Open Access Research article

Sentinel surveillance for human enterovirus 71 in Sarawak, Malaysia: lessons from the first 7 years

Yuwana Podin1, Edna LM Gias1, Flora Ong2, Yee-Wei Leong1, Siew-Fung Yee1, Mohd Apandi Yusof1, David Perera1, Bibiana Teo3, Thian-Yew Wee4, Sik-Chi Yao2, Sik-King Yao2, Andrew Kiyu2, Mohd Taha Arif25 and Mary Jane Cardosa1*

Author Affiliations

1 Institute of Health & Community Medicine, Universiti Malaysia Sarawak, Jalan Datuk Musa, Kota Samarahan, Sarawak, Malaysia

2 Sarawak Health Department, Jalan Tun Abang Haji Openg, Kuching, Sarawak, Malaysia

3 B Teo's Specialist Clinic, Kuching, Sarawak, Malaysia

4 TY Wee Specialist Clinic for Children, Kuching, Sarawak, Malaysia

5 Faculty of Medicine and Health Sciences, Universiti Malaysia Sarawak, Jalan Datuk Musa, Kota Samarahan, Sarawak, Malaysia

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BMC Public Health 2006, 6:180  doi:10.1186/1471-2458-6-180

Published: 7 July 2006



A major outbreak of human enterovirus 71-associated hand, foot and mouth disease in Sarawak in 1997 marked the beginning of a series of outbreaks in the Asia Pacific region. Some of these outbreaks had unusually high numbers of fatalities and this generated much fear and anxiety in the region.


We established a sentinel surveillance programme for hand, foot and mouth disease in Sarawak, Malaysia, in March 1998, and the observations of the first 7 years are described here. Virus isolation, serotyping and genotyping were performed on throat, rectal, vesicle and other swabs.


During this period Sarawak had two outbreaks of human enterovirus 71, in 2000 and 2003. The predominant strains circulating in the outbreaks of 1997, 2000 and 2003 were all from genogroup B, but the strains isolated during each outbreak were genetically distinct from each other. Human enterovirus 71 outbreaks occurred in a cyclical pattern every three years and Coxsackievirus A16 co-circulated with human enterovirus 71. Although vesicles were most likely to yield an isolate, this sample was not generally available from most cases and obtaining throat swabs was thus found to be the most efficient way to obtain virological information.


Knowledge of the epidemiology of human enterovirus 71 transmission will allow public health personnel to predict when outbreaks might occur and to plan interventions in an effective manner in order to reduce the burden of disease.