Four health officials have been sacked over an outbreak of hand, foot and mouth disease (HFMD) that killed at least three children and infected more than 3,000 others across two provinces.

Those dismissed were Yang Baojun, director of the health bureau in Minquan county, Henan province; Wang Zaiji, head of the People's Hospital, and two officials from the local disease prevention and control center, China National Radio (CNR) reported yesterday.

The Ministry of Health confirmed all four helped to cover up the outbreak in Henan province this year, as well as the death of a 2-year-old girl, CNR said.

Ten further deaths potentially related to the case have also been uncovered after a report staff at the county hospital allegedly falsified medical histories to disguise the large number of HFMD cases in the area.

The ministry declined to comment on the investigation but said an update would be released today.

Since Jan 1, Minquan has had 277 reported cases of HFMD.

In neighboring Shandong province, two baby boys died of the infection in Heze city between Sunday and Monday, said health officials yesterday.

A seven-month-old infant also died on Sunday night, 10 hours after he was rushed to the Heze Infectious Disease Hospital, while a 15-month-old boy died on Monday in the People's Hospital of Juancheng County, the provincial health department said.

The HFMD-related deaths were the first to occur in Shandong this year, although there has been 504 reported cases of the illness over the past three months, a noticeable rise on the same period last year.

"HFMD is highly contagious among children and spreads through the digestive system," said Dong Xiaoping, deputy director of the State Key Laboratory for Infectious Disease Prevention and Control.

The condition can be caused by a host of intestinal viruses, but EV71 and the Cox A16 were the most common, he said.

The viral illness reportedly infected more than 500,000 children in China last year and killed almost 200. "Overall, the fatality rate of HFMD is low. There is no need to panic," said Dong.

Most of those infected are children under five, with symptoms including small, red vesicles in the palms, feet and mouth, a light fever and nausea, oral ulcers, and a loss of appetite, he said.

However, the most effective time for treatment is just a few hours after the appearance of symptoms, said Dong, who added: "In the countryside, hospitals are often far away from households and the time it takes to travel to a local hospital could hamper the treatment."

The Ministry of Health sent teams to Heze on Monday to begin work on research, disinfection, technical training and public education, according to officials.

(China Daily?March 25, 2009)