The exposure history of the cases, i. e. those who attended daycare or had known contact with other HFMD cases, was poorly recorded and did not indicate any particular source of transmission. HFMD is known to spread through direct selleck chem contact with mucus, saliva, or feces of an infected person. Data from this Inhibitors,Modulators,Libraries study showed that only 18% of the fatal cases attended daycare which suggested that most of the HFMD transmission occurred at home and could be from contact with other family members having asymptomatic or mild infection such as parents, older siblings, nannies and other caregivers. Therefore, health education efforts including behavior change communication to prevent HFMD transmission should be conducted not only in school but widely in the community, targeting households and families with young children.

Further studies on virus circulation and virulence in different populations and settings are needed to provide a rational basis for targeting prevention and control measures. Most of HFMD cases and deaths were reported in Southern provinces, from May to October. The occurrence of HFMD during the rainy Inhibitors,Modulators,Libraries season was higher than the dry season 90% vs. 10%. The mean air temperature of Southern provinces was always higher than other provinces compared with range 18. 1 26. 9 C in other provinces. The monthly air temperature from March to November was higher than December, January and February. There were two peaks of HFMD deaths. In October, at the peak of the rainy season, HFMD deaths reached the highest number as the epidemic spread to the North where health workers had limited experience in case management of HFMD.

A study in Inhibitors,Modulators,Libraries Hong Kong on the relationship between meteorological parameters and HFMD activity showed that meteorological parameters helped in predicting HFMD activity and could assist in explaining the winter peak detected in recent years and in issuing early warning. Other studies on the association between meteorological parameters and occurrence of HFMD are warranted. In Vietnam, HFMD surveillance data need to be compiled for some more years to demonstrate the seasonality as HFMD is a newly emerging disease. Fever was reported in most cases, followed by myoclonus which was markedly higher than other symptoms. In reality, the myoclonus symptoms could be observed more frequently than in this study.

In a survey at Children Hospital Number 2 in Ho Chi Minh City, myoclonus was observed in almost all severe cases. The explanation Inhibitors,Modulators,Libraries for the low rate of myoclonus could be due to missing data in medical records. Proportions of the cases having fever and oral ulcer were slightly lower than in Inhibitors,Modulators,Libraries a study in Sarawak, Malaysia and another study in Peninsular Malaysia in 1997. Taken together, warning signs of severe HFMD could be considered as high fever, myoclonus and persistent overnight delivery vomiting with or without oral ulcers and vesicular erythema.