HAND, FOOT AND MOUTH DISEASE - INDIA: (WEST BENGAL)

A ProMED-mail post
http://www.promedmail.org Date: Wed 3 Oct 2012

Source: The Times of India, Kolkata [edited]
http://timesofindia.indiatimes.com/city/kolkata/Infectious-disease-sweeps-Kolkata-schools/articleshow/16647312.cms

Just when the city was starting to breathe easy after a tough battle with dengue fever over the last couple of months, doctors say thousands of children are battling with another disease that has symptoms similar to dengue fever. That kids are more vulnerable to hand, foot and mouth disease [HFMD] has left parents and doctors across the city worried. Paediatrician Shantanu Ray say he has never come across so many hand, foot and mouth cases in Kolkata before. "Most have been extremely severe. The rashes are taking at least a week to go. It's leading to a complete loss of appetite, weakness and fever. Lack of awareness has made things worse. Parents of affected children are often sending their children to school mistaking it to be ordinary body rashes. It has hastened the spread of the disease," he added. The initial symptoms of the disease -- fever, headache, loss of appetite and rashes -- have left both doctors and patients confused and scared. Even though hand, foot and mouth disease usually strikes only children and is rarely fatal, it has been severe, prompting doctors to treat it as seriously as dengue fever. Caused by a highly contagious virus, it has been affecting children aged between 2-8 years. Hand, foot and mouth disease rarely affects those above 10 years of age, but it spreads from person to person through nose and throat discharges, saliva, fluid from blisters, or the stools of an infected person. A child is most contagious in the 1st week when he/she contracts the disease. Soon after the dengue epidemic started in late July 2012, hand, foot and mouth disease had set in also. By late August 2012, thousands had been affected in Kolkata. The numbers have started going down, but the virus is still active, say doctors. "Since it coincided with dengue, it led to a panic. The symptoms are scarily similar to those of dengue. Apart from the rashes, which are restricted to the mouth, hands and feet, other indicators are no different from those of dengue. High fever, headache, loss of appetite are the common indicators," said Arindam Kar, director, Medical Institute of Critical Care. But it could be even more painful than dengue, pointed out some experts. The blisters triggered by the virus could appear on the tongue, lips and other parts of the mouth, making it painful to chew and swallow food. Several playschools had to shut down following the outbreak. Many asked parents to stop sending their children to school if they had rashes. "Almost 20 percent of our students had the disease. It was spreading fast, so we had shut down for a week," said the teacher in charge of a playschool in Alipore. "Fortunately, our students have not yet been affected. But there is reason to be careful," said Malini Bhagat, principal, Mahadevi Birla Girls' Higher Secondary School.
Hand, foot and mouth disease is a relatively common viral infection that usually begins in the throat. Caused by intestinal viruses of the family _Picornaviridae_, it takes 3 to 7 days for the symptoms to develop. It is less common in adults, but those with immune deficiencies are very susceptible. There is no specific treatment for the infection other than relief of symptoms. Treatment with antibiotics does not work and is usually not recommended. "But it might be necessary in some cases. Also, the blisters need to be treated with ointments to make them disappear fast," said Ray.

Commentary: A similar smaller scale epidemic has been reported from Delhi too (personal communication), and even in Chandigarh we have seen a few cases of HFMD. Early exit from school, and not joining back till the rashes subside is probably the best approach in this situation.