However, the figure includes only deaths of children in Henan province in the north and a single city in eastern Shandong province, suggesting the nationwide toll from hand, foot and mouth disease could be even higher.

State-run Xinhua news agency said that, as of Monday, 18 children had died in Henan, while the government of Heze city in Shandong said 13 had died in that city alone.

Health Minister Chen Zhu last week denied media reports that officials in Henan had tried to cover up the outbreak of the disease, which emerges early each year in China, by not reporting it to higher authorities.

The issue is a sensitive one after last year, when state media reported that foot-dragging by local officials had prevented the alarm being raised sooner.

The disease claimed an unusually high 128 lives in the first 11 months of last year.

There are numerous reports each year of Chinese local or provincial authorities covering up health and environmental threats to avoid being punished, sometimes exacerbating the problem.

Symptoms of hand, foot and mouth disease include fever and sores. It can be fatal in children because their immune systems are less developed than adults'.

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