Investigating Hand, Foot and Mouth Disease in Sarawak, Malaysia

A grant has just been awarded to University Malaysia Sarawak for the development of a microarray which will allow simultaneous detection of all enterovirus serotypes in a single test, allowing rapid public health decisions on EV71 outbreaks. Current technologies are slow and tedious in that each virus serotype must be ruled out one by one.

The Ministry of Science Technology and Innovation has just approved a grant to The Institute of Health & Community Medicine (IHCM), Universiti Malaysia Sarawak (UNIMAS) to develop a microarray which will allow simultaneous detection of all enterovirus serotypes in a single test. Current technologies are slow and tedious in that each virus serotype must be ruled out one by one.

The diagnostic test that IHCM will develop is designed to detect the molecular signature of each serotype of enterovirus so that we can very quickly determine if an HFMD virus isolate is something we need to worry about or if it is one that only causes mild disease. This technology will allow rapid public health decisions and control of the sweeping EV71 outbreaks we have come to expect every few years in Sarawak. The project is headed by Prof Dr Mary Jane Cardosa of the Institute of Health & Community Medicine, UNIMAS.

Hand, Foot and Mouth Disease in Sarawak (HFMD) - Development of Rapid Diagnostic Technologies: The Institute of Health & Community Medicine (IHCM), UNIMAS, has been assisting the Sarawak Health Department (SHD) in investigating HFMD outbreaks since 1997.

The Institute of Health & Community Medicine (IHCM), UNIMAS, has been assisting the Sarawak Health Department (SHD) in investigating HFMD outbreaks since 1997 when a large outbreak in Sarawak occurred coincidentally with a second virus leading to about 30 deaths of children in the state. The HFMD outbreak in 1997 was found to be due to human enterovirus 71 (EV71) and this was the first recognition of EV71 in Malaysia.

Following this outbreak, the Director of Health of Sarawak (Tan Sri Datu Dr Mohd Taha Arif, currently Dean of UNIMAS Faculty of Medical and Health Sciences) requested that IHCM work closely with the SHD to set up a sentinel surveillance programme to study the characteristics of HFMD in Sarawak in general, and more specifically to understand the dynamics of EV71 transmission in order to provide early warning of impending outbreaks. This surveillance programme began in March 1998 and continues to the present.

The findings of the first 7 years have recently been jointly published by UNIMAS and SHD authors in an international peer reviewed open access journal (2006) and can be accessed at http://www.ncbi.nlm.nih.gov/sites/entrez?db=pubmed&cmd=Retrieve&dopt=Abs... .

In summary, this surveillance programme has found the following:

* EV71 outbreaks have occurred every 3 years in Sarawak – 1997, 2000, 2003 and at the time of writing we predicted an outbreak in 2006, and this did indeed occur.

* The shape of the HFMD epidemiological curves are influenced by social factors such as the media and people’s movements during big public holidays (especially Gawai).

* EV71 is not the only virus associated with HFMD (other viruses include Coxsackievirus A16, Coxsackievirus A10, etc) but only EV71 causes very large outbreaks.

* The genogroups of the EV71 isolated during each major outbreak are genetically distinct from each other, but all have been first identified in Sarawak, while some have spread to Peninsular Malaysia, Singapore and Australia.

* The transmission of EV71 in a susceptible cohort is extremely rapid with only 4-6 weeks between first identification of an EV71 case in our sentinel clinics to peaking. The problem is that these outbreaks can drag on for many months after the peak, especially if the outbreak has not reached baseline before people start travelling or moving about the state (eg State elections in 2006, followed by Gawai holidays).

For more information, please contact
Prof Dr Mary Jane Cardosa at the expert link below
Contact details of experts are only available to registered journalists.
Members of the public who are interested in contacting Prof. Dr. Mary Jane Cardosa, please email ResearchSEA at [email protected]

Published: 06 Aug 2007

Contact details:

Universiti Malaysia Sarawak94300 Kota SamarahanSarawak, Malaysia

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