Hand foot and mouth disease due to enterovirus 71 in Malaysia
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Hand foot and mouth disease is a febrile sickness complex characterized by cutaneous eruption (exanthem) on the palms and soles with simultaneous occurrence of muco-cutanous vesiculo-ulcerative lesions (enanthem) affecting the mouth. The illness is caused by a number of enteroviruses with coxsackievirus A16 and enterovirus 71 as the main causative agents. Human enterovirus 71 (EV71) belongs to the species Human enterovirus A under the genus Enterovirus within the family Picornaviridae. EV71 has been associated with an array of clinical diseases including hand foot and mouth disease (HFMD), aseptic meningitis, encephalitis and poliomyelitis-like acute flaccid paralysis.
A large outbreak of HFMD due to highly neurovirulent EV71 emerged in Malaysia in 1997, and caused 41 deaths amongst young children. In late 2000, a recurrence of an outbreak of HFMD occurred in Malaysia with 8 fatalities in peninsular Malaysia. Outbreak of HFMD due to EV71 recurred in 2003 with an unknown number of cases and mortalities. A similar outbreak of HFMD with 2 recorded deaths in young children occurred in peninsular Malaysia in late 2005 and this was followed by a larger outbreak in Sarawak (Malaysian Borneo) with 6 reported fatalities in the early part of 2006. The current on-going outbreak of HFMD started in peninsular Malaysia in epidemiological week 12 of 2010. As with other HFMD outbreaks in Malaysia, both EV71 and CA16 were the main aetiological viruses isolated. In similarity with the HFMD outbreak in 2005, the isolation of CA16 preceded the appearance of EV71. Based on the VP1 gene nucleotide sequences, 4 sub-genogroups of EV71 (C1, C2, B3 and B4) co-circulated and caused the outbreak of hand, foot and mouth disease in peninsular Malaysia in 1997. Two sub-genogroups (C1 and B4) were noted to cause the outbreak in 2000 in both peninsular Malaysia and Sarawak. EV71 of sub-genogroup B5 with smaller contribution from sub-genogroup C1 caused the outbreak in 2003. In the 2005 outbreak, besides the EV71 strains of sub-genogroup C1, EV71 strains belonging to sub-genogroup B5 were isolated but formed a cluster which was distinct from the EV71 strains from the sub-genogroup B5 isolated in 2003. The four EV71 strains isolated from clinical specimens of patients with hand, foot and mouth disease in the Sarawak outbreak in early 2006 also belonged to sub-genogroup B5. Phylogenetic analysis of the VP1 gene suggests that the EV71 strains causing the outbreak in Sarawak could have originated from peninsular Malaysia. Epidemiological and molecular data since 1997 show the recurrence of HFMD due to EV71 in Malaysia every 2 to 4 years. In each of the past outbreaks, more than one sub-genogroup of the virus co-circulate.
Key wordsHand foot and mouth disease Enterovirus 71 Malaysia
- 2.Andersson S O, Bjorksten B, Burman L A. 1975. A comparative study of meningoencephalitis epidemics caused by echovirus type 7 and coxsackievirus type B5. Clinical and virological observation during two epidemics in northern Sweden. Scandinavian J Infect Dis, 7: 233–237.Google Scholar
- 8.Chomnaitree T, Menegus M A, Schervish-swierkosz E M, et al. 1982. Enterovirus 71 infection: a report of an outbreak with two cases of paralysis and a review of the literature. Pediatrics, 671: 489–493.Google Scholar
- 9.Chua K B, Chua B H, Lee C S M, et al. 2007. Genetic diversity of enterovirus 71 isolated from cases of hand, foot and mouth disease in the 1997, 2000 and 2005 outbreaks, Peninsular Malaysia. Malaysian J Pathol, 29: 69–78.Google Scholar
- 11.Deibel R, Gross L L, Collins D N. 1975. Isolation of a new enterovirus. Proc Soc Exp Biolo Med, 148: 203–207.Google Scholar
- 19.Kennett M, Birch C J, Lewis F A, et al. 1974. Enterovirus type 71 infection in Melbourne. Bull EHO, 51: 609–615.Google Scholar
- 24.Madhaven H N, Sharma K B. 1969. Enteroviruses from cases of encephalitis in Pondicherry. Indian J Med Res, 57: 1607–1610.Google Scholar
- 26.Melnick J L. 1996. Enteroviruses: Polioviruses, Coxsackieviruses, Echoviruses, and Newer Enteroviruses. In: Fields Virology (Fields B N, Knipe D M, Howley P M, et al. ed). 3rd ed. Philadelphia. Lippincott-Raven, p655–712.Google Scholar
- 31.Shindarov L M, Chumakov M P, Voroshilova M K, et al. 1979. Epidemiological, clinical and pathomorphological characteristics of epidemic poliomyelitis-like disease caused by enterovirus 71. J Hyg Epid Microbiol Immun, 3: 284–295.Google Scholar
- 34.World Health Organization. 1997. Outbreak of hand, foot and mouth disease in Sarawak. Cluster of deaths among infants and young children. Wkly Epidemiol Rec. 72: 211–212.Google Scholar