to inform the public of potential risks and the steps being taken; and
- to assist individuals, stakeholders or communities to accept the imperfect
nature of choices and to make the best possible decisions.
During the 2008 HFMD outbreak in mainland China, health officials across the
country who received risk communication training were found to use better risk
communication strategies in post-training messages compared with their pretraining
messages. The type of training and resulting messages resonated well
with the Chinese population and could be easily reproduced and adapted to other
similar situations.
The WHO guidelines on outbreak communication provide further information and
can be downloaded from
http://www.who.int/infectious-disease-news/IDdocs/whocds200528/whocds200
528en.pdf
(8) Monitoring and evaluation
Despite the emphasis on personal hygiene in disease mitigation, the significance
of such measures is not well understood. It has been suggested that cohort studies
involving child-care centres with an expanded hygiene package would be required to
better understand these measures.
6.3 Future Considerations
Greater knowledge on asymptomatic transmission of HFMD
The significance of the contribution of asymptomatic cases in HFMD transmission in
preschool centres is unknown, although the rate of asymptomatic cases of EV71 was
found to be as high as 71% in a community setting in Taiwan (China). Enteroviruses
can be excreted in the stools for up to six weeks and in throat secretions for up to two
weeks. However the viral load and the exact significance of this to the transmission of
disease in preschool centres is unknown.
Novel vaccines
Several vaccines for HFMD are currently under development. Robust surveillance data
and information on the impact of prevention measures are critical in determining how a
vaccine should be applied and how it should be evaluated.