<P> Outbreaks have occurred in China, Japan, Hong Kong, the Republic of Korea, Malaysia, Singapore, Thailand, Taiwan, and Vietnam . HFMD most commonly affects young children under the age of 10 and more often under the age of 5, but can also affect adults with varying symptoms . </P> <P> Since 1997 there have been 71 large enterovirus outbreaks reported, mostly in East and South East Asia, primarily affecting children . From the years 2008 to 2014, more than 1 million HFMD cases have been reported in China each year . </P> <Ul> <Li> In 1998, there was an outbreak in Taiwan, affecting mainly children . There were 405 severe complications, and 78 children died . The total number of cases in that epidemic is estimated to have been 1.5 million . </Li> <Li> In 2008 an outbreak in China, beginning in March in Fuyang, Anhui, led to 25,000 infections, and 42 deaths, by May 13 . Similar outbreaks were reported in Singapore (more than 2,600 cases as of April 20, 2008), Vietnam (2,300 cases, 11 deaths), Mongolia (1,600 cases), and Brunei (1053 cases from June--August 2008) </Li> <Li> In 2009 17 children died in an outbreak during March and April 2009 in China's eastern Shandong Province, and 18 children died in the neighboring Henan Province . Out of 115,000 reported cases in China from January to April, 773 were severe and 50 were fatal . </Li> <Li> In 2010 in China, an outbreak occurred in southern China's Guangxi Autonomous Region as well as Guangdong, Henan, Hebei and Shandong provinces . Until March 70,756 children were infected and 40 died from the disease . By June, the peak season for the disease, 537 had died . </Li> <Li> The World Health Organization reporting between January to October 2011 (1,340,259) states the number of cases in China had dropped by approx 300,000 from 2010 (1,654,866) cases, with new cases peaking in June . There were 437 deaths, down from 2010 (537 deaths). </Li> <Li> In December 2011, the California Department of Public Health identified a strong form of the virus, coxsackievirus A6 (CVA6), where nail loss in children is common . </Li> <Li> In 2012 in Alabama, United States there was an outbreak of an unusual type of the disease . It occurred in a season when it is not usually seen and affected teenagers and older adults . There were some hospitalizations due to the disease but no reported deaths . </Li> <Li> In 2012 in Cambodia, 52 of 59 reviewed cases of children reportedly dead (as of July 9, 2012) due to a mysterious disease were diagnosed to be caused by a virulent form of HFMD . Although a significant degree of uncertainty exists with reference to the diagnosis, the WHO report states, "Based on the latest laboratory results, a significant proportion of the samples tested positive for enterovirus 71 (EV - 71), which causes hand foot and mouth disease (HFMD). The EV - 71 virus has been known to generally cause severe complications amongst some patients ." </Li> <Li> HFMD infected 1,520,274 people with up to 431 deaths reported at the end of July in 2012 in China . </Li> </Ul> <Li> In 1998, there was an outbreak in Taiwan, affecting mainly children . There were 405 severe complications, and 78 children died . The total number of cases in that epidemic is estimated to have been 1.5 million . </Li>

Diagnosis code for hand foot and mouth disease