concern, people were angry at the delay in reporting the virus's outbreak.
"Fuyang local government seems to forget the lessons learned from Sars. In the process of this epidemic starting, the local government did not disclose the information in a timely way but took various improper steps to 'stop rumours' and control public opinion," wrote one angry webizen, Wei Jingjie.
Anhui is a poor province, with substandard medical care and 10 doctors there were punished for malpractice relating to the outbreak. "We usually don't see a cluster like this ... so we have to investigate that further together with the government," said Dr Troedsson.
The number of infections has risen to 16,000, up from an initial 800 when it first came to light in Anhui at the end of April, although this may be down to better reporting. "As we just started the web-based surveillance effort and reporting system, it is quite natural to see a rapid increase in numbers in the first few days of such reporting," said a Health Ministry spokesman.
Two kindergartens in Beijing were closed temporarily after children showed signs of the disease but authorities said they were confident any outbreak would not cause any upset to the Olympic Games, which start in August.
Singapore reported a 75 per cent surge in hand, food and mouth cases to 10,490 so far this year compared with last year, while in Vietnam, there were about 3,000 cases in the first four months of the year, more than the total number of reported cases for last year.
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