As a doc, during the summer we would often have “stomach flu” outbreaks caused by viruses called “Enteroviruses” which merely means intestine virus. Usually it meant mild diarrhea, and it was worse in young kids. One enterovirus, however, caused only mild stomach upset, but caused lots of tiny canker sores in the mouth, and small blister on the palms and bottom of the feet. We called this disease “Hand Foot and Mouth” Disease.

The virus has nothing to do with the much more serious animal disease “foot and mouth” disease; like most diseases, the name described the disease and was easy for everyone to remember. Technically, the name is “Acute Viral Gingivostomatatitis caused by Coxsackie virus”, which is a bit harder for laypeople to pronounce.

There are a couple other diseases that cause similar sores, but HFM disease (photos HERE) usually was in toddlers or young kids, and you could almost diagnose them acoss the room: They were cranky, and drooling all over mom, and mom usually looked harried from being up all night with a whining Junior.

Usually we just told her to feed him lots of liquids and cool food (syrupy ice cream, pudding) while giving tylenol and dabbing on tiny amounts of numbing medicine for pain. Once in awhile, one of the kids would get a secondary impetigo or mouth infection, but usually they did fine.

The usual cause was a Coxsackievirus, named after the city where the virus was identified. Whenever we had an epidemic of enteroviruses, we had to watch out for the rare complicated case, because these viruses could also infect the brain (encephalitis/meningitis) and sometimes the heart (myocarditis). Another virus of this family is polio. But as a whole, these viruses are mild, and as long as the kid didn’t get dehydrated, complications were rare.

So I was puzzled why so many babies died in the Chinese epidemic. Was it a different bug? And the answer is Yes.

This outbreak is caused by a cousin virus, Enterovirus 71, which has also caused epidemics in Taiwan, Malaysia, Brazil, Europe and the US. And unlike it’s cousin, it’s much more serious, and can even afflict adults. In a 1998 epidemic in Taiwan, 129,000 cases were reported by doctors, and public health authorities estimated that there were probably 1.5 million cases, most of them mild. However, 405 of the cases were “severe”, and 19% of the severe cases died, mostly young children. The deaths were caused by pulmonary edema (the lungs filled up with fluid) or encephalitis (brain infection).

Yet another nasty side effect of this virus is a syndrome that looks like Polio. The New England Journal of Medicine  has a report of how people who had severe cases did later, and found that 20 percent of those with encephalitis (where the brain or nervous system was infected) and 50% of those who had limb weakness similar to polio continued to have limb weakness.

The enteroviruses are typically spread via the “fecal/finger” route, and clean water and washing hands usually stops it. The bad news is that some cases seem to be spread via the air, probably from is via close contact with drooling kids who cough into the air.

Before you cancal your plane tickets to the Olympics, however, remember that China is a big country, and the epidemic is in a different area of China. And since most cases are spread via close contact, unless you visit relatives who have a sick kid, you should be okay.

And if your kid comes down with sores in the mouth this summer, remember it’s probably the mild type, and he’ll be better in 5 to seven days.


Nancy Reyes is a retired physician living in the rural Philippines. Her website is Finest Kind Clinic and Fishmarket, and she writes medical essays at HeyDoc Xanga Blog.

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