The World Health Organization (WHO) recently reported information regarding the current outbreak of Hand, Foot and Mouth Disease (HFMD) in Vietnam. While Avian influenza and Severe Acute Respiratory Syndrome (SARS) have been the two leading outbreak diseases in Vietnam over the past eight years, HFMD is the topic of the country’s current health concerns. Traditionally, HFMD has been common in Vietnam and there have been reports of larger-scale outbreaks from time to time, but so far this year the infection and death toll statistics are already significantly higher than usual. More than 42,000 individuals have been sickened this year, a vast increase from the 10,000 to 15,000 cases that have been reported on average per year since 2008. The main targets of HFMD have been children three years old or younger, and so far 98 children have died from the disease– that is already about triple the average annual number of chidren’s deaths.
Earlier this year I had the privilege of traveling the dusty, motorcycle-infested streets of Vietnam. After witnessing first-hand the severe lack of sanitary rules to govern sidewalk phở eateries and other food vendors, along with the knowledge that HFMD is most often spread from person to person through contact with virus-contaminated surfaces like unwashed hands, the recent report by WHO is not shocking. The virus can survive for a long period of time in the environment or sewage, which adds to the difficulty in preventing and controlling its spread. Children have the highest risk for infection since they lack the protection of antibodies that are developed within a person’s body with age. While no vaccine or specific treatment exists, the disease has generally been described as mild and quickly recoverable. So, then, what is surprising is the drastic increase in deaths from previous years; it is unclear what may account for this, and the Vietnamese Ministry of Health further warns that the number of cases will likely increase even more in the coming months as children most at risk resume preschool and kindergarten.
I had quite the experience traveling on the train called the “Reunification Express”; it allows one to travel from north to south Vietnam and vice versa. I was told, and to my surprise, that the train had been modernized and had seen many improvements over the past few years. Suffice it to say, it was no Amtrak. The bathroom consisted of a toilet bowl with a hole that led directly to the train tracks and ground. I could only imagine where the goods of those who used it for relief ended up. Issues of personal hygiene and sanitary practices are at the forefront of the outbreak of HFMD, which is why I mention the train facilities above. The WHO report attributed the spread of HMFD to contact with fluid in blisters or infected feces. As disgusting as it sounds, encountering bodily waste on the street is not a terribly rare or shocking event in rural Vietnam. Perhaps it is a lack of — or disregard for– these everyday public health lifestyle practices that can, and most likely does, account for the statistics being reported by WHO.
Fortunately, the Ministry of Health is closely monitoring the situation and precautionary measures have already been implemented throughout the country in order to reduce further spread of the disease. All health care facilities have received guidelines for surveillance, prevention and treatment of the disease; training courses are being conducted for preventive medicine staff as well as pre-school teachers, and a nation-wide public awareness campaign on television and other means of media are relaying preventative measures to the citizens.
Increased standards of both personal hygiene and environmental care are crucial to the prevention of HFMD, as there is no specific medication administered to combat the disease. It is hopeful, then, that the campaign for heightened awareness will not only prevent the further spread of the virus and lessen the number of casualties due to HFMD, but that Vietnam as a country will benefit as well. Despite the numerous public health issues I encountered, it is, among the countries I’ve visited, one of my favorites. And since my most recent trip, I hold Ho Chi Minh and Hanoi as two must go-to cities that I desire to travel back to in the future…but I just may not plan my trip between the months of March to May and September to December. Why? Southern Ho Chi Minh city has been one of the hardest hit by HFMD and these months are when the rates of infection are highest.
As tourism accounts for a relatively small but steadily increasing and significant portion of Viet Nam’s economy, it is not hard to believe that the institution of increased sanitary and public health measures, which one might presume will lessen the occurrence and spread of infectious diseases, will ultimately help Viet Nam from both a substantive health and an economic perspective.