title: Epidemiological and clinical characteristics of children who died from hand, foot and mouth disease in Vietnam, 2011.
abstract: BACKGROUND
  In 2011, a large outbreak of hand, foot and mouth disease (HFMD) in Vietnam resulted in 113,121 children seeking medical attention, of whom170 died. Understanding the epidemiology of fatal HFMD may improve treatment and help targeting prevention activities for vulnerable populations. We describe epidemiological and clinical characteristics of children who died from HFMD in Vietnam in 2011.
  
  
  METHODS
  Clinical data were obtained through reviewing medical records of the deaths occurring from January through December 2011 in all hospitals in Vietnam. Hospitals reported any deaths among patients with laboratory-confirmed enterovirus (EV) infection to the Ministry of Health. Data were extracted from the national database.
  
  
  RESULTS
  Of the 169 deaths reviewed for whom records were available, 87% were 3-year-old or younger, 69% were male, 18% attended daycare, 89% lived in Southern Vietnam, and 85% of the deaths occurred between May-October 2011. One hundred thirty (77%) cases sought treatment in a hospital within three days of onset of illness. Symptoms at admission included fever (98%), myoclonus (66%), vomiting (53%), oral ulcers (50%) and vesicular erythema (50%). One hundred six (75%) cases had leukocytosis and 91 (54%) had hyperglycemia. One hundred three (61%) tested positive for EV, of which 84 (82%) were positive for EV71.
  
  
  CONCLUSIONS
  Deaths associated with HFMD occurred throughout 2011 among males three years or younger who were cared for at home. The HFMD control program should focus on interventions at the household level. Clinicians should be alerted to symptoms suggestive of severe HFMD including fever, myoclonus, vomiting, oral ulcers and vesicles with high white blood cell count especially in young children.
authors.affiliation: Department of Epidemiology, Institute of Hygiene and Public Health in Ho Chi Minh City, 159 Hung Phu Street, District 8, Ho Chi Minh City, Vietnam. bnsapphire@gmail.com.
authors.forename: Ngoc T B
authors.initials: NT
authors.lastname: Nguyen
authors.forename: Hau V
authors.initials: HV
authors.lastname: Pham
authors.forename: Cuong Q
authors.initials: CQ
authors.lastname: Hoang
authors.forename: Tien M
authors.initials: TM
authors.lastname: Nguyen
authors.forename: Long T
authors.initials: LT
authors.lastname: Nguyen
authors.forename: Hung C
authors.initials: HC
authors.lastname: Phan
authors.forename: Lan T
authors.initials: LT
authors.lastname: Phan
authors.forename: Long N
authors.initials: LN
authors.lastname: Vu
authors.forename: Nguyen N
authors.initials: NN
authors.lastname: Tran Minh
mesh_terms: D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D004196:Disease Outbreaks; D004770:Enterovirus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D004769:Enterovirus Infections / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality*; D005260:Female; D006232:Hand, Foot and Mouth Disease / Q000453:epidemiology* / Q000382:microbiology / Q000401:mortality; D006760:Hospitalization; D006801:Humans; D007223:Infant; D008297:Male; D014744:Vietnam / Q000453:epidemiology