How does the shortage of hand, foot and mouth medicine affect children?

Immunoglobulin (IVIG), one of the effective treatments for children with severe hand, foot and mouth disease, is running out, forcing doctors to consider using it only when absolutely necessary.

The number of children with hand, foot and mouth disease continues to increase with many severe cases and deaths, but hospitals in Ho Chi Minh City and the South lack supplies of intravenous IVIG. In particular, this year the infection rate of Enterovirus 71 (EV71) is gradually dominating in samples of severe cases. This virus strain causes severe illness and a higher risk of death than other agents, causing major outbreaks in 2011 and 2018.

IVIG is one of the effective supportive treatments for severe hand, foot and mouth disease, reducing the rate of progression and serious complications. The drug is prepared directly from human plasma, so production depends entirely on the plasma supply through blood donations.

On June 24, Nguyen Van Vinh Chau, Deputy Director of the Ho Chi Minh City Department of Health, said that in Vietnam, Immunoglobulin products are not produced domestically and must be imported entirely from abroad. Over the past two years, the global supply of drugs has been scarce due to the impact of Covid-19, causing hospitals to constantly worry about drug shortages.

Regarding how the lack of drugs affects treatment, Associate Professor, Dr. Nguyen Thanh Hung, Director of Children's Hospital 1, said that in the context of a continuous number of children with severe, critical hand, foot and mouth disease being hospitalized, if hospitals use drugs as prescribed, the reserve will quickly be depleted. Recently, experts from hospitals have met and agreed to temporarily adjust treatment methods, using drugs with utmost care.

"For example, if a child has severe hand, foot and mouth disease and needs two doses according to the regimen, only one dose will be used for monitoring and further evaluation, saving the medicine for more serious cases," said Dr. Hung, adding that doctors must consult and consider very carefully to make a decision, in an effort to save the life of each child.

Similarly, at Can Tho Children's Hospital (which receives children from the Mekong Delta region), the lack of IVIG amid a sudden increase in patients has caused the unit to face many difficulties in treatment, forcing the transfer of seriously ill children.

"In the next 1-2 weeks, if the number of cases continues to increase without a source of medicine, it will be very difficult to receive and treat patients," said Dr. Ong Huy Thanh, Deputy Director of the hospital.

Children with severe hand, foot and mouth disease must receive intensive care at Children's Hospital 1 (HCMC). Photo: Le Phuong — Children with severe hand, foot and mouth disease must receive intensive care at Children's Hospital 1 (HCMC). Photo: *Le Phuong*

In early June, the Ho Chi Minh City Department of Health requested the Drug Administration of the Ministry of Health to support the sourcing of drugs to treat hand, foot and mouth disease. Because they are prepared directly from human plasma, they can only be circulated and used after receiving a quality certificate from the National Institute for Control of Vaccines and Medical Biologicals. On June 23, the Institute issued a certificate of origin for 6,000 vials of the drug imported by a company. Hospitals have accessed this newly imported drug source and are carrying out procedures to purchase the drug, ensuring that there is no interruption in supply.

According to the Deputy Director of the Ho Chi Minh City Department of Health, a difficult problem is that these drugs have a short shelf life, require time to produce, and it is difficult to plan for purchasing because it is difficult to predict the progress of the epidemic. The drugs need to be purchased for storage, if not used up, they will expire and have to be destroyed, which is very wasteful. At the same time, they have to be explained, so hospitals often do not dare to purchase a lot.

"While waiting for local production sources, the Ministry of Health needs to have a suitable purchasing and usage mechanism to help ensure drug supply for endemic diseases and some dangerous and rare diseases," said Dr. Chau.

In a recent meeting with the Ministry of Health, Vice Chairman of the Ho Chi Minh City People's Committee Duong Anh Duc proposed that the Ministry soon issue mechanisms and policies to resolve financial issues arising from not using up all the medicine stock. Only then can we "liberate" the anxiety of medical staff when purchasing and bidding, ensuring the supply of medicine in disease treatment.

On the other hand, the leader of the Ho Chi Minh City Department of Health proposed that the authorities have policies to encourage and attract pharmaceutical enterprises to research and produce Immunoglobulin drugs instead of relying on imports, in the context of the long-term hand, foot and mouth disease epidemic.

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