Hand Foot and Mouth Disease

Cambodia has been in the news lately for an outbreak of hand, foot and mouth disease. It started out a bit scary, with news that over 50 children had died of a "mysterious illness" after going to hospitals for treatment. After the World Health Organization and Cambodia's Ministry of Health started investigating, they found that many of the children who died had enterovirus-71 (EV-71), a particularly virulent strain of the virus that causes hand foot and mouth disease.

Hand foot and mouth disease (HFMD) is typically pretty benign - meaning it shouldn't kill you. There's no treatment; as a virus, antibiotics don't do anything. Typical symptoms include a high fever, blister-like sores in the mouth, and a rash on the hands and feet.

Our next-door neighbor, Vietnam, saw over 100,000 cases of HFMD caused by EV-71 last year. But this is the first time Cambodia has seen the EV-71 strain. Unfortunately for Cambodia, news came out that many doctors had treated the cases of HFMD with steroids, which suppresses the immune system, making children extremely vulnerable to worsening symptoms and complications. Many of the children of the initial fatalities had died of encephalitis (swelling of the brain) and respiratory failure. I have to say, sadly, that I am not surprised steroids played a role in their deaths, as I have seen gross misuse of steroids in patients here who were started on the medication unnecessarily. We have seen more than one patient for steroid-dependency so severe they would die if the steroids were stopped suddenly.

So what does all this mean for us here in Poipet? Luckily, most of the cases reported have been in the south, far away from us. But this still didn't keep the Ministry of Education from closing down all public and private preschools and elementary schools throughout the entire country. Neither the Ministry of Education nor WHO were consulted for this decision. This means that one of the Saturday programs I have been helping with at a local preschool has been cancelled until further notice. Public schools were preparing to go on two-month holiday August and September anyway. But at this point, no one is sure how long private schools must remain shut as well.

Along the border, Thai authorities have also beefed up their monitoring. Countless Cambodians cross over the border every day to Rong Kluea, a large market on the Thai side, to work and beg. Many children cross over as well, but Thai authorities started screening children and turning away those with signs of illness.  

I guess this means I'll have to make sure I don't have a fever next week when I cross over to travel to Bangkok!