Virus in China Highlights an Old Problem

HONG KONG – A tight-lipped Chinese government response to a common childhood illness – albeit a more lethal outbreak than usual – underscores how China's propaganda machine, geared to controlling political discourse, still struggles to communicate information about disease with an increasingly educated public.

As of Monday, the outbreak of hand, foot and mouth disease, or HFMD, that started in China's eastern Anhui province has affected 8,531 children, most below the age of two, according to the state-run Xinhua news agency.

Twenty-five children, nearly all of whom lived in Fuyang city of Anhui province, have died in the latest outbreak.

While cases of the illness, whose unusually high death rate first caught the attention of international health officials, first showed up in early March, according to an earlier Xinhua report, official word from the government was released only in late April, allowing rumors to simmer for weeks.

The vacuum of information has taken its toll on the local government and health officials involved in the outbreak, as some Chinese media outlets have suggested there was a cover-up. Communist Party officials often instinctively shy away from releasing even relatively benign news for fear of causing greater panic, only to find later that the dearth of information sowed more panic than the information itself probably would have.

An official with the Ministry of Health in Beijing said he thought an active cover-up was unlikely, and that incompetence among inexperienced local health officials was the more likely culprit. "The local doctors did not know how to deal with this," he said. If there was a slow response, it was "because they don't know about this disease...; maybe the technical capacity of the local health workers is not high and needs to be improved."

Hans Troedsson, the World Health Organization's chief representative in China, said that while the death of children for whatever reason will rightly spark concern, this particular virus is a routine and common illness in the region.

"It's nothing to be worried about. This is a common childhood disease. We've seen outbreaks like this in the region," including Singapore, Vietnam and elsewhere in China, Dr. Troedsson said. "We'll see more cases. But there's no reason for alarm."

Singapore has tallied 9,026 cases of the disease so far this year, according to a statement issued by the city-state's Ministry of Health in late April, noting that the disease is "endemic in Singapore and there will be yearly seasonal outbreaks."

Over the past week, officials from the Ministry of Health in Beijing have issued strong statements emphasizing the need to swiftly tackle the spread of the disease. Xinhua reported Monday that 10 doctors and officials in Anhui province had been punished for "their misdeeds in handling the hand-foot-mouth disease," citing unnamed official sources. Two doctors were sanctioned for delaying moving a patient to a larger hospital, and other doctors were punished for profiteering off sick patients.

Hand, foot and mouth disease can affect adults, but young children are most vulnerable. While the mortality rate of the current outbreak of HFMD in China is very high compared with that of previous outbreaks – raising questions about exactly what mix of factors might be contributing to the deaths – China's Health Ministry has pinpointed the particular subtype of virus behind the outbreak in Anhui, according to Dr. Troedsson, who met with Chen Zhu, China's health minister, Monday afternoon.

"This is hand, foot and mouth disease, not some severe pneumonia spreading among families," said Yuen Kwok-yung, chairman of microbiology at the University of Hong Kong. "I expect it every year.... It's nothing compared to SARS or bird flu." A local Chinese newspaper had reported that residents of Fuyang were referring to the mystery illness as "Baby SARS."

Still, Dr. Yuen doesn't think that the scrutiny of Chinese health officials is a bad thing. "When you have such a heightened awareness about infectious diseases, when the real thing comes you're ready for it," he said.