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Alert on Emerging Viruses

Symptoms of Hand, Foot and Mouth Disease (Photo courtesy of DOH-NEC)Symptoms of Hand, Foot and Mouth Disease (Photo courtesy of DOH-NEC)


In July, the World Health Organization (WHO) and the Ministry of Health of the Kingdom of Cambodia issued a press release that reported a respiratory disease with neurological system symptoms affecting children under seven (7) years old. It was announced as a “mysterious disease,” and as part of the International Health Regulations, neighboring countries are forewarned to act appropriately. Extensive investigations concluded severe complications of hand, foot and mouth disease (HFMD) caused by Enterovirus 71(EV-71).


The WHO explained that HFMD is a common viral illness that mostly affects infants and children below five years old. HFMD is usually a mild disease, and nearly all patients recover in seven to 10 days without medical treatment. It is most commonly caused by coxsackievirus A16 which usually results in a mild self-limiting disease with few complications. However, HFMD is also caused by Enteroviruses, including EV-71, which has been associated with serious complications, and may be fatal. One of the complications is dehydration since some are not able to swallow enough liquids due to painful mouth sores. Moreover, EV-71 has been associated with meningitis and encephalitis, and may cause severe complications, including neurological, cardiovascular and respiratory problems.


In the Philippines, the Department of Health said that EV-71 infections occur in the country but are not included in the rreportable diseases. The fatal EV-71 infection is still very rare in the Philippines. Health Secretary Enrique T. Ona instructed the National Epidemiology Center to include EV-71 infection as a notifiable disease in the country where all health providers, particularly physicians, must report individual cases or even outbreaks. Laboratory screening of specimens and confirmation of cases are done at the Research Institute of Tropical Medicine.


In September, the WHO alerted again health authorities around the globe about the recently detected, novel coronavirus in two patients, both previously healthy adults who suffered severe respiratory illness. The first patient, a man aged 60 years from Saudi Arabia, was hospitalized in June 2012 and died; the second patient, a man aged 49 years from Qatar with onset of symptoms, who was transported to the United Kingdom for intensive care. The WHO and its partners worked closely to better understand the public health risk presented by the new coronavirus strain.


Coronaviruses are a large, diverse group of viruses that affect many animal species. A few of these viruses cause a wide range of respiratory illness in humans, typically with "common cold" symptoms. The genetic sequence data indicate that this new virus is a beta-coronavirus similar to bat coronaviruses, but not similar to any other coronavirus previously described in humans including the coronavirus that caused severe acute respiratory syndrome (SARS). Moreover, a comparison of viral genetic sequences from the two patients indicated that the two viruses are closely related. Treatment is supportive because no specific therapy has been shown to be effective.


By October, no additional confirmed cases have been reported and there is no evidence so far of person-to-person transmission of the novel coronavirus. The WHO did not advise special screening at points of entry with regard to this new strain, nor did it recommend any travel or trade restrictions.


The WHO recommended health workers to be alert to anyone with acute respiratory syndrome and needing hospitalization who had been in the Middle East where the virus was found or in contact with a suspected or confirmed case within the last 10 days.