China’s approach to public health takes a hardline stance, which is understandable give the dense population. Dr Eisel Palestroque a paediatrician at DeltaWest, says “Outbreaks of diseases not considered serious in other countries may lead to school closures in Shanghai and healthy family members being quarantined.”
According to the US Centers for Disease Control and Prevention, Global Health China, the most common childhood diseases of concern for public health in China are:
Hand, foot and mouth disease (HFMD)
HFMD is not one disease but several enteroviruses that cause fever, mouth sores, and rashes, with blisters on the hands, feet and buttocks. Common in children under the age of 10, and most severe in children under 5, HFMD is highly contagious and spreads quickly in the heat of spring and early summer.
In recent years, more HFMD cases have been caused by enterovirus 71 (EV71), which may be fatal. Hospitals must report all confirmed cases of HFMD to health authorities, and kindergartens must close a classroom for 14 days when two or more cases are confirmed.
Chickenpox in Shanghai
Once a common childhood illness, chickenpox has become rare thanks to an effective vaccine that both reduces the chances of contracting the illness, and its severity. Symptoms include headache and fever, followed by an itchy red skin rash all over the body.
Varicella vaccination is optional in China and vaccination rates are very low. This combined with living in a densely populated area, makes outbreaks more likely in Shanghai. Symptoms are fare worse for adults. Pregnant women and their foetuses are at risk of complications, including birth defects or stillbirth. Schools usually quarantine chickenpox causes until the rash has scabbed over, to protect their staff and students. Significant outbreaks may lead to class closures, at the discretion of the school.
Influenza in Shanghai
Much worse than the common cold, the flu is a respiratory infection caused by influenza viruses that affect people of all ages. Flu viruses mutate fast, and medical professionals advise that the best defense against the flu is an annual vaccination. Dr Palestroque recommends preventative hygiene. “Frequent hand washing with soap and water prevents the spread of flus.”
Children catch the flu easily, and while the severity varies seasonally, some children die from the flu every year. Children under the age of 5 commonly need medical care when they contract the flu, and severe complications are common in toddlers.
China has also witnessed several new influenza type A viruses, including the 2003 SARS outbreak. In recent years, two strains of avian flu (H1N1 and H7N9) emerged in southern China. In Shanghai, the risk of contracting avian influenza from live poultry or wild birds is low for city residents. However, to minimize risk, the US Centers for Disease Control and Prevention recommends avoiding poultry farms, bird markets and other places where live poultry are raised, kept or sold during outbreaks. If you choose to eat chicken or eggs during an outbreak, be sure it is well-cooked, advises Dr Palestroque.
Scarlet fever in Shanghai
Related to A streptococcus, scarlet fever is a relatively mild infection that causes fever, sore throat, a strawberry-like tongue, and sandpaper like skin rashes that peel off within a week. It spreads from person to person through respiratory droplets or through direct contact with mucus, saliva or the skin of infected people. Once diagnosed, it is easy to treat with antibiotics.
Most cases of scarlet fever are mild, but can lead to serious complications if left untreated. In 2011. Shanghai witnessed an unprecedented outbreak of childhood scarlet fever. While the overall impact was minimal, there are fears that a similar outbreak in a less-developed area of China could result in a significant number of fatalities. Health officials must report all confirmed cases to the authorities, and kindergartens must close a classroom for 14 days when two or more cases are confirmed. Healthy siblings are often quarantined as well to prevent further infection.
Childhood measles in Shanghai
Known for its distinctive top-to-bottom rash, measles is a highly contagious viral disease. Symptoms include high fever, runny nose, red eyes and tiny white spots on the inside of the mouth, followed by a rash several days later. Life-threatening complications are most common in children under 5 and adults with immune deficiencies, including blindness, encephalitis, severe diarrhoea, ear infections and pneumonia. Deaths are reported every year in China, although most people recover in two two three weeks. Measles can be prevented by immunization.
In 2013, the number of confirmed measles cases reported to the World Health Organization by China tripled. Health authorities in Beijing are alarmed by the 35,677 confirmed cases reported between January and May 2014, which surpassed the 27,646 total cases reported in 2013. Infectious disease experts believe the current outbreaks are associated with low vaccination rates in China’s migrant population. Record-breaking measles outbreaks have also been reported in the US, southeast Asia, and western Europe this year, also linked to low immunization rates.