Outbreak of acute fever and rash in Honiara and parts of Guadalcanal

There has been increasing reports of patients presenting with acute fever and rash (AFR).

The National Surveillance Unit of the Ministry of Health have received reports of these AFR cases from Honiara clinics including Good Samaritan Hospital in Guadalcanal on the 10^th of October.

88 percent of Honiara clinics had reported seeing unusual increase of fever and rash cases. Based on epidemiological information available from limited number of cases, 78.6% (121) of the cases were aged between 0 to 2 years (age range 0-8 years).There are more males (57%) than females (43%). Based on information from patients presenting at the Honaira clincs including private medical clinics in Honiara, 16 cases reside in White River, 13 along Tasahe, Mbokona 10, Henderson 7, Lunga 7 Mbokonvera 5 and Papaho 5.

Based on the clinical description of the cases, there is a strong evidence that the cases meet the clinical presentation of Hand, foot, and mouth disease (HFMD).

What is HFMD?

HFMD is a common but highly contagious viral infection in children caused by different viruses which commonly include Coxsackievirus and enterovirus. It is generally a mild and self-resolving illness, which mainly occurs in children under 5 years of age but can also occur in older children and adults.

Symptoms of HFMD

The sickness starts within three to five days after contact with an infected person. In most of the cases HFMD starts with  fever, sore throat, tiredness, lack of appetite and feeling unwell. A blister-like rash on the hands, feet and in the mouth usually develops one to two days after the initial symptoms.

Blisters that begin as small red dots which later become ulcers. Blisters can appear inside the cheeks, gums, and on the sides of the tongue, as well as on the palms of the hands and soles of the feet. In infants, blisters can sometimes be seen in the nappy area. The disease usually last for 7 to 10 days.

Very rarely, the disease can affect the heart, brain, lining of the brain and spinal cord (meningitis), lungs, or eyes, requiring special medical attention and care.

Transmission mode

Hand, foot, and mouth disease is usually spread by person-to-person contact. The virus spread by secretions from the mouth or respiratory system (often through sneezing and coughing), by direct contact with the fluid from blisters, and via objects or surfaces with the virus on them. It can also spread from the faeces of an infected person to the mouth of the next person by contaminated hands.

Persons at risk

Children are more at risk of contracting the disease. HFMD can spread easily and quickly within households and others settings such as schools, particularly among children. Many adults, including pregnant women, are often exposed without developing symptoms. There is no clear evidence of risk to unborn babies from HFMD. However, infected mothers (and siblings) can pass the infection onto newborn babies who rarely can have severe disease.

Prevention

Good personal hygiene is the best protection. The following measures can help prevent the spread:

• Wash hands with soap and water and thoroughly dry them after going to the toilet, before eating, after wiping noses, and after changing nappies or soiled clothing.
• Avoid sharing cups, eating utensils, items of personal hygiene (for example: towels, washers and toothbrushes), and clothing (especially shoes and socks).
• Avoid touching contaminated objects and surfaces.
• Thoroughly wash any soiled clothing and any surfaces or toys that may have been contaminated.
• Keep sick children at home while unwell.

Treatment

 

There is no specific medical treatment for hand, foot, and mouth disease. Take over-the-counter medications such as Panadol to relieve fever and pain caused by mouth sores. Never give aspirin to children. Drink enough liquids. Mouth sores can make it painful to swallow, so your child may not want to drink much. Make sure they drink enough to stay hydrated.

 

When to see a healthcare provider

See a healthcare provider if

• Your child is not able to drink normally and you’re worried they might be getting dehydrated.
• Your child is not alert and responsive.
• Your child’s fever lasts longer than 3 days.
• Symptoms do not improve after 10 days.
• Your child has a weakened immune system (body’s ability to fight germs and sickness).
• Symptoms are severe.
• Your child is very young, especially younger than 6 months.

All HCC clinics, NRH and Good Samaritan Hospital have been alerted to look out and report cases of fever and rash. HCC surveillance team has been activated and enhanced surveillance for suspected HFMD in all 9 clinics is ongoing as part of their outbreak investigation.

Ministry of Health and Medical Services (MHMS) is declaring an outbreak of Acute Fever and Rash in Honiara and Guadalcanal with enhanced surveillance across a number of health facilities or sentinel sites across the country. There are no reports of such cases in the provinces. While, it is very likely to be an outbreak of HFMD, the possibility of other infections such as measles or a mixed outbreak cannot be ruled out. The MHMS will be sending the specimens for these cases to Australia for confirmation of the diagnosis.

Public is also encouraged to take their children for measles vaccination if they have not been completely vaccinated against measles.