Description of the situation
10 June 1997
Disease Outbreak Reported
The number of deaths in the outbreak of myocarditis increased to 21 on 9 June. Three of the 21 deaths occurred in the second half of April, 10 during May and the remaining 8 occurred in June. Most children had fever for 2-3 days and were admitted to hospital when their condition deteriorated. The clinical picture indicated viral involvement with coxsackie virus as a possible agent. Coxsackie virus was also suspected in a concurrent outbreak of hand, foot, and mouth disease in Sibu. Antibody to coxsackie B virus has been detected in specimens taken from four children who had died of viral myocarditis and three who had hand, foot and mouth disease. The laboratory results were from a team of clinical virologists and scientists at the Institute for Medical Research, Malaysia.
Coxsackie virus is mainly transmitted by the oral-faecal route and the public has been advised to maintain good personal hygiene, hand washing after defaecation and before handling food, avoid sharing baby pacifiers, avoid overcrowding. Public health measures include increased control of flies and cockroaches, and closures of nurseries, playschools, kindergartens and public swimming pools in Kuching and Sibu where most deaths have occurred. Surveillance of hand, foot and mouth disease has been established in cooperation with private doctors. All health facilities and hospitals in the State are on the alert and an observation ward has been established in Sibu Hospital. A similar facility is planned in Sarawak General Hospital in Kuching. Active case finding has been instituted among the family members of all the cases reported.