Deaths Among Children During an Outbreak of Hand - Foot - Mouth Disease -- Taiwan, Republic of China, February-July 1998
The Executive Yuan, Taiwan, Republic of China
1998 Vol.14 NO.8
During February-July 1998, the Ministry of Health in Taiwan received 314 children have been hospitalized with hand, foot, mouth disease (HFMD) associated with suspected meningitis, encephalitis, or acute flaccid paralysis (AFP), and 55 have died (Table 1). Cases of HFMD have been reported from all regions of Taiwan, including Taipei City, with most reported from the central and northern regions. The first case was reported in February 1998 and the peak incidence was between May 24 and 30 (Figure 1). All 55 previously healthy children initially developed an acute illness characterized by fever, or mouth ulcers. Approximately 2-7 days (median: 3 days) after onset of illness, case-patients were hospitalized for rapid cardiopulmonary failure. In 41 case-patients, death occurred within 24 hours of hospitalization despite respiratory and cardiovascular support. Of the 55 children, 43 (78%) were aged <3 years (median age : 17 mouths; range : 3-151 mouths), 32 (58%) were male, and most lived in the central (27 [ 49%]) or northern (21 [ 38%]) regions of Taiwan (Figure 2). Reasons for seeking medical attention included respiratory distress (17 [ 31%]) or an altered level of consciousness ( 14 [ 25%]) . Thirteen ( 24%) children were comatose on admission (Table 2). Forty-four (80%) case-patients either died in the emergency department or were admitted directly to an intensive-care unit. All case-patients required intubation for respiratory distress during their illness. EV7 1 was identified in the central nervous system tissue from one autopsy (case 1) and in preliminary studies was isolated from 14 specimens from the 55 case-patients.
This report describes the clinical course of two fatal cases and presents summary findings from an ongoing clinical, epidemiologic, and laboratory investigation of the 55 deaths (Figure 1). A case was defined as refractory shock following a prodromal acute illness characterized by fever or rash that resulted in the death of a previously healthy child.