Outbreak Investigation of Hand–Foot–Mouth disease in Nong Kung Si district, Kalasin Province, October–November 2020

Abstract

Background: On 2^nd November 2020, Office of Disease Prevention and Control region 7 had detected the epidemic of Hand-Foot-Mouth disease (HFM) in Nong Kung Si district, Kalasin province. A joint investigation team conducted to investigate the outbreak during 6–12 November 2020. The objectives were to confirm the outbreak and the diagnosis, to describe the distribution of the outbreak, to identify the risk factors and to recommend the disease control measures.
Methods: The descriptive epidemiologic study was performed. We reviewed the HFM situations of Nong Kung Si district, reviewed the medical records and interviewed the teachers as well as the guardians at the kindergartens. The laboratory study was performed by sending throat swab specimens for causative agents testing. The environmental study was also conducted at two local kindergartens.
Results: The HFM epidemic of Nong Kung Si district, Kalasin province had occurred since September 2020. During 15 October–12 November 2020, there were 19 HFM cases (nine females and ten males) with no death, four cases were found from active case finding. The lowest and highest age were 1 and 5 years old. Most cases were 2–3 years old (26.32%). Most common clinical manifestations were ‘Oral ulcers’ (94.74%) followed by ‘Fever’ (84.21%), ‘Palm rash’ (73.68%), and ‘Sole rash’ (63.16%), respectively. The laboratory results showed Coxsackievirus A16. The risk factors among the children at kindergartens were ‘Closed contact with each other’, ‘Eating food with unwashed-bare hands’, ‘Sharing glasses, toys and stationeries’, ‘Keeping their blankets in the same closet’ and ‘Leaving towels and toothbrushes on the same shelf’.
Recommendations: We recommend (1) the local governments give the announcement about the situation of HFM to networks of kindergartens/schools and communities, (2) the local governments cooperate with public health agencies in evaluating the kindergartens in order to close the gap and achieve with the standard criteria, (3) public health networks conduct the HFM surveillance and closely monitor the HFM situation, and give health education about HFM to the teachers, the guardians and the children both at the kindergartens and the communities.