Hand, foot and mouth disease cases increase rapidly, Ho Chi Minh City responds to outbreak risk

The number of hand, foot and mouth cases has increased by nearly 150% in the past month, with many severe cases. The Ho Chi Minh City Department of Health has prepared three scenarios to respond to the risk of an outbreak.

Last week, the city recorded 423 cases of hand, foot and mouth disease, an increase in both hospitalizations and outpatient visits. 147 children, all under 6 years old, are being treated in hospitals. Of these, 18 children are seriously ill and need intensive care, 14 are on ventilators and one is on dialysis. To date, the city has recorded one death from hand, foot and mouth disease.

Compared to the same period last year, the number of hand, foot and mouth disease cases has decreased by more than 53%, however, the appearance of the Enterovirus 71 strain with fast spreading and high virulence causing severe illness has made health officials concerned about the risk of an outbreak. To respond to severe cases of level 2a or higher, estimated to account for about 10% of inpatient cases, the Department of Health has prepared three scenarios for admission and treatment.

The first scenario requires 200 beds, including 30 intensive care beds, with less than 50 hospitalizations per day, less than 200 inpatients, and less than 20 severe cases. At that time, priority will be given to treatment at the city's three specialized pediatric hospitals.

When the number of hand, foot and mouth disease cases hospitalized each day increases by 50-100 cases, 200-700 cases are being treated as inpatients and 20-70 cases are becoming severe, Ho Chi Minh City will switch to the second scenario . At that time, 700 beds (including 80 intensive care beds) are needed, with pediatric patients treated at three specialized pediatric hospitals and the city's Hospital for Tropical Diseases.

The third scenario is expected to be implemented when 100-200 cases of hand, foot and mouth disease are hospitalized each day and 700-1,400 inpatients are treated, with about 70-140 severe cases. The total number of treatment beds is 1,400 (including 150 intensive care beds). The treatment system implements the process of classifying outpatients and inpatients, and assigning routes to avoid overload at end-line hospitals and minimize deaths.

A child with grade 3 hand, foot and mouth disease is being treated at the City Children's Hospital. Photo: Provided by the hospital — A child with grade 3 hand, foot and mouth disease is being treated at the City Children's Hospital. Photo: *Provided by the hospital*

The Department of Health recommends that medical facilities prepare medicines and infusions, medical equipment and supplies for the three scenarios above. Upper-level hospitals in the city provide professional support to lower-level hospitals and provinces in the region, avoiding unsafe transfer of patients to the city. Doctors at all levels set up a hotline to consult and decide on hospital transfers.

The issue that the Department of Health is concerned about is that seriously ill patients are transferred from other provinces and cities, while the city's drug supply is limited. In early June, the Department of Health asked the Drug Administration (Ministry of Health) to help find a drug supply source and is expected to have the drug in July.

Hand, foot and mouth disease is an acute viral infection transmitted through the digestive tract, commonly found in children under 5 years old and capable of causing large epidemics. Symptoms include fever, sore throat, lesions of the oral mucosa and skin, mainly in the form of blisters on the palms, soles, knees, and buttocks. Most patients have a mild course. Some cases are severe and have dangerous complications such as meningitis and sepsis, which can lead to death.

Preventive measures include cleaning children's toys and the house with soap, Javel solution or common disinfectants. Early detection of signs of hand, foot and mouth disease in children for timely isolation and to limit the spread. Severe symptoms include persistent high fever, vomiting, dizziness, shaking hands and feet, and should take the child to the hospital immediately.

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