Severe Enterovirus Infection Linked to Hand, Foot and Mouth Disease Outbreak in Hong Kong Childcare Center

CHP investigates case of severe enterovirus 71 infection and epidemiologically linked outbreak of hand, foot and mouth disease

The Centre for Health Protection (CHP) of the Department of Health (DH) is today (October 31) investigating a case of severe enterovirus (EV) 71 infection and an epidemiologically linked outbreak of hand, foot and mouth disease (HFMD), and again urged the public and institutions to maintain strict hand, personal and environmental hygiene.

The severe case involved a 12-day-old baby girl. She has presented with fever since October 25, and was brought to the Accident and Emergency Department of Prince of Wales Hospital and admitted for treatment on the same day. Her clinical sample tested positive for EV71 upon laboratory testing. The clinical diagnoses were EV71 infection complicated with meningitis. The patient is now in stable condition.

Initial enquiries revealed that the patient had no travel history during the incubation period. Her 18-month-old brother and her father had developed HFMD infection symptoms since October 18 and 22 respectively, and both of them had recovered. Her other home contacts have remained asymptomatic. The CHP has arranged laboratory testing for the two symptomatic home contacts.

The CHP's epidemiological investigations also revealed that Tsung Tsin Mission of Hong Kong Joyful Place, where the patient's brother is receiving childcare services, recorded a recent outbreak of HFMD. According to preliminary information, the outbreak involves six children, including the patient's brother, three boys and two girls, aged between 15 months and 18 months. They have developed HFMD symptoms between October 18 and 26, and all of them sought medical attention and no hospitalisation was required. They are now in a stable condition. All children in the child care centre have been put under medical surveillance by the CHP.

According to the information collected from the epidemiological investigations so far, the CHP suspected that the outbreak of HFMD in the child care centre was caused by EV71. The CHP will arrange laboratory testing for all children with relevant symptoms in order to ascertain the causative agent of infection.

Officers of the CHP have conducted a site visit to the child care centre to understand the disinfection, infection control and child care steps, and advised necessary measures. The CHP has advised the child care centre to suspend classes starting from tomorrow for 14 days to prevent further spread of HFMD. The child care centre has been requested to conduct thorough cleaning and disinfection under the supervision of the CHP. The CHP's investigations are ongoing.

"EV71 is one of the causative agents for HFMD. The infection is transmitted by direct contact with an infected person's nose or throat discharges, saliva, fluid from blisters or stool. Good personal and environmental hygiene are the most important measures to prevent EV71 infection," a spokesman for the CHP said.

"HFMD is common in children, while adult cases may also appear. It is usually caused by enteroviruses such as Coxsackie virus and EV71. It is clinically characterised by maculopapular rashes or vesicular lesions occurring on the palms, soles and other parts of the body such as the buttocks and thighs. Vesicular lesions and ulcers may also be found in the oral cavity. Sometimes patients present mainly with painful ulcers at the back of the mouth, namely herpangina, without rash on the hands or feet," the spokesman said.

"The local HFMD activity is currently at high level. In Hong Kong, the usual peak season for HFMD and EV71 infection is from May to July. A smaller peak may also occur from October to December. As young children are more susceptible, parents should stay alert to their health condition. Institutional outbreaks may occur where HFMD can easily spread among young children with close contact," the spokesman added.

The spokesman reminded that alcohol-based handrub should not substitute hand hygiene with liquid soap and water, as alcohol does not effectively kill some viruses causing HFMD, for example, EV71. To prevent HFMD, members of the public (especially the management of institutions) should take heed of the following preventive measures:

Maintain good air circulation;

Wash hands before meals and after going to the toilet or handling diapers or other stool-soiled materials;

Keep hands clean and wash hands properly, especially when they are dirtied by respiratory secretions, such as after sneezing;

Cover the nose and mouth while sneezing or coughing and dispose of nasal and oral discharges properly;

Regularly clean and disinfect frequently touched surfaces such as furniture, toys and commonly shared items with 1:99 diluted household bleach (mixing one part of household bleach containing 5.25 per cent sodium hypochlorite with 99 parts of water), leave for 15 to 30 minutes, and then rinse with water and keep dry;

Use absorbent disposable towels to wipe away obvious contaminants such as respiratory secretions, vomitus or excreta, and then disinfect the surface and neighbouring areas with 1:49 diluted household bleach (mixing one part of bleach containing 5.25 per cent sodium hypochlorite with 49 parts of water), leave for 15 to 30 minutes and then rinse with water and keep dry;

Children who are ill should be kept out of school until their fever and rash have subsided and all vesicles have dried and crusted;

Avoid going to overcrowded places; and

Parents should maintain close communication with schools to let them know the latest situation of sick children.

​The CHP's weekly publication, EV SCAN (www.chp.gov.hk/en/view_content/21639.html), is issued every Friday to report the latest local situation of HFMD. Members of the public may also visit the CHP's page onHFMD and EV71 infectionfor more information.

Former registered contractor convicted for carrying out building works in a dangerous manner

The Kwun Tong Magistrates' Courts today (October 31) ruled that a former registered general building contractor and its sub-contractor had contravened the Buildings Ordinance (Cap. 123) (BO) and imposed each with a fine of $8,000. The Buildings Department (BD) will seek legal advice on whether to appeal against the amount of the fines imposed.

The case involved a fatal incident at a construction site at Tung Yuen Street, Yau Tong in December 2022. A worker was hit by a collapsed steel section when carrying out removal works of a temporary lateral support at the construction site, and died subsequently. An investigation by the BD found that precautionary measures had not been adequately provided by the contractor and its sub-contractor during the dismantling of the temporary lateral support. The BD initiated prosecutions against the contractor and its sub-contractor under section 40(2B)(a) of the BO in December last year.

The subject contractor (i.e. Aggressive Construction Engineering Limited) was removed from the Register of General Building Contractors on November 16 last year.

Pursuant to section 40(2B)(a) of the BO, any person directly concerned with the relevant building works, who carries out or authorises or permits such works to be carried out, in such manner that it causes injury to any person or damage to any property, shall be guilty of an offence and liable on conviction to a fine of $1,000,000 and to imprisonment for three years.