An investigation of a fatal hand, foot, and mouth disease (HFMD) prompts health alert with a survey of knowledge, attitude, and practice (KAP) in prevention and control in Child Care Centers (CCCs) in Surin province, Thailand,

Abstract

Background: A 10-month old boy with HFMD visited a community hospital and died on 10th July 2014. An investigation was conducted to confirm diagnosis, identify cause of death, and implement prevention and control measures. Furthermore, survey of Knowledge, Attitude, and Practice (KAP) was studied to determine proportion of Control in Child Care Centers (CCCs) knowledge and their practice during HFMD outbreaks.
Methods: Reviewed the death’s medical record, interviewed his parents and case finding of HFMD in his village was conducted. Environmental survey in his house and two CCCs were done. Furthermore we collected fresh stool and throat swab for Enterovirus isolation among close contacts and student in 2 CCCs. Self-response questionnaire of the KAP survey was developed with a reliability of Cronbach's alpha = 0.75 in the pilot study and distributed to all CCCs in this province.
Results: A 10-month old boy had maculopapular rash at both legs, vesicles at head and neck then he developed generalized seizure and died with diagnosed severe HFMD. His serum and stool specimen were negative for EV71 IgM and isolation. Of 4 family members and 28 neighbor contacts, only two neighbors had positive to CoxsackieA6 and A16 by isolation. 19% and 44% of students in two CCCs were Enterovirus carrier. 71% of all 497 CCCs in the province responded, 78% misunderstood using alcohol hand rub for viral killing, 49% using flashlight for mouth exam and 56% had isolation area in CCC.
Conclusions: This fatal case was a suspected HFMD with typical clinical presentation of severe Enterovirus infection, although we could not identified Enterovirus from this case. Source of infection might be from the community. 44% and 19% of student were carriers of Enterovirus in CCCs. Potential spread of the disease caused by inappropriate management when outbreak occur and inappropriate screening for HFMD.