Facing the current enterovirus epidemic in the world, Taiwan CDC urges travellers to be cautious when visiting affected areas with children under age 5, and take the necessary preventive measures. Some of the worst hit regions include Anhui Province in China and Singapore.

According to the data published by the Health Department of Anhui Province, China on April 29,2008, as of April 28, 1520 cases of hand-mouth-foot disease (HFMD, due to EV-71 infection), including 20 deaths, had been reported in Fugang City.The number of HFMD cases in China is predicted to peak from May to July.The number of reported cases from January to April 20 this year has increased by 218.99% in comparison with the same period last year.

Ministry of Health of Singapore announced on April 29, 2008 that the number of HFMD cases reported had increased to 1466 cases in the week ending April 26, 2008 from 1245 in the previous week, reflecting an 18% increase.21 cases, including one diagnosed with encephalitis, required hospitalization.So far, the accumulated number of HFMD cases this year has risen to 9026, compared to 5241 reported during the same period in 2007.Among the reported cases this year, 25% of them tested positive for EV71.As of April 28, 2008, 11 preschools and childcare centres have been ordered to close for a period of 10 days.34 other facilities were advised to consider voluntary closure for 10 days.

Enterovirus infections can cause various diseases, though most infected persons (50%-80%) have no symptom at all.A small percentage of infected persons develop fever or a flu-like illness.Less commonly, some may have HFMD, herpangina, aseptic meningitis, viral meningitis, paralysis, acute hemorrhagic conjunctivitis or myocarditis.HFMD is mainly caused by Coxsackie A virus and EV-71. In addition, symptoms such as fever, blisters on mucosa of the mouth, tongue, soft palate, gums, lips, the palms, the soles of the feet, toes and fingers usually develop over a course of 7 to 10 days.Infants under age of one are the most vulnerable, followed children aged 1-5 years.

Enteroviruses are mainly transmitted via the fecal-oral route (feces, water or contaminated food) or the respiratory route (aerosol droplet, cough or sneeze).They can also be spread via direct contact with blister exudates.The incubation period of enteroviruses is 2 to 10 days.Infected cases can become contagious a few days before showing any primary symptom, and are most contagious one week after symptoms are revealed.Basic hygiene measures can effectively reduce the possibility of infection: frequent hand-washing, balanced diet, regular exercise and sufficient sleep, keep the household clean and well ventilated, clean and disinfect children’s toys frequently, and avoid visiting public areas when there is an outbreak. For more information, please visit the Taiwan CDC website (http://www.cdc.gov.tw) and look under “Travelers’ Health”, or dial the toll-free consultation hotline, 1922, operated by Taiwan CDC.