The ASEAN+3 FETN Field Epidemiology & Surveillance of HFMD/Severe Enteroviral Infection among ASEAN Plus Three Countries Workshop was held 29-30 October 2012 in Ho Chi Minh City, Viet Nam, to foster experience and knowledge sharing as well as explore relevant areas for collaboration in surveillance, clinical management, and laboratory. Representatives from Brunei Darussalam, Cambodia, Indonesia, Japan, Lao PDR, Malaysia, Myanmar, Philippines, Singapore, Thailand, Viet Nam, ASEAN Secretariat, CDC, WHO, Inviragen, Oxford University Clinical Research Unit, and Saw Swee School of Public Health were in attendance. The meeting was organized by Viet Nam's Ministry of Health (MoH), FETP, Pasteur Institute Ho Chi Minh City, and ASEAN+3 FETN Secretariat, with support from AusAID, Viet Nam's MoH, the MoH and institutes of ASEAN Plus Three Countries utilizing the ASEAN Cost Sharing Principle, and participating organizations.

The Opening Ceremony commenced with Dr. Hoang Quoc Cuong, Officer, Training Center, Pasteur Institute of Ho Chi Minh City, delivering the Opening Report to the esteemed Vice Minister of Health Viet Nam Associate Professor Dr. Nguyen Thanh Long. Dr. Cuong highlighted the background of the meeting, which evolved from the HFMD surveillance system and response-focused concept paper developed following the first FETN Steering Committee Meeting (Thailand, October 2011) to the modified Terms of Reference (ToR) that followed the 2nd ASEAN Plus Three Senior Officials Meeting on Health Development (SOMHD) Plus China (Philippines, March 2012), where Senior Officials expressed their concerns and tasked ASEAN+3 FETN to address HFMD in an integrated and programmatic manner. During the 2nd FETN Steering Committee Meeting (Thailand, July 2012), Viet Nam cordially agreed to Lead and Host the HFMD activity, and plans to prepare for the workshop occurred soon after. Vice Minister of Health Dr. Long expressed the honor it was for Viet Nam to host the timely workshop given this year's widely-publicized increase in cases, both severe and non severe, among ASEAN Plus Three Member States. Dr. Long emphasized this workshop was a step forward in international technical cooperation in the key areas of surveillance, clinical management, and laboratory assessment. Dr. Long concluded by sharing his wishes for Member States to take the spirit of this workshop to other areas of cooperation for emerging diseases in the region.

Viet Nam's Vice Minister of Health Associate Professor Dr. Nguyen Thanh Long; ASEAN+3 FETN Chair Dr. Kumnuan Ungchusak (Thailand); Dr. Ma Vicenta Rosario Poblete Vasquez (Philippines); Dr. Kazutoshi Nakashima (Japan); Mrs. Rosliany (Indonesia)

To illustrate the HFMD situation in the region, experts presented their experience in surveillance, clinical management, and laboratory practice. The meeting also included a session to address special topics for HFMD, such as HFMD/Severe Enteroviral Infection Laboratory Surveillance System Development in Thailand, HFMD/Severe Enteroviral Infection Vaccine Development and Challenges, and an update on Inviragen's EV71 vaccine in development.

Dr. Babatunde Olowokure (WHO Viet Nam); Dr. Nguyen Minh Tien (Viet Nam); Dr. Noorzilawati Sahak (Malaysia); Dr. Rodney Hoff (Saw Swee Hock School of Public Health)

With Singapore's Dr. Pengiran Hishamuddin as moderator, Representatives from Cambodia, Malaysia, Thailand, and Viet Nam, participated in the Experiences and Moving Forward with Lessons Learned in HFMD/Severe Enteroviral Infection Panel Discussion. There was an emphasis on the following:

• Effective strategies to control and manage outbreaks include heightened surveillance, early detection, and coordination of control activities intra-department, inter-agencies, and sectors.
• Subsequent public health actions such as the utilization of molecular techniques, an implemented national surveillance system for pediatric cardiopulmonary failure and fatal HFMD cases, and prompt risk communication, were vital in controlling the outbreak (in Thailand, 2006).
• Current campaign for improved hygiene practices delivered throughout the community may alleviate pressure from recent challenges experienced such as mass media pressure, clinical management, and overwhelmed health facilities, in the future.

Other ASEAN Plus Three Countries also shared their experiences, practices, and challenges for HFMD through poster presentations and summaries. Please send us an inquiry if you wish to see posters and presentations. We will then confirm authorization with the appropriate parties. All meeting materials are housed on FETN's Secure Reports Page.

Dr. Ly Sovann (Cambodia) confirms clinicians have received training and a guideline has been developed; Dr. Tran Ngoc Huu (Viet Nam) highlights the role of FETP during the 2011 outbreak of HFMD; Dr. Phetmala Phonamath and Dr. Bounthanom Sengkeopaseuth proudly share their poster describing practices and challenges in HFMD surveillance in Lao PDR.

With focus areas surveillance, clinical management, and laboratory, three working groups convened activities utilizing the HFMD summaries from ASEAN Plus Three Countries disseminated prior the meeting, Thailand's guideline in HFMD/Severe Enteroviral Infection in surveillance and laboratory, Thailand's HFMD/Severe Enteroviral Infection clinical data collection form, and the Management Algorithm found within WHO's Guide to Clinical Management and Public Health Response for HFMD. The teams identified gaps and proposed activities to address them, including:

• Building Capacity of Clinicians for Severe HFMD Case Management Workshop among ASEAN Plus Three Countries (Lead Country: Viet Nam)
• Biosafety and Biosecurity Lab Training Workshop (ASEAN Secretariat will share ToR with ASEAN Partnership of Laboratories)
• Development of a common HFMD Investigation Tool (Lead Country: Philippines, under ASEAN+3 FETN workplan)
• HFMD Surveillance System Evaluation (Lead Country: Thailand, under ASEAN+3 FETN workplan)

Since the meeting, follow-up to proposed activities has been remarkable. ToRs for each activity proposed by the laboratory team have been developed and are currently in the "review of ToR" phase. Viet Nam's team outlined the timeline to develop the Building Capacity of Clinicians Workshop, and the ToR is expected in December 2012. The team in the Philippines continues to receive copies of Member States' HFMD case investigation form/tool used for HFMD surveillance, which will be used to develop the common HFMD Investigation Tool. Thailand has developed a timeline for the HFMD Surveillance System Evaluation, which is expected to occur in June 2013 under the annual Thai FETP surveillance system evaluation assignment. The ToR for this activity will be shared with all in December 2012.

The laboratory team finalizes their presentation showcasing modifications made to the laboratory guideline; the clinical management team develops a list of indications for IVIG; the surveillance team agrees that a common investigation form (template) would be useful in the collection of data to ascertain epidemiological risk factors for HFMD.