Hand-foot-mouth death toll rises to 130; no epidemic declared

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The hand, foot and mouth disease (HFMD) outbreak across Vietnam has not been declared a national epidemic despite the fact that it has claimed 130 lives and infected 71,472 people this year.

In September alone, 26,000 new HFMD cases and 31 deaths were reported. In the first half of October, 10,000 new cases and 16 deaths were reported.

Most of the HFMD cases are children. However, adults have also contracted HFMD while taking care of sick children.

Experts say HFMD had become an epidemic given the rising numbers of fatalities and infections in all 63 cities and provinces. But Vietnamese authorities have been hesitant to declare it a national epidemic.

Dr. Tran Tinh Hien, former deputy director of Ho Chi Minh City Hospital for Tropical Diseases, said the number of HFMD infections was higher than the number recorded during the influenza A (H1N1) outbreak two years ago.

Dr. Nguyen Tran Hien, chief of the National Institute of Hygiene and Epidemiology, said HFMD is definitely an epidemic given that it has spread to all cities and provinces in the country.

In late August, when the HFMD death toll hit 83 (out of 35,000 infections) in 52 cities and provinces, a Ministry of Health official told Thanh Nien the disease was still under control, therefore there was no need to declare it an epidemic.

Before that, in mid August, Health Minister Nguyen Thi Kim Tien told Ho Chi Minh City health authorities that an HFMD epidemic had broken out.

"Its status is no longer "˜at risk of breaking out' as before, it has actually started," Tien said.

However, much to the public's surprise, the outbreak was never officially declared an epidemic.

On October 17, Minister Tien told Thanh Nien the HFMD outbreak would only be declared an epidemic if it spiraled out of control, adding that Vietnam had not declared the bird flu (H5N1) or swine flu (H1N1) outbreaks epidemics before.

"Although no announcement has been made, health authorities are taking the best measures to prevent an epidemic," she said.

No announcement made

Nguyen Van Binh, chief of the Vietnam Administration of Preventive Medicine, told Thanh Nien that it is local authorities, not the Health Ministry, that are responsible for making announcements about epidemics.

Binh quoted regulations as saying that the ministry can announce a national epidemic only after at least two provinces do so locally.

Explaining why no localities have made the announcement, Binh said the number of infections has yet to exceed control thresholds established by authorities.

But the Health Ministry and local agencies have not publicly defined those thresholds.

And while the Health Ministry refuses to officially pronounce HFMD an epidemic, it has called the outbreak an "epidemic" in many of its reports.

Health Minister Nguyen Thi Kim Tien told Thanh Nien that the declaration of an epidemic may affect the economy so caution needed to be exercised.

A source told Thanh Nien that cities and provinces were afraid to declare epidemics because they would then have to spend too much of their limited budget and resources on epidemic prevention.

The source implied that the city and provincial leaders thought their budgets should be used on more important things.

Many localities are concerned that a declaration of epidemic would badly affect investment, tourism and social security, according to the source.

An officer at the Nha Trang Pasteur Institute in the central province of Khanh Hoa told Thanh Nien that the institute had advised authorities of Quang Ngai Province to declare the HFMD epidemic during a working trip to the province two months ago, but to no avail.

Since the disease hit the province in April, it has spread to 166 of 184 communes and towns, with more than 6,100 cases recorded, including five fatalities. The number of cases is 45 times higher than the number over the same period last year.

Quang Ngai is leading the central region in terms of HFMD infections, making up 70 percent of the region's total HFMD cases, and ranked seventh among 63 cities and provinces across the country in terms of fatalities.

However, Dr Nguyen Tan Duc, deputy director of the provincial Health Department, maintained that the disease was still under control.

"The province was prepared to make the announcement when the number of new HFMD cases reached 552 per week, along with five fatalities, and local hospitals were overloaded with HFMD patients.

"Later, the situation eased as no more deaths were reported and more patients were released from hospitals, so authorities decided not to declare the epidemic."

However, Duc admitted that the province is facing a lot of difficulties in coping with the disease as HFMD has spread via schools in many communes and towns.

Since the rainy season has come, HFMD outbreaks are more likely to occur, he added.

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