12/12/07

Project’s Key Points:

        The mission is to help the people in South East Asian countries that infected by Hand-Foot-Mouth Disease (HFMD) frequently in recent year. This year, the disease tends to be more and more severe in Thailand. Therefore, our goal is to reduce the virulence of the disease. By using treatments and preventions to reduce transmissions of the disease are the main propose. Sending professional teams to help and improving local health center are the means for treatment of HFMD. To educate local publics and community people of infected region about HFMD are the purposes for prevention. Offering the knowledge about HFMD, people can practice their personal hygiene and general cleanliness. As washing hands frequently and thoroughly before handling food and after using the bathroom or changing diapers, also spread bleach around infected objects and areas can reduce the transmission of these viruses.

Discussing the Issues:

        Hand-foot-mouth disease (HFMD) is a common illness of infants and children which mainly in under 10 years old, but may also occur in adults too. Everyone is at risk of infection, but not everyone who is infected becomes ill. Hand-foot-mouth disease is caused by a group of viruses called enterovirus. The most common cause of HFMD cases are coxsackievirus A16 and enterovirus 71. These types of viruses can occur at any time of year, but hand-foot-and-mouth disease is most common in the summer and autumn months. Usually HFMD caused by coxsackievirus A16 is not serious as mild disease and all patients can recover from the infection without medical treatment in 7 to 10 days.

Another cause of HFMD is Enterovirus 71 which can cause viral meningitis and other more serious diseases, such as encephalitis, or a poliomyelitis-like paralysis. Enterovirus 71 encephalitis in child can be very severe and may be fatal. Enterovirus 71 can survive at tropic humid environment. Thailand locates at tropic region which has infected cases in whole year. Therefore, HFMD become a serious infectious disease in Thailand area. Enterovirus 71 infected HFMD caused severe cases of children under 5 years old is about 90%. The morality rate is about 10% to 26%. Enterovirus 71 is worldwide spread and it was first identified in California in 1969. This type of virus survived around our live, therefore, from Austria, Japan, Hong Kong, Malaysia, Sweden, Bulgaria, France and Hungary all may have risk to get HFMD. Enterovirus 71 may attack cerebellum, brain stem, and basal ganglia, and usually cause death by damage these areas.

Cases of fatal encephalitis occurred during the outbreaks of HFMD in Malaysia in 1997, Taiwan in 1998, and Singapore in 2000. The outbreak typically occurs at small epidemics in nursery schools, child daycare or kindergartens. According to the Centers for Disease Control (CDC), the large outbreak of HFMD in Taiwan caused by Enterovirus 71 had a high mortality rate of 19.3% in the severe cases. During this outbreak, mortality rates were highest in children under 3. In a large epidemic of HFMD related to Enterovirus 71 in Singapore. 725 cases of HFMD and 7 fatalities occurred which most from interstitial pneumonitis or brainstem encephalitis. A later study of an HFMD epidemic in Australia, again with Enterovirus 71, reported that about 64% of patients developed severe neurologic disease in which the host immune response seemed to cause most of the neurologic manifestations.

The recent outbreak is in Thailand. From August in 2006, a total number of 1009 cases of hand-foot-mouth disease (HFMD) have been detected. Then caused 4 children died from the disease and most of the patients were between 2 and 5 years old. In 2007, HFMD patients increase to 2,567 in Bangkok, and total number of the infection cases are 7,578 in Tailand this year. And more than 90 percent of the patients were children younger than 5. From the case, the total number of patients of this year was twice than last year in Thailand. The disease continued to spread in the cool season and despite the fact that it usually only spreads during the humid season.

Symptoms:

Usually hand-foot-mouth disease takes 3 to 6 days for a person to get symptoms after being exposed to the virus. The symptom starts with a mild fever and then causes sores in the mouth then rash with blisters on the hands and feet. The disease usually goes away by itself in a week or so. One or 2 days after the fever begins, painful sores develop in the mouth. They begin as small red spots that blister and then often become ulcers. They are usually located on tongue, gums, and inside of cheeks. Mouth sores can be painful and hard for child to eat that cause poor appetite. The skin rash develops over 1 to 2 days with flat or raised red spots, some with blisters. The rash does not itch, and it is usually located on the palms of the hands and soles of the feet.

Transmissions:

       The disease spread through direct contact with the mucus from nose and throat discharges, saliva, and fluid from blisters or feces of an infected person. Therefore, it spreads easily through coughing and sneezing. When contact with infected stool, such as to change a diaper. Often the disease breaks out within a community. Children are most likely to spread the disease during the first week of the illness. But the virus can stay in the infected stool and can sometimes spread to others for several months after the blisters and sores have healed.

Diagnose:

        Hand-foot-mouth disease is usually diagnosed based on a complete history and physical examination of children. By the symptoms describing and look at the sores and blisters, HFMD is one of many infections that result in mouth sores. Doctors can identify between HFMD and other causes of mouth sores based on the age of the patients and pattern symptoms from the patient. A throat swab or stool specimen may be sent to a laboratory to determine which type of enterovirus caused the illness. But the testing often takes 2 to 4 weeks to obtain a final answer. Therefore, the identification the difference of mild HFMD cases and fatal HFMD need time to determinate them.

Treatments:

         No specific treatment is available for this disease or other enterovirus infections. Symptomatic treatment is given to provide relief from fever, aches, or pain from the mouth ulcers. You can treat symptoms at home by giving your child pain relievers and plenty of fluids. Many doctors do not issue medicine for this illness, unless the infection is severe.

          To help lessen discomfort, doctors often recommend:

•  Rest

•  Drink plenty of fluids - milk-based fluids may be easier to tolerate than acidic liquids, such as juice or soda.

• Over-the-counter pain relievers, such as acetaminophen (Tylenol) or ibuprofen (Adivil, Motrin) if needed.

All signs and symptoms of hand-foot-mouth disease usually clear up in 7 to 10 days.

Preventions:

Specific prevention for HFMD is not available, but the risk of infection can be lowered by good hygienic practices. Certain precautions can help to reduce the chances of infection with hand-foot-and-mouth disease:

1. Wash hand carefully: Be sure to wash hands frequently and thoroughly, especially after using the toilet or changing a diaper, and before preparing food and eating. When soap and water aren't available, use hand wipes or gels treated with germ-killing alcohol.

2. Disinfect common areas: Get in the habit of cleaning high-traffic areas and surfaces first with soap and water, then with a diluted solution of chlorine bleach, approximately 1/4 cup of bleach to 1 gallon of water. Child care centers should follow a strict schedule of cleaning and disinfecting all common areas, including shared items such as toys, as the virus can live on these objects for days. Clean your baby's pacifiers often.

3. Teach good hygiene: Be a positive role model by showing your children how to practice good hygiene and how to keep themselves clean. Explain to them why it's best not to put their fingers, hands or any other objects in their mouths.

4. Isolate contagious people: Hand-foot-mouth disease is highly contagious, people with the illness should limit their exposure to others while they have active signs and symptoms. Hand-foot-mouth disease is most contagious during the first week of the illness. However, the coxsackievirus may spread for weeks after signs and symptoms have disappeared. 

Keep children with hand-foot-and-mouth disease out of child care or school until fever is gone and mouth sores have healed. If you have the illness, stay home from work. Also certain foods and beverages that can cause burning or stinging may irritate blisters on the tongue or in the mouth or throat caused by hand-foot-and-mouth disease.

          These tips to help make blister soreness less bothersome and eating and drinking more tolerable:

1. Suck on popsicles or ice chips.

2. Eat ice cream or sherbet.

3. Drink cold beverages, such as milk or ice water.

4. Avoid acidic foods and beverages, such as citrus fruits, fruit drinks and soda.

5. Avoid salty or spicy foods.

6. Choose foods that are soft and don't require a lot of chewing.

7. Rinse mouth with warm water after meals.

Call for Action:

There is no vaccine currently available for these enteroviruses. Symptomatic treatments are given to provide relief from fever, aches, or pain from the mouth ulcers. Good personal hygiene and general cleanliness can reduce the spread of these viruses.

Plan of Action:

This health plan intends on using the funding to help reduce the HFMD cases in these South East Asian countries. The population in Thailand is approximately 65,000,000 people and it is located in Siam. The action will be divided into following items in the projects:

1.      Recruiting professional health teams: To gathering several professional health teams to support local hospitals in Thailand. 10 teams are needed, and each team including 2 medical doctors, 4 nurses and 4 medical assistants stay in HFMD occurred area before HFMD occurs.

2.      Establishing medical treatment clinics: 10 clinics will be set up in most needed areas in order to treat patients.

3.      Collecting medical supplement and equipment: Medicines, relevant supplies, bleach …etc.

4.      Building up local health education systems: Assigning medical teachers in 10 groups to educate people and local medical staffs.

5.      Providing medical assistant consulting teams for meeting and conference: 10 consulting teams supported by 2 doctors for disease healing and mitigating suggestions and directions to local hospitals.

6.      Publishing medical booklet (brochure) with picture about this disease in different languages: Print booklets in 2,000 in an area. 10 areas are included.

7.      Posting up posters in cities and suburban areas: Print poster 100 piece and post up in 10 areas.(train stations, hospitals, major public buildings, medical clinics…etc.)

8.      Improving research abilities of diagnosing enterovius disease and vaccine development: Increasing researchers and necessary instruments and facilities of 10 research centers to enhance the abilities.

Budget:

The budget will be the sum of following expenses in the projects:

1. Recruiting professional health teams:

 (1) Salary :

$40,000 for one doctor * 2 = 80,000 a year

$24,000 for one nurse * 4 = 96,000 a year

$10,000 for one assistant * 4 = 40,000 a year

-  10 teams = (80,000+ 100,000+40,000) = $2,160,000

(2) Airplane and transportation fee:

-     $1,500 per person * 100 people = $150,000

(3) Living expense: (a year)

-   $6,000 per person * 100 people = $600,000

Subtotal: 2,160,000 + 150,000 + 600,000 = $2,910,000

2. Establishing medical treatment clinics:

Subtotal: $23,000 for one clinic * 10 = $230,000

3. Collecting medical supplement and equipment:

Subtotal: $28,000 for one clinic * 10 = $280,000

4. Building up local health education systems:

Subtotal: 25,000 for one group * 10 = $250,000

5. Providing medical assistant consulting teams for meeting and conference:

Subtotal: $10,000 for one team * 10 = $100,000

6. Design and publish medical booklet (brochure) with picture about this disease in different languages:

Subtotal: $15,000 for one team * 10 = $150,000

7. Posting up posters in cities and suburban areas:

Subtotal: $8,000 for one team * 10 = $80,000

8. Improving research abilities of diagnosing enterovius disease and vaccine development:

Subtotal: $100,000 for one team * 10 = $1,000,000

____________________________________________________________________

Total: $5,000,000

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