... althoughC1 and C4virusesdocirculate in VietNam,thedominantsubgenogrouphasbeen, and remains,C5(22).Thatsubgenogroupemerged in Taiwan(China) in 2006. A similarsituationexists in China,wherethesingledominantsubgenogroupC4causedmajoroutbreaks in 2008 and 2009(23,24).Thatsubgenogroupwassampled in China and Japan in thelate1990s and early2000s and wasdominant in Taiwan(China) in 2004 and 2005.Itiscurrentlycirculating in Japan,theRepublicofKorea,Taiwan(China),Thailand and VietNam.TheRepublicofKorearecorded a subgenogroupC3clusterofcases in 2000,whenB4virusesweredominantelsewhere in theregion(25).Figure2illustratesthetemporaldistributionofthedifferentsubgenogroupsofEV71circulating ... versus15.5% and 15%,respectively).EV71wasassociatedwith47.3%(26/545)ofcases in 2000 and wasthedominantstrainassociatedwithfatalities in 2001(25/41,61%).Between1998 and 2005,thenumberofsevereHFMD/HAcasesperyearrangedfrom35 to 405.Ofthe1548severecasesidentifiedduringtheeight-yearperiod,93%werefouryearsofageoryounger, and 75%weretwoyearsofageoryounger.Themale -to- femaleratiowas1.5:1. A totalof245fatalcaseswerereportedduringthesameperiod.EV71positivityratesamongthefatalcasesrangedfrom11% to 100% in eachyear(42-44).Thenumberofseverecases and deaths,respectively,were:11 and 0 in 2006;12 and 2 in 2007;373 and 14 in 2008; and 29 and 2 in 2009.[ 7 ] A Guide to Clinical Management and Public Health Responsefor Hand, Foot and Mouth Disease (HFMD)JapanApproximately2400paediatricclinicsparticipated in thesentinelsurveillancesystem in ... ] A Guide to Clinical Management and Public Health Responsefor Hand, Foot and Mouth Disease (HFMD)transmission; pathogenesis; laboratory diagnosis; clinical features and management; and prevention and control. In ...